30 g/day

No, I’m not talking about how much fiber one should have in a day – though, 30 g is about right, I think.  I’m referring to the amount of weight a newborn should gain per day during the first few months of life.

For my American readers – 30 grams = 1 oz.

30g/day was drilled into my head in medical school and particularly so in my Family Medicine training program.  A newborn will typically lose about 10% of his/her birth weight in the first few days of life, but usually by a week of age, the majority of infants will have regained the weight.  I was also taught that this should occur within the first 7 days of life.

So, in my first few years of family practice, I was quite diligent about these milestones.  If a baby hadn’t gotten back to birth weight within a week or wasn’t gaining that magical 30g/day, I would refer to the pediatricians across the hall from my office.  After a few of these referrals, the pediatrician walked over to my office to have a little “chat”.  She’s a lovely woman (she actually sees all my children) who sat me down and told me, that while she appreciated all the consults I was sending her way,  all of the infants were healthy and I was jumping the gun on the referrals.  I explained my reasoning, and she basically told me that “in the real world of clinical practice, most infants will regain their birth weight within 2-3 weeks, and so long as they are gaining weight, don’t focus on the 30g/day rule.”  She reminded me it was more important to assess how the mother was nursing, or how much formula was being given; she reminded me that the hydration status of the infant was more important than the number of grams gained.  Clinically, how does the infant look?  Was the infant having adequate numbers of wet diapers during the day? etc.  It was amazing advice and (sadly for her), my referrals drastically declined.

Yet, when it comes to my own child, I am stuck on that 30g/day rule.  Perhaps it’s because, with my first-born, I had a pathetic milk supply and didn’t recognize that my daughter was hungry and losing weight.  By the time she was 2 weeks old, she had lost about 20% of her birth weight, was just getting enough milk to stay hydrated, but not enough to gain weight.  I had to start supplementing with formula and watching her guzzle back that first 4 oz of formula in about 20 seconds made me realize just how hungry she was.  Cue the gut-wrenching mommy guilt.

I didn’t have to supplement with my second child – we had a great nursing relationship and he gained weight well.  Now, with the third. it seems to be following the same pattern, yet today I decided to take the baby to my office for a weight check only to discover that he’s gaining only about 15 oz/ day.

Cue the mommy guilt again. Oh God, do I not have enough milk for him?  Is he hungry and I’m just not clueing in?  Should I be waking him every 2 hours?  When I relayed my concerns to my husband, he just looked at me and said “He’s fine.”  He’s pooping and peeing appropriately.  He seems satisfied at the breast (unlike the firstborn who was clearly frustrated after a few minutes on the breast).  I am being way too hard on myself, yet I just can’t help it. And to top it all off, the baby now has the cold his older siblings have.

Did I mention he’s only 3 weeks old?

FML.

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