Our March Lunch & Learn is scheduled for Friday, March 6th, from 12:00 p.m. to 1:00 p.m. Megan Kindred, PhD(c), APRN, FNP-C, IBCLC will be our speaker.
Please REGISTER for meeting access. This has been approved for 1 R-CERP. Note: only current HALCEA members are eligible for CERPs.
HALCEA Education Series: The Weight Dilemma - Exploring Acceptable Variances in Infant Growth
Abstract
Background: A standard recommendation for appropriate weight gain among term infants is 4-7 ounces (120-200g) per week. However, infants who consistently gain at a rate near the bottom of this range show a steady decrease in percentile trajectory on the WHO Weight-for-Age growth charts. For example, a male infant born at the 50th percentile who is back to birth weight by two weeks and proceeds to grow at the low end of this range will drop below the 1st percentile on the WHO growth charts by 9 weeks of age and may be diagnosed with growth faltering or failure to thrive.
Purpose: This review aims to synthesize the current evidence surrounding infant weight gain and to list factors that affect infant weight trajectories. Methods: A targeted review of publications from 2010 to 2023 evaluating factors associated with infant weight gain was conducted. Primary research studies evaluating infant weight gain were synthesized to identify significant factors affecting infant weight gain trajectories.
Results: Multiple factors influence weight trajectory, including primary or exclusive food source (breast milk or infant formula) and feeding mode (direct breastfeeding or bottle feeding). Additional common contributing factors include maternal and paternal stature and birth weight. Uncommon contributing factors include improper infant formula preparation, malabsorptive processes, disorders that cause excessive caloric utilization, and genetic syndromes or mutations. While it is ideal for infants to gain approximately 30g per day in the first several months of life, there are circumstances when less weight gain is acceptable. For example, an infant considered large for gestational age but born to parents of small stature may gain slowly as they adjust to their genetic norm. Regardless, a thorough history and physical exam should be obtained whenever an infant gains weight more slowly than expected. Particular attention should be paid to the infant’s average 24-hour intake, as the most common cause of inadequate weight gain is inadequate intake relative to needs. If intake is determined to be adequate, organic causes should be investigated, particularly when the infant is below the 0.4 percentile.
Conclusions: Infant weight gain is a significant health indicator. Providers caring for infants should understand how to interpret slow weight gain. They should be able to accurately identify when slow weight gain is acceptable and when it needs to be addressed. In clinical practice, the point of intervening for slow weight gain varies widely. Although no widely accepted standard exists, healthcare providers may benefit from a systematic approach to interpreting infant weight trajectories. A clinical algorithm may offer a concise and easy-to-follow pathway. Additional research is needed to determine the feasibility and utility of a clinical algorithm that aids in the identification of infants with slow weight gain and guides subsequent workup and treatment.
Disclaimer: Houston Area Lactation Consultants & Educators Association has been accepted by the International Board of Lactation Consultant Examiners® (IBLCE®) as a Preferred Provider for the listed Continuing Education Recognition Points (CERPs) programme. Determination of CERPs eligibility or CERPs Provider status does not imply IBLCE’s endorsement or assessment of education quality. As a Preferred Provider, Houston Area Lactation Consultants & Educators Association attests that it complies with the WHO Code and subsequent WHA resolutions.