Expected Weight Changes After Birth for Term Breastfed Newborns
by Anne Eglash MD, IBCLC, FABM
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. The authors of this week’s CQW performed a systematic review of recent evidence to evaluate current guidelines suggesting 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 of weight loss. In addition, some of the infants in the studies were not breastfed.
The authors searched the literature published in 2015-2019 to explore the expected amount of neonatal weight loss in healthy term infants. They found 11 studies that met their eligibility criteria, but only 3 of the studies included any weights after hospital discharge. In some of the studies, infants were excluded if they were started on supplementation due to weight loss.
The authors of this systematic review concluded that mean weight loss on day 2 was 6-7%, 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.
- Weight loss was generally found to be 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.
Allison Laverty Montag
What a great question! I would love to see more research so we see appropriate supplementation. I understand the need to watch out for little ones and it can be scary when there isn’t appropriate follow up.