The other day I went to a local group meeting of the Australian Breastfeeding Association. The topic was ‘Understanding baby’s weight gain’. It was inspired by the too-many mothers who are made to feel like they are ‘failing’ because their baby is not keeping up with those tricky baby weight charts, and often people are too quick to assume that the problem is the mother’s milk supply. It’s another example of the kyriachy’s refusal to believe in women’s bodies, much preferring ‘man’-made things, which can be controlled, things which come in shiny bottles, in clearly measurable quantities, with a nutritional analysis on the side of the label.
Here are some of my thoughts on the issues, based in my own experience of a baby with weight issues. These comments broadly come in two categories:
(a) Keep it in perspective: Weight charts are political and weight is just one indicator of overall health.
(b) Sometimes there is something wrong and saying there isn’t won’t help. But neither will weaning.
So here goes:
(a) Keep it in perspective
Baby weight charts are political. By this I mean they are not some immodifiable guide given to use by the Goddesses. Rather they emerge from a human process which involves power and judgements about what is a ‘normal’ healthy baby – something which varies enormously, particularly across ethnic groups (though also within). When health professionals use the charts, they rarely have this process and associated considerations in mind. They focus on the numbers as absolutes and forget to keep it in perspective.
Outrageously, the graph still used by health professionals throughout most of Australia is based on old data from mostly bottle-fed babies in the USA. The growth of breastfed babies tends to slow down much more after 4 months – not as much as some suggest, but it still matters given the small amounts of weight parents are concerned about. Using the old growth chart creates unnecessary extra anxiety.
The World Health Organisation has a more recent, more realistic graph here, based on healthy breastfed babies from a range of countries. More background on the new charts is available here.
However, while these new charts are an improvement, they still need to be kept in perspective. Do they accurately reflect how all babies ‘should’ grow? No. They are averages. It is a rare baby that grows smoothly up the middle percentile line – they grow quick, then grow slow, then later quick again. Very few babies are average, and nor should they be. Someone’s gotta be small and someone’s gotta be big, and there is nothing inherently better about being either. Note that all the babies used to create the graphs were considered ‘healthy’ and by definition some must have been at the top of the graph and some at the bottom. [I am focusing on ‘small’ babies here, but a lot of this also applies to parents who worry that their baby is too ‘big’ (and I would even go so far as to suggest that people worry more about girls being too big than boys). This can also have negative consequences if their intake is restricted, when they might be genetically inclined to grow quickly early and level out later – or they might just be bigger than average forever and that’s totally TOTALLY fine.]
Getting back to ‘small’ babies, the worry about them is really very widespread. When Wren was losing weight, I came across sooo many mothers who had been through a period when they were told their baby or child was growing too slowly. For all of them, it had been a period of anxiety. Yet for most of them, that period had passed and their child had grown and developed into a ‘normal’ healthy child. The worry was for nothing.
What this demonstrates is that there is a unhealthy focus on baby weight. Weight is just one indicator of overall health. It is a useful indicator for health professionals, because it is easily, quickly measurable. They like it because it doesn’t depend on (highly variable) accounts from parents (what would we know after all?). However, as a parent of a child, you see them every day, you see loads of other indicators: mood, appetite, changes in skin tone, poos/wees, physical development, mental development. You know what? You don’t even need to weigh your child to know they are growing! (You also don’t need to measure their temperature to know they have a fever – but don’t expect a doctor to believe you on that one.) Are they going up in clothes sizes? Do people keep exclaiming “my how she’s grown!”? That’s all the proof you need. It’s a much healthier way to keep check than obsessing over every 10grams.
(b) Sometimes there is something wrong and saying there isn’t won’t help. But neither will weaning.
Nothing I have said is intended to suggest in any way that weight gain is never a problem and that we should pay no attention to it at all. When my son Wren started losing weight (note: losing weight, not just growing slowly) at around 7 months, almost every other parent I spoke to tried to reassure me that there was nothing wrong. This was not helpful. The response of these well-meaning people was based on (a) the problems I’ve outlined above, (b) often their own experience, and (c) a real fear of acknowledging the possibility fact that sometimes there is something wrong with babies. We all love our babies and believe they are perfect and hope they will always be healthy, but skirting cautiously around it when they are not, like it’s some kind of taboo, IS NOT HELPFUL. It is frustrating. Acknowledging that something might be wrong is sad and worrying, but it is not the end of the world, and gees it’s just better to know and deal with it than keep trying to believe everything is okay. It probably will be okay – though ‘okay’ might come to mean something a bit different – as long as you address it. And as a friend of someone in this situation: listen, don’t dismiss! [This also applies to problems with babies other than weight – I had a friend whose baby had a serious developmental delay and people kept reassuring her that there was nothing wrong, even when she herself knew there was – and it ended up being something which could be treated]
Ahem. So let me tell you our story.
Although it might have taken me a little while to put it all together – I was far from an anxious mother – I knew that Wren was sick. And I knew this from my daily experience with him, not because of the weight charts. He was miserable. He looked pale. He was doing sloppy poos far more often than he used to. He wanted to drink breast milk all the time. He had stopped trying to crawl or pull himself up to stand. And yes, I noticed that his clothes seemed bigger and his body was getting more bony. So I took him to a child health nurse. She didn’t really listen to my explanations or concerns, perhaps assuming I was an over-anxious mother. She calmly got him on the scales, plotted his weight on the graph, then exclaimed “My goodness! He’s dropped right off the graph!” She needed the graph to see there was a problem – I didn’t. He hasn’t dropped off anything, I thought, this is my baby you’re talking about, not a line on a graph! Something’s wrong, like I told you. We were referred to a paediatrician.
The initial response from child health nurses and paediatricians was to question what was going into him. He was not yet eating much solids, but I was confident that he was getting loads of breastmilk. Despite my insistence that it wasn’t his intake that was the problem, something was going wrong inside, I was told to breastfeed less, push solids more, and supplement with a high calorie formula.
It was a frightening time. I was vulnerable and uncertain about what was wrong. If I had not been such an educated, confident breastfeeder, it is very likely that I would have followed their advice. But I am very glad that I didn’t. The doctor was ‘surprised’ when test results revealed that there were high levels of undigested fats in his poo. I told you so! It is going in! That fat is from my milk! It took many more tests and a few months – during which time he actually did very well, thankyou – before he was finally diagnosed with pancreatic insufficiency caused by cystic fibrosis. Babies with cystic fibrosis need breastmilk more than most, for the immune protection and because it is more easily digestable than any other food.
I really believe that health care professionals confronted with a baby with weight problems should be much more careful about their advice. While I was not specifically told to wean, I was never encouraged to keep breastfeeding and many things were said which could have undermined my confidence in my breastmilk. The initial assumption should be that breastmilk is best, unless there is some evidence to the contrary. When the first question that every nurse and doctor asks is ‘do you have much milk?’ this can build up to make a mother question whether she really is producing enough milk, as sometimes it is hard to tell. Health professionals need to be more aware of their own power and the vulnerable position mothers are in, when their children are not growing as they ‘should’.
When I later expressed my concerns to one of these health professionals, about their lack of support for breastfeeding, the response was: But we weren’t to know he had cystic fibrosis. Exactly. YOU DIDN”T KNOW. And yet you gave me advice which could have led me to stop breastfeeding which would have had negative health consequences for my child. It really should be assumed that babies with weight problems should continue breastfeeding, because if they are really sick, then breastmilk becomes even more important.
So I guess what I am trying to say with all this is: trust yourself more than your doctor. Most of what I have said comes from my own experience, which may be different to yours, so you don’t have to listen to me either.
The Turtle and the Wren 