Growth concerns in the early weeks of life
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3533 (Published 21 September 2020) Cite this as: BMJ 2020;370:m3533
- Russell J Peek, consultant paediatrician1 4,
- Nicky Wilson, general practitioner, peer supporter and trustee24 5,
- Emma Cronin-Preece, infant feeding lead specialist health visitor3 4
- 1Gloucestershire Hospitals NHS Foundation Trust
- 2Aspen Medical Centre
- 3Gloucestershire Health and Care NHS Foundation Trust
- 4Gloucestershire Infant Feeding Strategic Partnership
- 5Gloucestershire Breastfeeding Support Network
- Correspondence to R Peek Russell.Peek{at}nhs.net
What you need to know
One in 10 breastfed babies loses more than 10% of birthweight in the first week of life
Where an infant has an underlying illness that causes poor weight gain, clinical features will usually be present
Persisting pain during breastfeeding can indicate problems with positioning and attachment. Simple interventions are often effective in improving milk transfer
Amelia is four weeks old. At the request of her health visitor, Amelia’s mother comes to see you with concerns about growth. Amelia is Lucy's first baby, is breastfed, and has just regained her birth weight. The growth chart in her parent-held child health record shows Amelia is currently on the 25th centile, having been on the 75th centile at birth. Lucy is worried about whether she is able to meet Amelia’s nutritional needs.
This article explores how to approach concerns about infant growth in the early weeks after birth, how to manage common problems, and when to seek additional support.
What you should cover
The aims of the consultation are to understand and explore parental concerns, look for evidence of illness in mother or baby, assess feeding, and provide advice, guiding families to additional support if required. Conversations about infant growth can be emotive and highly influential, making it essential to recognise and respond to parental concerns with sensitivity and provide evidence-informed guidance.
Anxiety about infant weight gain is common and can lead to early cessation of breastfeeding.12 In a UK-wide survey on infant feeding, the most common reasons to discontinue breastfeeding were concerns about milk supply, latch, or painful feeding.3 Slow weight gain in infants is usually related to suboptimal nutritional intake. Glandular breast tissue hypoplasia, which limits a woman’s ability to produce milk, is uncommon, with a reported incidence of 1 in 1000.45 Therefore, the consultation should consider maternal concerns and …
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