Signs of slow growth

What are the signs that my baby is not growing well because of breastfeeding problems?

Four assessments can help mothers determine whether their baby is getting enough milk. Look for abnormal (a) feeding patterns, (b) behaviours, and (c) appearance, and (d) poor weight gain. When a baby is not getting enough milk, abnormal signs appear in at least two of these areas. There are many possible abnormal signs, including very short, long, or ineffective feeds; feeding fewer than 7 times or more than 10 times a day; general unhappiness when not feeding; regular sleeps of more than 5 hours; a tummy that does not bulge; loose skin on the neck and thighs; and weight change that doesn’t follow the normal pattern on a growth chart. Babies who are not taking in enough milk need their breastfeeding challenges addressed and may need supplementing with extra milk.

A) Signs of the baby not getting enough milk

An scowling, underfed baby boy. He has a thin neck, his tummy is not full, and the insides of his thighs have loose skin.

Please note: This FAQ refers to babies who are older than one week. If your baby is within one week of delivery, please turn to our underfed newborn page as newborn babies may look and act a little different compared to underfed older ones. 

Babies who are healthy and getting enough milk show signs of normal growth. There are four assessment tools that are used to ensure this:

  1. Feeding pattern
  2. Behaviour
  3. Appearance
  4. Weight gain

When babies are not getting enough milk, abnormal patterns appear with at least two of the four assessment tools. 

For example, a baby’s feeding pattern and behaviour may be in the normal range but the baby is thin and not gaining. Another baby who is not getting enough milk may gain a little slowly and look lean but not thin but be irritable and feed all the time. Both babies are not taking in enough milk and may need supplementing with appropriate milk.

If only the weight gain is slow or odd, the baby may be normal or there may be a problem.

B) Abnormal feeding patterns

Underfed babies may not have normal types of feeds or the normal number of breastfeeds in one day. 

1) Abnormal types of feeds

Babies may have abnormal feeds including those that are regularly:   

  1. Short or ineffective in which the baby:
    1. Is sleepy and weak at the breast.
    2. Is not sucking well on each side.
    3. Is angry at the breast and frequently tugs and pulls.
    4. Is not able to latch or stay latched.
    5. Suddenly refuses to breastfeed at all.
  2. Long (more than 20 minutes per side).

If the mother has a low milk supply, the baby may:   

  1. Have fewer than expected swallows while breastfeeding.
  2. Not choke at the breast once the milk has come in.

2) Abnormal number of feeds each day

Babies may have an abnormal number of feeds and may:

  1. Feed too often (more than 10 times a day).
  2. Not feed often enough (fewer than 7 times a day).

C) Abnormal behaviour

Underfed babies tend to behave abnormally. These babies are generally not happy when fed and held and show abnormal behaviours. Some may be irritable and others are lethargic. 

1) Behaviour

a) Irritable underfed babies

Some underfed babies:

  1. Are still hungry after the second breast.
  2. Won’t settle unless:
    1. Feeding.
    2. Sleeping.
    3. Using a pacifier.
    4. Given a milk supplement.
  3. May need lots of rocking or “dancing” with a caregiver to stop crying.
  4. May be especially irritable once the mother’s periods come back or for a few days before her period.

b) Lethargic underfed babies

Underfed babies may be lethargic and may:

  • Regularly sleep for more than 5 hours at one time.
  • Not be very active when awake. Instead of frequent movement and wiggling, they may be very passive. 

2) Low output

While pees and poops (stools) may be used to assess a baby's growth, they are not all that helpful after the first weeks. Between one and six months, healthy babies stool less often and those who are getting some milk, but not quite enough, continue to pee relatively well. Pees will decrease if the baby is dehydrated.

D) Abnormal appearance

An underfed baby. Her arms and legs have loose skin.

Unlike babies who are growing well, babies who are not getting enough milk may be thin. Mothers may notice that the baby has:

  1. A tummy that does not bulge.
  2. Loose skin in the front of the neck.
  3. Loose skin on the insides of the thighs.
  4. A triangular, as opposed to oval, face shape with a wide forehead and narrow chin due to very little fat in the cheeks.
  5. A scowling facial expression most or all of the time.

E) Poor weight gain

Without enough milk, the baby’s weight may not follow the growth chart curves and the baby may:

  1. Suddenly stop gaining weight.
  2. Cross growth curves downward.
  3. Fall below the 15th percentile on a growth curve.

The baby may have gained poorly as a newborn.