How to tell if your baby is gaining weight, growing well, and developing as expected – without getting them weighed.
During these difficult times, where Well Baby clinics are closed and home visiting has been reduced or is no longer available, many families are concerned about tracking their babies’ growth and development. We have compiled this information in order to firstly provide reassurance for families used to weighing regularly about what is normal, and to encourage families who have concerns or when of the typical indicators of sufficient milk intake are absent, to ask for additional support from a healthcare professional.
If your baby was born premature or has underlying or current ill health, this
guide may not be accurate for your baby, and you should ensure that you
continue to stay in contact with your healthcare providers, as often as needed.
National guidance has previously been that babies should be weighed at birth and again during the first week (often day 3 and 5, sometimes only day 5). They were then routinely weighed at 10 days and around 6 weeks. NICE guidance tells us that from 6 weeks, healthy babies should be weighed no more than once a month. However, often parents who are unsure about whether baby is thriving, have relied upon the weight gain as an indicator. This document provides other indicators to use, to reduce your social contacts during this time.
Babies aged 0 – 3 weeks
- In the first 48 hours, your baby is likely to have only 2 or 3 wet nappies. Wet nappies should then start to become more frequent, with at least 6 every 24 hours from day 5 onwards.
- Your baby should be fed responsively, when they show early feeding cues such as beginning to stir, mouth opening, turning their head and rooting. Crying is the last cue for feeding, and means your baby will need to be calmed in order to feed effectively.
- Sometimes the baby may need to be ‘nudged’ to feed more often than they ask for.
- Your baby should feed at least 8 times in 24 hours – but double this number is also normal.
- At the beginning, your baby will pass a black tar-like stool (poo) called meconium. By day 3, this should be changing to a lighter, runnier, olive greenish poo that is easier to clean up.
- From around day 4 and for the first few weeks your baby should pass 2 or more yellowish poos each day. Most babies pass lots of poo, and this is a good sign.
- Your baby should have at least 6 wet and 2 dirty nappies every day, and although the amount of poo varies from day to day and baby to baby, ideally each poo should be at least the size of a £2 coin.
- Your baby be gaining weight after the first week; an initial weight loss after birth is common, however we expect them to regain their birth weight by around 2 weeks of age. Your midwifery team will put a care plan in place if a baby’s early weight loss or subsequent slow gain is considered significant.
- It is normal for your baby to wake frequently at night for feeding.
- It is normal for your baby to want to be held often.
- You should be able to see and feel physical changes in your baby each week, such feeling heavier and ‘filling out’. Have a look at their photographs to compare week to week. You should start to see chubbier cheeks, and rolls in their arms and legs beginning to form.
Notes on early breastfeeding…
- Your breasts and nipples should not be sore. If they are, ask for help from a qualified peer supporter, or a member of your midwifery or health visiting team, as appropriate.
- Your baby will be content and satisfied after most feeds and will come off the breast on their own.
- Your post-feed nipple may be longer than it was when it went into baby’s mouth, but should not be misshapen, slanted or squashed.
- Breastfed babies typically pass loose poos – like commercial korma sauce from a jar. This is normal.
- Fussing at the breast or cluster feeding does not indicate a low milk supply. Often this behaviour occurs during a growth spurt or ‘developmental leap’. Sometimes they simply want to be close to their mum – breastfeeding is not just food for a baby, it is also comfort. ‘Non nutritive suckling’ is just as beneficial for your baby and for your hormones, so let them have time at the breast as often as they request it.
For more information on safely breastfeeding during the COVID-19 Pandemic, please see our Breastfeeding Support Information.
If you are bottle feeding…
- Your baby may need short breaks during the feed and may need to burp sometimes. When your baby does not want any more feed, hold them upright and gently rub or pat their back to bring up any wind. They may not always burp.
- Pace feed your baby, and look out for cues that they have had enough. Don’t encourage your baby to take more milk than they want. Videos on paced feeding can be found online.
If you are formula feeding…
- Follow all recommendations from the manufacturer about how to safely prepare and serve infant formula. Ready to feed liquid milk is pasteurised and safer to use; powdered milk requires preparation with water of at least 70°C to kill the bacteria in the powder.
For more information on safely formula feeding during the COVID-19 Pandemic, please see our Formula Feeding Information.
Babies aged 3 – 6 weeks
- Most babies will now be back to their birthweight. If your baby has not returned to birthweight by 3 weeks, you should already have a care plan in place. Speak to your midwife or health visitor if you do not have this. It is a good idea to seek some additional support.
- Your baby should generally be relaxed during and after feeding.
- Your baby should be doing 6 or more heavy wet nappies a day, and at least two yellow poos – again, minimum £2 coin or dessert spoon size each time.
- Your baby should still be feeding responsively at this age, roughly every 2-3 hours minimum, although it may be more frequent.
- You should be able to see more physical changes in your baby: they may be feeling heavier, and going up in clothing and nappy sizes.
- It is normal for your baby to wake frequently at night for feeding.
- It is normal for your baby to want to be held often.
- Use photographs of baby to compare how your baby looks now to how they did last week, or the week before.
Babies from 6 weeks
- Your baby should still be feeding responsively at this age, still roughly 8-10 times minimum per 24 hours, although this may start to spread out for bottle fed babies.
- You should be able to see further physical changes in your baby, feeling heavier, you may find yourself increasing clothing and nappy sizes. When you look at your baby’s newborn photographs, there should be a noticeable physical difference: your baby should visibly have gained weight.
- Your baby will begin to smile and have discovered their fingers and toes.
- Your baby may now be reaching for toys.
- It is normal for your baby to wake frequently at night for feeding.
- It is normal for your baby to want to be held often.
- Babies typically feed more frequently around the 6 week mark in order to give their mum’s milk supply a little boost (what you have is enough, but your baby is growing, so they need a little more from now on!) and they are very skilled at doing this!
- Bottle fed babies also go through these leaps and may also wish to cluster feed. It is best to offer smaller amounts in the bottle at regular intervals, whilst paced feeding, rather than trying to get baby to finish a larger volume of milk in one sitting.
- Try some skin to skin if your baby is not settling.
If you have concerns about how your baby is feeding at any stage, you may benefit from some additional infant feeding support. Whether you are breast or formula feeding, peer supporters are well informed and often best placed to support you.
Your midwifery or heath visiting team can also assist, and specialist help is also available.
Peer supporters can help troubleshoot feeding issues such as resolving pain or damage to the breasts, breast care, and increasing milk supply (when necessary).
It can be tempting to use your bathrooms scales to weigh your baby, however, bathroom scales are not typically well calibrated and are not sensitive enough to weigh babies. Trying to weigh your baby this way could cause undue anxiety. In order to weigh a baby at home with no outside contact parents would need to invest in special baby weighing scales – these can be quite expensive, and as discussed above, it’s not always necessary to weigh your baby in order to feel confident that they are growing and developing as expected.
Signs that your baby is NOTgrowing as expected
It can be very worrying to parents when their babies are not gaining weight as expected. It is imperative that if your baby is showing any of the following signs that you seek urgent help from your local Infant Feeding Team. You may need a specialist care plan to ensure your baby’s weight does not continue to falter.
- Your baby is lethargic between feeds, not relaxed during feeds, or falling asleep very quickly without much ‘active’ feeding time.
- Your baby is sleeping long periods (4+ hours) and not waking by themselves to feed.
- Your baby is not doing 6+ heavy wet nappies per day.
- Your baby is not doing at 2+ big yellow poos per day in the first 6 weeks.
- You baby’s poos are frequently brown or green, or may only be ‘skidmarks’ or small stains in the nappy.
- Your baby’s eyes appear sunken
- Your baby’s skin is loose or baggy
- Your baby’s nappies may be looser
- Your baby’s ribcage may be visible
- Your baby may appear to have grown in length but does not look to be ‘filling out’
If you are breastfeeding, it is still advisable to continue to breastfeed your baby even when they do not grow as expected. NICE Guidelines indicate parents should seek qualified breastfeeding support, and begin to supplement with mum’s own expressed milk, if there is a genuine concern over baby’s weight. If any of the above signs are true for your baby.
Further Resources:
https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2010/11/otbs_leaflet.pdf
https://www.essentialparent.com/lesson/breastfeeding-the-baby-with-faltering-weight-1943/
https://www.nice.org.uk/guidance/NG75
https://www.emmapickettbreastfeedingsupport.com/twitter-and-blog