The following information is taken from IABLE, the Institute for the Advancement of Breastfeeding and Lactation Education, by Anne Eglash MD IBCLC FABM October 23, 2019 and the Journal of Obstetric, Gynecologic and Neonatal Nursing October 11, 2019 by DiTomasso D, Cloud M.
What is the average neonatal weight loss in the first few days after birth for healthy term breastfed infants?
We know that nearly all newborns lose weight during the first few days of life. Concerns regarding weight loss often lead to supplementation, which in some cases is appropriate, and in other cases not. A systematic review of recent evidence to evaluate current guidelines suggest caution when weight loss reaches 7% of birthweight. The authors explain that the 7% recommendation came from studies that did not follow infants long enough to see the true nadir, or lowest point, of weight loss. In addition, some of the infants in the studies were not breastfed. The authors of this review concluded that average newborn weight loss on day 2 was 6-7% of birthweight and 7-8% on day 3. These stats included both vaginal and cesarean births. There are so many factors that determine infant weight loss, such as maternal IV fluids intrapartum, birth trauma, cesarean birth, delay in lactogenesis, maternal illness, insufficient glandular tissue, infant sleepiness, timing of the first feeding, and neonatal jaundice, among many others. There was no consistency across these studies as to the exclusion of any of these conditions.
Other findings in this systematic review of evidence regarding weight loss among term healthy breastfed infants included finding weight loss generally greater on day 3 than day 2. The majority of the infants in the included studies were back to birthweight between 10-14 days postpartum. In several studies, weight loss of 7% or greater in the hospital was associated with significantly less exclusive breastfeeding by day 14. The studies did not have consensus on whether peak weight loss occurs on days 2, 3, or 4 after birth. At times, breastfed newborns lost 10% or more of their birth weight. Rates of exclusive breastfeeding decreased when newborns lost greater amounts of weight. Weight loss is commonly 7% to 8% of birth weight or greater by the third day after birth among healthy, full-term, breastfed newborns.
IABLE Comment by Anne Eglash MD IBCLC FABM
The bottom line here is that our research on infant weight loss postpartum is not strong. Older recommendations by the American Academy of Pediatrics suggested that 7% weight loss ought to rouse concern, but we know from this review that weight loss on day 3 was higher, often up to 8%. We all witness newborns reaching 10% weight loss by day 3, yet for many of these dyads, breastfeeding is going well, milk supply is rapidly increasing at that time, so supplementation is not necessary, vs other dyads for which supplementation is absolutely needed.
A true weight loss standard would be based on a population of 100% exclusively breastfed healthy infants, born 39-40 weeks gestation who have no complications such as jaundice. Their mothers would not be at risk for a delay in lactation or other reasons for insufficient milk supply. To this date, we still do not have this kind of data. We don’t have a ‘magical’ weight loss number that tells us when to supplement. Every breastfeeding dyad needs professional management over a period of time until weight gain cadence is appropriate, and breastfeeding is perceived as going well by mom and her supporters. This means that if healthcare professionals are making decisions on supplementation, it is critical that they gain sufficient knowledge on this healthcare topic, and follow the dyad as closely as they do for any other medical problem that requires close follow up.
Comment by Diane Erdmann RN BSN IBCLC, Breastfeeding Support & Supplies of Omaha
The important thing for moms to take from this information is to be patient with her body, breasts and baby after delivery. Give Mother Nature a chance to show you that with lots of skin to skin and frequent breastfeeding after birth, your breasts can produce enough colostrum and eventually mature milk to meet your baby’s needs. There are definitely medical needs for supplementation, which hopefully will be donor milk rather than formula, but not necessarily for every full-term healthy newborn. If your baby is latching on and nursing well, you hear more frequent swallowing each day, they are having normal wets and stools and your breasts are dramatically fuller by day 3 to 5, then you and baby are progressing normally. Getting your baby’s weight checked 1 to 2 days after discharge to make sure your mature milk came in and again at 2 weeks to verify baby is up to birth weight is the minimal follow up you should expect. Getting a baby’s weight checked is the only way to know for sure baby is getting enough breastmilk. When moms see me for a lactation consultation, we weigh baby after nursing on each breast and you see to the tenth of an ounce how much baby got and then I am able to determine what recommendations to give mom. I have seen tens of thousands of newborns and would be happy to help you get your breastfeeding journey off to a good start.