Before-and-after weights for slow-growing babies

Can I use before-feed and after-feed weights to see how much milk my slow-growing baby takes from the breast?

When a baby is not growing well, it may be because the baby is sick or because the baby is underfed. It’s important to know which it is, because the treatment for each is different. Before-feed and after-feed weights show both types of babies taking in a small amount of milk but mothers of sick babies are often able to express significant amounts of milk after breastfeeding. Sick babies often refuse supplements but underfed ones will accept them and grow quickly after starting them. Before-feed and after-feed weights can also show how much milk a baby, who is too sick to breastfeed well, is taking in and help health-care providers know how much milk supplement to give.

A) Using before-and-after weights to assess a slow-growing baby

Please see your health-care providers if your baby is not growing well. 

1) Deciding if the baby is underfed or sick 

Both sick babies and babies whose mothers do not have enough milk may not grow well. It can be hard to tell the two kinds of babies apart, but it is important to do so because the treatment of each is different.

a) The response to supplements 

Underfed babies generally respond dramatically to milk supplements. They gain weight very quickly and are much happier and energetic after starting them.

Sick babies who are gaining poorly, however, may not accept supplements. Starting supplements, if accepted, may not result in increased growth or a happier baby. Some may have difficulties using certain supplementing tools.

b) Expressed amounts of milk after breastfeeding

If mothers are still unsure of the baby’s problem, they can use before-feed and after-feed weights (before-and-after weights) and expressing.  

Before-and-after weights show both types of babies taking in a small amount of milk. However mothers with a low milk supply tend to express about 15 millilitres (1/2 U.S. fluid ounces) from each breast after the baby has breastfed well, but the mothers of sick babies often express significantly larger amounts.

2) Assessing how much milk a sick baby is taking in

Some babies are clearly sick and will breastfeed weakly. Before-and-after weights will show how much milk the baby is taking in and can guide mothers and health-care providers in the amount of milk supplement a baby needs.

B) How to use before-and-after weights to assess how much milk a sick baby is taking in

Using before-and-after weights to see how much milk a sick baby is taking in is similar to the process used to assess how much milk a mother is making. Ideally, before-and-after weights are measured at each feeding for two 24-hour periods.

Mothers in this situation should express after each breastfeed to confirm that more milk is available if the baby were interested and to maintain their milk supply so that the baby has enough milk to grow after the problem is fixed.

C) Example of before-and-after weights used to assess a slow-growing baby

Our clinic was asked to see a two-month-old baby girl and her mother. Her doctors assumed her slow growth to be due to the baby not getting enough milk by breastfeeding. She refused to drink supplements from a bottle; her doctors thought this was due to an inability to bottle. 

Babies who are underfed are generally thin and unhappy and eagerly accept milk supplements. This baby was small and gaining very slowly but was fleshy, happy, and refusing bottled supplements. She latched and sucked normally while breastfeeding and did not act hungry afterwards.

Before-and-after weights showed that the baby was taking in about 450 millilitres (15 U.S. fluid ounces) from the breast, an abnormally small amount given the age of the baby. We asked the mother to express after each breastfeed; she obtained about 300 ml (10 oz) each day. 

We were certain that her problems were not caused by breastfeeding. Before-and-after weights allowed us to quickly document her poor milk intake and expressing showed additional milk was present in the breast. 

We alerted her health-care providers to a likely health problem. It turned out to be a torn breathing muscle (diaphragm) that kept the baby from growing and she needed immediate surgery.

We have used before-and-after weights in this way to help identify babies with other medical problems including bowel blockages, genetic illnesses, and heart problems.