Breastfeeding Myth: My Baby Isn't Gaining Enough So I Need to Supplement

Yes, there are some instances where baby's lack of weight gain is cause for supplementation.  In many cases, there is actually no problem with baby's growth, just misinformation on the part of doctors.  Did you know there are different growth charts out there?  Some charts are for strictly formula fed babies, some charts for strictly breastfed babies, and some for a combination.  Most doctors use the CDC growth charts. 

Are these charts appropriate for exclusively breast-fed babies?

The 2000 CDC growth charts can be used to assess the growth of exclusively breast-fed infants, however when interpreting the growth pattern one must take into account that mode of infant feeding can influence infant growth. In general, exclusively breast-fed infants tend to gain weight more rapidly in the first 2 to 3 months. From 6 to 12 months breast-fed infants tend to weigh less than formula-fed infants.
The 2000 CDC Growth Chart reference population includes data for both formula-fed and breast-fed infants, proportional to the distribution of breast- and formula-fed infants in the population. During the past two decades, approximately one-half of all infants in the United States received some breast milk and approximately one-third were breast-fed for 3 months or more. A Working Group of the World Health Organization is collecting data at seven international study centers to develop a new set of international growth charts for infants and preschoolers through age 5 years. These charts will be based on the growth of exclusively or predominantly breast-fed children.

I keep hearing stories from moms that their pediatritian wants baby to gain weight so they reach the 50th percentile.  There is no need for all babies to be in the 50th percentile.  My doctor assured me that the growth charts contain RANGES of normal because there are very healthy small children and very healthy large children - not all children grow the same way.  The CDC explains:

What is a percentile?

Percentiles are the most commonly used clinical indicator to assess the size and growth patterns of individual children in the United States. Percentiles rank the position of an individual by indicating what percent of the reference population the individual would equal or exceed. For example, on the weight-for-age growth charts, a 5-year-old girl whose weight is at the 25th percentile, weighs the same or more than 25 percent of the reference population of 5-year-old girls, and weighs less than 75 percent of the 5-year-old girls in the reference population.

My doctor looks at several factors in determining if Little Man is growing appropriately.  She watches to see if he maintains his own growth curve wherever it falls on the chart (for the first several months, he was UNDER the charts and she was happy as long as he followed the curve) and evaluates his overall well-being:  is he meeting milestones?  is he curious?  is he making progress?  has he learned a new skill that could affect weight gain (crawling, walking)?  At his last appointment (13 months), he dropped from the 20th percentile to the 10th percentile in weight.  Because he recently started walking and since he was chattering and curious and getting into EVERYTHING, she was quite comfortable with his growth.  When he wasa newborn and only gaining an ounce a week, she looked and saw he wasn't progressing and it was time to supplement.

For those who would like to better evaluate their exclusively breastfed baby's growth, check out the World Health Organization's breastfed baby growth chart.  You will need to convert to metric for this chart.

There are many ways for babies to grow that are normal.  If you are concerned, talk with your doctor and ask about the different growth charts.