BabycareAdvice.com Articles: When your baby's weight gain decreases!

Many parents worry when they become aware of a decline in the rate at which their baby gains weight. Most worry needlessly! The first thing to determine is if the decline in your baby's weight gain is a false alarm or a reason for concern. (See How much weight should healthy babies gain?)

In many instances parents become concerned when they encounter what can appear to be a decline in the amount of weight gained by their healthy baby, which in reality is a false alarm due to...

Where a decline in the amount of weight gained is a genuine reason for concern, the cause is due to either or both...

There are many different reasons for these 2 problems to occur. Common reasons, which can result in a decline in a healthy baby's weight gain, are described in more detail in 'When your baby is not gaining enough weight' further below.

False alarms!

Mistakes made when weighing a baby or in interpreting the results often occur for one or more of the following reasons...

1. Using different scales

What can appear to be a decline in your baby's weight gain may simply be due to using different scales. Scales need calibration and regular maintenance to ensure they remain accurate.

Using the same scales each time will generally provide a consistent measurement; even if the scales are a little out of kilter. However, using different scales may provide inconsistencies, due to the possibility that one or both scales are in need of calibration.

2. Different clothing

If you are not weighing your baby nude, then variations in the amount of clothing need to be considered. What can appear as low weight gain can simply be your baby is wearing less clothing.

3. Fluctuations in body fluids

Scales measure total body weight, this includes body fluids, which can constantly fluctuate. Included in the measurement of your baby's weight is...

Variations in body fluids alone can contribute to a fluctuation of 1/4 lb (or more) for young babies or up to 3/4 lb for older babies. More subtle variations can also occur depending on the time of day, with slightly lower measurements in the morning compared to afternoon and evening.

4. Natural decline in the rate of growth

Your baby will not continue to gain weight at the same rate as he did in the early weeks and months of life. Most babies show a natural decline in weekly weight gains around the age of 5 or 6 months. A further decline can also be seen at around the age of 9 months and again at around 12 months.

Larger babies often display this natural decline in growth at a much earlier age, sometimes as young as 3 months.

As your baby's rate of growth declines, so too will his appetite and the amount of milk (breast milk or infant formula) he drinks will also decrease. Because he's no longer growing as quickly, he needs less milk. (Wait for him to let you know when he doesn't want as much.)

5. Unrealistic expectations

What is often overlooked when assessing growth is a baby's genetic potential (i.e. how tall his parents and other family members are). What can appear like a decline in growth is often due to a natural correction of weight, which can occur when a baby has gained large amounts of weight in the early weeks and months of life.

When using a growth chart to measure your baby's growth, it would be realistic to expect that his weight would closely match his length on the percentile curves. It would be unrealistic to expect your baby's weight to remain on a much higher percentile curve compared to his length, despite having reached that level in the early months.

A fall across 1 or mor percentile curves can be very normal, provided your baby's weight and length sit on similar (not necessarily the same) percentile curves. Weight which sits 2 percentile or more below the corresponding percentile curve for length may be a reason for concern and is something that needs to be discussed with your healthcare provider.

6. Comparing your baby to other babies

Take care not to fall into the trap of comparing your baby with other babies you meet. Your baby is an individual and will develop at his own pace.

Relying too heavily on measurement tools such as 'Average weekly figures' (which depict a weekly weight range of growth for different ages) can result in unnecessary concern if the many false alarms described above are not considered when interpreting results.

A growth chart will provide a better assessment of your baby's growth. However, it's important to keep in mind that growth charts are only a guide. Few babies will stick to a one percentile curve for weight. Crossing of percentile curves is common.

Your health care provider can evaluate your baby's growth taking into consideration his genetic potential and his history and will provide much more insight into your baby's growth than any chart can on it's own.

When your baby is NOT gaining enough weight!

A decline in your baby's rate of growth can occur suddenly or gradually over a long period of time. A child who struggles to gain weight is often described as 'failing to thrive'

There are many different reasons for a baby's rate of growth to be affected. Some are common errors in diet; others are due to illnesses, conditions or disorders.

1. Not drinking enough milk

If your healthy baby is not gaining enough weight the reason may be due to not drinking enough milk (breast milk or infant formula). Checking your baby's milk intake is the first place to start when weight gains are not enough.

* Decreased bowel movements is the single most important sign that distinguishes an inadequate intake from a digestive disorder (which produce frequent watery bowel movements). Together these signs may indicate inadequate intake, separately these signs can all be due to other reasons.

2. An inappropriate diet

Solid foods are an inferior substitute for milk for babies less than 12 months old. Dietary changes which result in a decreased milk consumption (breast milk or infant formula) may in turn result in decreased weight gain.

Milk is the most important food for babies less than 12 months old. Milk offers more calories/kilojoules compacted into small volumes compared to solid food, (the exception being dairy foods such as cheese, yogurt and custard, which are an inferior substitute for milk for infants). Breast milk and infant formula alone offers all the nourishment and nutrients needed for healthy growth until 6 months of age.

Contrary to popular belief a decline in weight gain is not a sign your baby is needs to start eating solid foods. (However, babies generally display a natural decline in growth at around 5 to 6 months of age, which is the age when solids are recommended to start.) Where a baby is struggling to gain sufficient weight an early introduction to solid foods may further complicated the situation.

Once solid foods have been started it's important that your baby continues to consume sufficient amounts of milk (breast milk or formula). The amount of milk your baby drinks will decrease with a natural decline in growth; however, milk remains a necessary food to sustain healthy growth until the age of 12 months.

Common errors which can result is an unnatural decrease in milk intake include...

Another common error which can affect growth is switching from breast milk or formula to regular milk too EARLY. Babies are not ready for regular cow's milk or any other milk (except in small amounts) before the age of 12 months. These milks do not contain the necessary vitamins and minerals for healthy growth for babies. Young babies' immature digestive systems find the proteins contained in regular cow's milk difficult to digest.

Offering juice too early or too much juice may not only affect milk consumption it can also affect digestion. Many young babies lack sufficient quantities of the necessary digestive enzymes to adequately digest the large amounts of natural sugars contained in small amounts of juice. (See carbohydrate malabsorption for more information.)

Once a child starts eating solid foods, providing a balanced diet of nutritional foods from a variety of different food groups is important. A poor diet can result is poor weight gain due to anemia (low iron in the blood) and malnutrition.

The younger a child is exposed to solids the greater the risk of developing an allergic reaction to that food. Recommendations to extend the time to start babies on solid foods from 4 months of age to recent recommendations of 6 months of age, are made due to the increasing number of children developing food allergies.

3. Oro-motor problems

Some conditions result in poor oro-motor skills which affect a child's ability to drink. Some are more obvious e.g. prematurity, cerebral palsy, tongue tie or cleft palate. Others may be more subtle, such as a weak suck. There problems are generally identified at or soon after birth.

4. Gastro-esophageal reflux disease (GERD)

A baby's weight can be affected by severe symptoms of gastro-esophageal reflux disease, which include...

a) Large, frequent, vomits. Your baby may drink sufficient quantities of milk but it might not stay where it should, and this may result in insufficient calories/kilojoules to meet his needs.

b) Feeding difficulties can develop due to the burning discomfort of heartburn. Your baby may refuse to feed, fuss and squirm, turn his head from side to side, back arch and scream as he tries to distance himself from the breast or bottle. As a result the amount of milk he takes over the day may be insufficient to meet his needs.

c) Difficult feeding behavior, which may have originated due to the discomfort associated with GERD, can persist because of learned behavior long after heartburn has been successfully treated with medications.

5. Learned behavior

Feeding problems can result in a baby or child not drinking enough milk and/or eating enough solid foods. With the very best intentions at heart, some parents or caregivers may pressure their child to drink or eat, due to their concern about their child's weight or apparent lack of appetite.

Sometimes the level of pressure can reach a stage of making eating and/or drinking an unpleasant experience for the child (as well as the parent). A child may then become distressed as soon as he is placed into a feeding position, either in arms for breast or bottle feeding or in a highchair for solids, OR he may take a small amount before starting to fuss.

Fussy feeding behavior, which can occur as young as 2 months of age, may develop because the child has learned to anticipate this pressure due to past experiences. (Feeding difficulties can also occur for other reasons unrelated to learned behavior.)

Older babies (usually over 6 months) may vomit deliberately if they have learned that vomiting is the only way they can make their parent or caregiver stop pressuring them. The vomiting which occurs accidentally to begin with may become a deliberate act as the child learns his parent's response is to stop.

6. Illness

Understandably a decreased appetite due to illness is likely to result in a decrease in the amount of weight gained. A sudden decline in weight gains is often due to illness.

3 Common infective illnesses that may result in a decline in the rate of growth or loss of weight in babies and young children are...

Gastro-intestinal infections (also known as gastroenteritis, stomach flu, infectious diarrhea) are most often due to a virus, but can also be due to bacteria, yeast/fungus or intestinal parasites (protozoa, tape worms or round worms).

Gastro-intestinal infections are generally easily recognized by classic, sudden and short term symptoms of...

Symptoms generally improve within a week. Symptoms that continue for longer than a week may require a further medical assessment.

A child may loose weight during an episode of a gastro-intestinal infection. However, once the illness is over the child will generally have a ravenous appetite and quickly make up for lost weight.

A similar pattern of poor appetite or weight loss frequently presents when a child has an upper respiratory tract infection i.e. cold or flu. Symptoms which are easily identifiable include...

Although a common condition in babies and young children a urinary tact infection (UTI) is not always considered.

Signs of a UTI in babies and young children can vary greatly. The characteristic symptoms of UTI commonly seen in adults are absent in babies and young children. Often the only indications of a UTI in young babies are nonspecific symptoms such as...

FEVER is present in most babies and toddlers but often absent in babies younger than 1 month. Fever can also be absent in toddlers and children with recurrent or long-standing infections.

7. Digestive disorders

When a baby has a digestive disorder, although the energy intake (calories/kilojoules) may be sufficient, some of the nutrients i.e. proteins, carbohydrates or fats contained in the milk or food are poorly digested and/or absorbed by his body.

Milk is the main source of energy (calories/kilojoules) for babies, in instances of a digestive disorder related to MILK babies will lose weight, have frequent watery bowel movement (diarrhea) and become dehydrated.

Similar symptoms may be evident where a digestive disorder is related to particular foods. However, weight gain can be affected in varying degrees dependant on the amount and how often the offending food is consumed.

There are also a number of rare metabolic disorders which can result in weight loss in babies and children. Many of these conditions are diagnosed soon after birth by screening tests (a heel prick, blood test at 5 days). A metabolic disorders may be suspected (and diagnosed by urine and blood tests) when gastric symptoms and weight loss persists despite changes to a baby's diet in an attempt to alleviate symptoms due to the more common disorders of lactose intolerance and milk allergy or intolerance.

8. Anemia

Anemia is a medical condition in which the quality of red blood cells falls below an acceptable level. There are many different reasons for anemia to develop, the most common form of anemia in infants and young children occurs due to lack of dietary iron.

9. Medications

Many medications (prescribed, over-the-counter and herbal) commonly given to babies and children for...

Given only occasionally or short term, medications will not significantly alter weight. But given regularly, long term medications can potentially impact on a baby's growth.

Quite separate from the side effects listed above, prolonged use of antacid medications, commonly used in the treatment of gastro-esophageal reflux, can affect digestion and absorption of nutrients. Antacids reduce stomach acid; however, stomach acid is necessary for the proper digestion of proteins.

10. Chronic illness, congenital & genetic conditions, disorders or abnormalities

Some congental or genetic conditions such as cardiac conditions and chronic lung conditions can place a greater demand on a child's energy (calories/kilojoules) requirements. Conditions that involve the digestive system, may result in insufficient digestion and/or absorption of nutrients. Conditions that affect the brain, liver, or kidneys or pancreas may also affect a baby's growth.

In most instances, congenital and genetic problems are identified prior to birth, at birth or soon after birth. Serious congenital or genetic problems may result in a child struggling to gain weight from birth. This struggle often presents even prior to birth, as babies with congenital or genetic problems are often born very small. (This is very different to being born pre-term.)

11. Sleep deprivation

In itself sleep deprivation is not a cause for a decline in weight gains, except in situations were extreme overtiredness affects a baby's ability to feed effectively, thereby reducing his milk intake. Were intake is adequate an active, sleepless or wakeful baby will require more energry (calories/kilojoules) than one who sleeps soundly and naps regularly.

The human growth hormone is secreted during the REM (rapid eye movement) sleep stage. (See Infant sleep patterns for more on sleep stages). Babies and young children spend approx 50% of their sleep in the important sleep stage. Establishing healthy sleep habits increases opportunities for growth and also significant improves a baby's level of contentment.

IMPORTANT: This information is provided as GUIDE ONLY. We STRONGLY recommend that you discuss ANY CONCERNS about your baby health and/or growth with your health care provider.

How we can help!

We do not provide medical advice regarding the many medical reasons for a child to fail to gain sufficient weight.

However, through a consultation at BabycareAdvice.com we can assist you to identify if your child's declining weight is reason for concern. We can also provide advice on some of the many behavioral feeding management strategies to encourage an improved appetite, which compliment medical strategies (recommended by your health care provider).

If you would like more information about our consultation service click here.

When your baby's weight gain decreases!

Reasons for declining weight gains