Healthy newborns lose approximately five to ten percent of their birth weight a week after birth (1). However, most of them regain this weight within two weeks and triple it by 12 months (2). These weight changes are general indicators that the baby is growing fine, and their calorie consumption is optimum.
However, not every baby grows as expected. The growth rate among babies varies, and so does their weight gain pattern. If your baby is not gaining weight as expected, do not fret. There can be several benign reasons for slow weight gain in babies. A pediatrician can help you identify the precise cause and take the necessary steps to avert any long-term adverse effects.
This post takes you through the possible causes of a baby not gaining weight, notable signs and symptoms the baby is not gaining weight, and treatment to follow.
Reasons For A Baby Not Gaining Weight
A baby may be gaining weight slowly or not gaining weight at all. In both cases, several factors can be responsible (3). The following are some of the notable potential reasons.
1. Insufficient calorie intake
Most healthy, full-term newborns take one to two ounces of milk per feeding every two to three hours (4). As they grow, the amount of milk per feed increases, and the feeding frequency reduces, yet babies get the required number of calories. However, some babies may not get the calories they need due to any of the following reasons.
- Poor latching and positioning of the baby due to issues, such as lip tie or tongue tie, make it difficult for the baby to consume adequate breast milk. Chronic latching issues can also cause pain and discomfort to the mother, leading to infrequent feedings. These breastfeeding issues can be corrected with the guidance of a lactation consultant.
- Chronic low milk production is one of the prominent reasons for a baby not gaining weight properly. Low milk supply can happen due to several medical and non-medical reasons, such as infrequent breastfeeding or breast surgery. Consulting a lactation consultant is crucial for prompt resolution of the issues.
- Short nursing sessions are another common reason for a baby not gaining weight. Nursing sessions become shorter if the mother and the baby face feeding difficulties, such as low milk supply or the baby falls asleep on the breast or while bottle-feeding. Waking a baby up for feeding and keeping them engaged by stroking their cheeks or hands can help them nurse longer.
- Starting solids can cause slow weight gain as the baby’s body adjusts to the new feeding pattern. Remember, even when babies are eating solids, many of their calories come from breast milk or formula. If the frequency of breast milk or formula feeding reduces while feeding solids, it could lead to slow weight gain.
- Medical conditions: Certain medical conditions, such as Down’s syndrome and premature birth, cause slow weight gain. These conditions usually cause feeding difficulties due to underdeveloped muscles required to suck and swallow (5).
2. Low absorption of calories
Some babies may be consuming sufficient calories, but the absorption of those calories may not be happening due to (6):
- GERD: Gastroesophageal reflux disorder is a digestive disorder where the baby unusually and frequently spits up after feeds. The underdeveloped or weak lower esophageal sphincter is the prominent cause of reflux in infants. GERD could impede feeding sessions or interfere with digestion, hindering the absorption of calories.
- Food allergies and sensitivities: Some babies are allergic or sensitive to certain foods. For instance, in celiac disease, an autoimmune disorder, a baby cannot digest wheat. If they consume wheat or wheat-based cereal, they get diarrhea or vomiting, contributing to poor calorie absorption, which could ultimately prevent the baby from gaining weight.
Besides these, medical conditions such as galactosemia and cystic fibrosis can impair the body’s ability to produce energy from food or hinder energy absorption, causing slow or no weight gain.
3. Over-utilization of calories
Babies have increased energy needs due to rapid growth and development. However, in certain conditions, these needs increase further. For instance, babies with breathing difficulties or infections need more calories than usual to heal, recover, and gain weight.
If your baby isn’t gaining weight, irrespective of the cause, consult a pediatrician promptly.
Diagnosis Of Weight Gain Issues In Babies
A pediatrician will do a physical examination, take your infant’s medical history, and check their height and weight to diagnose weight gain issues. They will plot your baby’s height and weight on the pediatric growth chart to determine the growth pattern. A pediatric growth chart is an assessment tool that compares a baby’s weight-for-age and weight-for-length against the standard ranges for babies of the same gender and age (7).
The US Centers for Disease Control and Prevention (CDC) recommends using the WHO’s growth standards chart to monitor breastfeeding infants’ growth (8). For formula-fed babies, using the CDC’s growth chart is advisable.
Your doctor will record your baby’s weight and height on every visit and monitor your baby’s overall growth. If a baby shows persistent low weight gain over a period, they may assess the baby further to determine the cause.
In cases of no weight gain for an extended period, the doctor may advise some tests, such as blood count, thyroid hormone test, and urinalysis.
How To Help Babies Gain Weight?
You can help babies gain weight in several ways. Discuss a strategy with your pediatrician for the best outcome for your baby.
- Focus on treating any underlying medical condition, such as a digestive disorder or other illness. Prompt treatment of the condition in most cases can help a baby attain the correct weight. If your doctor sees the need, they may suggest nutritional supplements to fill the dietary gaps.
- Monitor your baby’s latch. Inverted nipples, tongue-tie, and cleft palate are a few causes of latching failure. If the baby cannot latch properly or you face any issue with the positioning of the baby, promptly consult a lactation consultant.
- Avoid using pacifiers until feeding is established. It can take three to four weeks for a baby to become adept at breastfeeding or bottle-feeding (9). Offering a pacifier before feeding is established could lead to nipple confusion, leading to inadequate feeding. Even when feeding is established, do not use a pacifier as a temporary aid to calm a hungry and cranky baby. Offer breast or bottle when the baby is hungry and the pacifier when the baby is cranky but not hungry.
- Keep your baby awake during feeds. An awake and active baby usually nurses for about 20 minutes or more on one or both breasts during each feeding (10). If you feel your baby might fall asleep, tickle their palms and feet, change your breastfeeding position, burp them, or switch the breast to keep them awake.
- Increase the frequency of feeding to ensure the baby is consuming sufficient breast milk or formula. Frequent breastfeeding is also helpful in boosting milk production. Stay hydrated, eat a well-balanced diet, and rest well to ensure healthy milk production. You may consume some baby-safe lactation-boosting foods, such as fennel and oatmeal, after consulting your lactation consultant.
- Monitor the baby’s calorie intake by recording their milk consumption using markers on the bottle. You can also closely observe the manner your baby sucks and swallows while feeding. Babies tend to suck slowly and persistently when the milk flow is optimum. Alternatively, you can do a diaper check. A well-fed baby wets six to eight diapers in a day (11).
- Increase the baby’s calorie intake. To do so, encourage your baby to empty one breast before switching to another. It ensures the baby is getting the hindmilk, containing a higher percentage of fat than foremilk. For formula-fed babies, you can consult a pediatrician to know if a formula change is required. They may even suggest you change the formula to water ratio to make the feed denser.
- Check about supplementing the feed or using a mixed feed approach. In such cases, the doctor may suggest you feed both breast milk and formula to your baby. If you are formula feeding, you can feed expressed breast milk to your baby through a bottle or any other alternative feeding technique, such as a dropper or finger feeding.
Besides these, weigh your baby regularly at home until they start gaining weight. Maintain a weight record and share the data with your doctor to work closely for your baby’s healthy weight gain.
Weight gain is a vital growth parameter for babies and toddlers. Most babies may not look plump but are considered healthy when within their healthy weight range. However, if you find your baby is gaining weight slowly or not gaining it, consult a doctor. They will help determine the exact cause and suggest ways to support healthy weight gain in the baby.
2. Infant Nutrition And Feeding; USDA
3. Why Isn’t Your Baby Gaining Weight? And When Should You Worry?; Nationwide Children’s
4. How Often and How Much Should Your Baby Eat?; Healthy Children; AAP
5. Slow Weight Gain in Infants and Children; Boston Children’s Hospital
6. Failure to Thrive; Kids Health Nemours
7. Clinical Growth Charts; CDC
8. WHO Growth Standards Are Recommended for Use in the U.S. for Infants and Children 0 to 2 Years of Age; CDC
9. Pacifiers and Thumb Sucking; Healthy Children; AAP
10. Breastfeeding FAQs: How Much and How Often; Kids Health From Nemours
11. Breastfeeding: How do you know your baby is getting enough milk?; About Kids Health