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Is Weighing Baby to Measure Milk Intake a Good Idea?

Sue Iwinski
Prospect CT USA
From: LEAVEN, Vol. 42 No. 3, July-August-September 2006, pp. 51-53

When I was a Leader Applicant in 1994 I learned that "test weighing," weighing a baby before and after one or more feedings to see how much milk a baby had received while breastfeeding, was not very useful in most cases for a healthy, full-term baby. After all, we knew there were other accurate yet easy ways of telling that baby is doing well, like counting wet diapers/nappies and bowel movements each 24 hours. Why would mothers want to focus on individual feedings when we are well aware that babies do not take the same amount at each feeding? As long as you feed them whenever they are hungry, or wake them up for feedings when they are healthy (albeit sleepy) full-term newborns, they will get what they need from the breast. Furthermore, the use of baby scales can feed into our cultural preoccupation with feeding or parenting by numbers, instead of by cue, the latter being a more instinctive and responsive dance between a mother and her healthy baby.

When breastfeeding experience and knowledge were even less common than they are now, baby scales were often used to measure breastfeeding success. Doctors weighed babies before and after feedings and if the result was not what they deemed appropriate, mothers were told they didn't have enough milk. Many mothers ended up weaning unnecessarily, believing their ability to produce milk was deficient when the problem was the faulty interpretation of the information. The brave mothers who fed their babies "the natural way" were sometimes instructed to use baby scales at home, either to calculate milk intake or baby's weight gain. Some lucky mothers were able to breastfeed under these circumstances, either because the measurements fit what was at that time assumed to be healthy, or because they gave more weight to their obviously healthy and happy babies than to the scale.

This historical perspective influences my interpretation of the information provided by the scale in my work as a lactation consultant in a breastfeeding medicine practice. What I have also learned is that accurate weights are useful when faced with breastfeeding challenges, especially in the early weeks and months.

Counting wet and soiled diapers/nappies in the early days can reassure everyone that baby is getting enough milk for hydration and growth. After day four, healthy, full-term newborns should have at least six wet diapers/nappies and at least three quarter-sized (2.5 cm) or larger bowel movements each 24 hours. A tissue placed inside disposable diapers aids in determining wetness. When a baby loses a lot of weight in the first two to four days (over seven percent of birth weight), it can be helpful to address any breastfeeding issues and to confirm that the baby begins gaining weight around day four postpartum. When the wet and/or soiled diaper/nappy counts are low, pre- and post-feeding weighing, by a qualified professional, can also show how much milk the baby is receiving during a feeding.

This measures actual transfer (or intake) of milk, not merely how long or how often baby has been at the breast, or how the attachment to the breast and breastfeeding look. Appearances can be misleading. While it may look as if milk transfer is low, the baby can take in a surprising amount, while at other times milk transfer may seem to be significant, but the baby has not taken in much milk at all.

During the first two to four days, if a baby has lost seven to 10 percent or more of his birth weight and pre- and post-feeding weights indicate milk transfer is good (expected milk intake varies with age of baby), appropriate breastfeeding management will usually be sufficient to turn things around. However, if that baby, even after latch-on and positioning assistance, is not appearing satiated and is transferring very little milk during a two- to three-hour consult appointment, additional interventions might be indicated to help baby begin not only gaining weight, but having adequate energy to feed well at the breast.

A common slow weight gain scenario we see at the breastfeeding medical practice where I work is the baby who, in the first few months, really wants/needs to be on the breast constantly. (I am not talking about unrealistic expectations, lack of maternal support, or mothering burnout.) The scale shows this baby to be gaining less than the average of six ounces (168 grams) per week and to be taking in one ounce (28 grams) or less of milk per hour of attachment to the breast. (Neville et al. 1988 has shown that by four weeks of age, healthy well-gaining breastfed babies usually consume 25 to 30 fluid ounces, or 750 to 900 ml, per 24 hours.) The intake measured by the scale, combined with a history, physical exam of mother and baby, and observation of breastfeeding, correlates with other assessments and often helps validate what the mother's instincts told her all along, that something was not right. In cases like this, interventions may be required to increase mother's milk supply and to help the baby consume calories more efficiently, so he can get out of this abnormal, energy-conserving, slow-gaining state.

Sometimes the scale can provide additional confirmation of suspected overabundant milk supply. The high volume of milk transferred in a few moments can be quite noteworthy (four to eight fluid ounces, or 120 to 240 ml, in a few minutes is not unusual), even though the mother believes that she is not making enough milk for her "constantly" hungry baby. When a mother is shown the large intake volume, it can help her understand that trying to increase her milk supply by taking galactagogues or frequently switching sides can exacerbate, not resolve, the situation.

As helpful as the scale might be in the hands of an experienced person, in the wrong hands it can be misleading and discouraging. Test weighing is like a snapshot of a certain moment in time: all aspects of a situation must be considered before making generalizations and conclusions. For example, if a baby is growing and gaining normally, feedings are comfortable (for mother and baby), and feedings are within normal duration and frequency, the amount of milk transferred at one feeding is not necessarily relevant. Many of us have heard inexperienced health care providers making erroneous conclusions after test weighing. One mother, whose baby was growing normally, had concerns about her baby's feeding frequency (within the normal range of eight to12 times per 24 hours). She was told to bring the baby to her pediatric office's lactation specialist. After test weighings in the office, she was told that the amount of milk her baby transferred was "too low" and that she must not be making enough milk.

Sometimes mothers use scales at home to reassure themselves that baby is getting enough milk and then worry because their babies are not drinking the large volumes often consumed by formula-fed babies. The larger volumes consumed by formula-fed babies are not only related to the differences between formula and human milk, but also due to the differences between breastfeeding verses bottle-feeding. Feeding by the scale is not a useful way for mothers to learn their baby's hunger and satiety cues. Using a scale can be helpful for some mothers with conditions such as breast reduction surgery, or for babies with specialized medical needs, or premature babies with medical complications. But scale use is usually temporary. These mothers, in a consultation with a health care professional, may find it better to focus on baby's general weight gain only once a day, or even every few days.

Another problem with test weighing can be with the accuracy or quality of the scales. Scales designed to accurately measure milk intake are digital, can be calibrated, and measure to the nearest tenth of an ounce (or two grams). Many scales are more difficult to read and do not need to be accurate for measuring very small differences since they are designed for weighing the baby, not the amount of milk a baby ingests.

Leaders can help mothers understand that test weighing is just another tool that can be used or misused. It can provide additional information to help identify and appropriately manage breastfeeding issues or it can discourage mothers unnecessarily and cause premature weaning. When approached by a mother who lacks confidence, or one who is concerned about her baby's milk intake, Leaders can provide information and reassurance and encourage her to consult her baby's health care provider or other appropriate health care professional.

References

Mohrbacher, N. and Stock, J. THE BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg, IL: La Leche League International, 2003; 20, 40-41, 223, 302, 310.

Neville, M.C. et al. Studies in human lactation. Milk volumes in lactating women during onset of lactation and full lactation. Am j Clin Nutr 1988; 48:1375-86.

Riordan, J. Breastfeeding and Human Lactation, third edition. Sudbury, MA: Jones and Bartlett, 2005; 303-04.

West, D. DEFINING YOUR OWN SUCCESS: BREASTFEEDING AFTER BREAST REDUCTION SURGERY. Schaumburg, IL: La Leche League International, 2001; 90-91, 136-37.

Guidelines for Health Care Providers and Others Using a Baby Scale in Breastfeeding Situations

Author's note: These are intended to be a resource for health care professionals, but they could also be helpful to La Leche League Leaders and mothers when a health care professional or the mother is using a scale.

  1. Use a digital scale that has been calibrated and is accurate to the nearest tenth of an ounce (or two grams). It should have computer integration to allow for the baby's movement when used for measuring milk intake at a feeding or for infant weight checks that are only days apart.
  2. Do not add or remove diapers/nappies or clothes between the pre-feeding weight and post-feeding weighings. The only change will be the milk consumed by baby.
  3. Health care providers, or mothers under their care, should evaluate the information received via the scale together with current age-appropriate parameters for normal milk intake volume and growth for breastfed infants.
  4. Health care providers should consider the information received in conjunction with a mother and infant history, health care provider's examinations, and feeding assessment.
  5. Recognize that the information received is a "snapshot" of milk transfer at this particular feeding, in this particular environment, on this particular day, and may or may not be indicative of every feeding.
  6. Recognize that isolated pre- and post-feeding weights that demonstrate lower than expected milk transfer do not negate other parameters (weight gain, satiety cues with normal feeding durations) for determining overall effectiveness of breastfeeding and adequate 24-hour intake of calories for satiety and growth.
  7. Recognize that the scale tells us nothing about the caloric content of the milk transferred and whether or not the baby is getting enough calories in 24 hours.
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