My baby has lost 10% of his birth weight. What does that mean?

Reaching a 10% weight loss is not a desired benchmark for your newborn, but hold on - does it always mean breastfeeding isn't working? The answer is No! Especially if you had a C-section, or a long labor where you were given a lot of IV fluids, reaching a 10% loss is not uncommon. And in some cases, you may be able to continue breastfeeding exclusively, with no intervention at all. But reaching this point does require a thorough evaluation with a lactation consultant and pediatrician, to come up with a plan that is right for you and your baby.

Breastfeeding parents should be prepared for their newborn to initially lose weight. Those first numbers on the scale, that become your baby's "stats," to be included in every birth announcement and text about your baby's arrival, are not maintained in the first few days. You will likely take your baby home from the hospital, if that's where you delivered, weighing many ounces less than his birth weight. The reason is that the first milk, colostrum, is so small in quantity, like a teaspoon per serving, that it won't keep his weight at the level that his umbilical cord established. In the first 2-3 days, colostrum will help your baby stabilize his blood sugar, expel all the black tarry poop (meconium) in his gut, stay hydrated, and energized. But after his first sleepy 24 hours, you'll notice that he becomes alert and demanding, nursing frequently, and possibly cluster-feeding at night, like he's unsatisfied. This is by design: all the action at the "breastaurant" places an order for mature milk, and after 2-3 days, your body responds by increasing the volume. (Technically, the production of mature milk is automatically triggered by the delivery of the placenta, and resulting hormonal changes, but it sure doesn't hurt to have a baby continually activating those faucets of colostrum!)

If that increase in volume doesn't occur in a timely manner, and first time C-section moms beware - it frequently is delayed, then your baby will let you know by showing persistent hunger cues and getting frantic at breast, ("Hangry") OR too sleepy to feed effectively. The numbers on the scale offer another clue: your baby's weight may be dropping steadily, with the percentage of weight loss nearing 10%. One good reason to hold off on a pacifier for several weeks relates to this situation: it interferes with your baby's ability to "tell" you he needs more milk. A hungry baby WILL suck on a pacifier and go to sleep, and that's not necessarily a good thing! You need the lines of communication open, and newborn babies should always get calories for their sucking effort, not the negative feedback a pacifier provides.

Luckily, in the event that baby's weight loss is becoming an issue, you can start pumping or manually expressing your milk after baby nurses, and offer him some bonus milk. This will also help your body understand to speed up the process of making mature milk. It does require extra steps that can be exhausting, however, it's a temporary solution that can often be discontinued when milk starts to come in.

Moms frequently ask, "How will I know that my mature milk is in?" It's not like you get a text alert when it arrives! In truth, the signs vary from mom to mom, so it's important to watch and listen for signs of adequate intake as your baby feeds, like frequent swallows, more wet diapers, and lighter colored, looser bowel movements. For some moms, milk coming in is unmistakable and sudden: they wake up in the morning or from a nap, and they have Dolly Parton-sized boobs. Their breasts are firm, tight, uncomfortable, and expanded. Possibly they are leaking milk, especially while baby is nursing; the unused breast begins dripping like a faucet.

In other cases, mature milk's arrival is more subtle. Moms report that their breasts feel heavier, and they notice that baby's swallows are more pronounced. Manual expression reveals white milk instead of clear or yellow colostrum. Especially in moms who already have large breasts, the physical changes may not be as obvious.

Baby will need that increase in volume by the 3rd/4th day. That's why he is getting weighed every 24 hrs, to ensure that he is losing a normal amount of weight. We know that once a baby loses 10% of his birth weight, he can't afford to lose anymore without his effort being compromised. He won't nurse vigorously and remove much milk when he is weakened. He may begin to get dehydrated or jaundiced. He may sleep at the breast instead of sucking actively. So if he has lost 10%, and he has just one other strike against him, such as:

1. Baby's bilirubin level is trending in the wrong direction or outside normal limits, indicating a jaundice risk.

2. Baby is sleepy at breast and not actively sucking well enough to remove significant amounts of milk

3. Mom has no breast changes yet indicative of her supply increasing.

4. Baby has not had enough wet or dirty diapers that indicate good intake.

...then a supplement is in order. If mom is able to provide enough of her own milk by pumping after nursing baby, that may be utilized, but frequently, her supply is in the process of catching up, and so donor milk or formula is required to provide the volume that baby needs, temporarily. (see blog post on Triple Feeding)

Now, I did mention that supplementation is not always necessary when a baby has reached a 10% loss. Again, reaching the 10% benchmark is common in first time moms who have delivered by C-section. A baby's birth weight can be boosted by IV fluids that mom got during pre-op and surgery, and those couple of ounces of "water weight" are easily lost in the form of urine, during baby's first 24 hrs. In and of itself, that 10% loss on Day 3 does not necessarily mean that the plan of 'exclusively nursing on cue' needs to be modified. But it does warrant a very close look at baby's condition and his nursing behavior. A lactation consultant should evaluate baby's feeding, and not just check baby's latch, but observe baby feeding on both breasts. The LC then shares her assessment with the baby doctor, and finally, a discussion occurs with the family to identify all the factors at play. Many pediatricians are comfortable green lighting the continuation of exclusive breastfeeding if ALL of the following conditions exist:

1. Baby's bilirubin level is normal and not trending in a dangerous dierection.

2. Baby is vigorous at breast, demanding to nurse often, which means at the very least eight feedings in 24 hrs, preferably more. Ideally, a lactation consultant has observed the feeding and attests to its "nutritive" quality. Meaning, baby isn't faking us out, or sleeping on the job; he's sucking actively with frequent, large swallows that are obviously transfering nutrition, or milk, out of the breast. And the LC will want to see that he has the energy to nurse a significant time on both breasts, not just one breast for five minutes.

3. Mom reports positive breast changes such as heaviness, fullness, or engorgement.

4. Baby has adequate output: at least three wet diapers on Day 3, four wet diapers on Day 4, and five wet diapers on Day 5, in addition to 3-4 stools daily.

In this case, triple feeding may not be necessary, and mom can continue offering the breast frequently, without relying on a pacifier. One condition however, is that the pediatrician may require an assessment and weight check on the next day, to ensure that everything is still on track. Once weight gain is documented, things are headed in the right direction, and parents can hopefully begin to relax a little and start to feel confident about their baby getting "enough" at the milk bar!