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I have a tiny baby.

As I write this, my beautiful baby boy, just about 7 months old, is sleeping against my chest. He is happy, healthy, and loves his mama. He isn’t crawling, but he can sure get around! He has even started pulling himself up to standing. Coming in at less than 14 pounds, he isn’t even close to being on the growth charts. This caused a lot of anxiety in the early months, and since then I have seen so many moms panicking about their baby’s weight. I want to share some of what I have learned, in the hopes that it will put your heart at ease.

Disclaimer: This is for healthy, full-term babies who are meeting all their milestones. Any concerns should be discussed with a trusted doctor.

1. Things aren’t what they seem – Babies are “supposed” to return to their birth weight after 2 weeks. My baby lost the full allowed 10%, and started gain it back rapidly (2oz a day) until he hit the weight he was at 24 hours old. After than, his weight gained slowed dramatically and he did not hit his birth weight until he was 3 weeks old.

This would be cause for concern for most babies. My baby boy came into the world at 8lb 3oz, a completely respectable weight. No one suspected that this might be inflated. See, the main reason that most gestational diabetes pregnancies are not allowed to go overdue is because of the risk of the baby getting too big. I had gestational diabetes, my son was born at 41 weeks, and he only weighed 8 pounds. Hooray! Pat on the back for mama!

But wait….what if that was inflated? What if my baby was supposed to be smaller than that? That would explain why his birth was so traumatic for me, and why I am still recovering from the damage 7 months later. It would explain why his weight dropped 6oz in 24 hours (normal, as they told me), and another 10oz before my milk came in (a cause for concern, and the reason for a lot of weight checks that first month). It would explain why his body stopped the recovery weight gain short of his birth weight. My pre-pregnancy size was 5’2″, 115 pounds, and 34″ hips. I’m not exactly built to make an above average baby.

Just because my baby’s weight was normal for a baby, doesn’t necessarily mean it was normal for him.

2. Look at lowest weight, not birth weight – This was so important for me to learn. There are so many reasons a baby’s birth weight might be inflated, like in my story above.

When looking at weight gain over the first months, it’s dangerous to compare to birth weight. Especially if baby lost a lot or was overdue. In these cases, birth weight is likely to be above average, even if you don’t have an above average baby.

Instead, weight gain should be measured from baby’s lowest weight. This can make a drastic difference in how gain is perceived: now, instead of my baby gaining less than a pound in his first month of life, he gained a pound and a half. A much more favorable outcome.

3. Someone has to be in the bottom – You know that growth chart that always gets pulled out? If your baby is average, great! If he’s above average, “wow, what a big healthy boy you have!” But what if your baby is below average? Or what if he’s not even on the chart?

Doctors are usually happy as long as Baby is on the chart. It’s when they drop below that 2% line that everyone panics. But why?

The WHO growth chart is based on healthy babies. Which means your baby can be in the range of the chart without being unhealthy. Not just in their prescribed range from 2-98%, but the whole chart. No one gets upset when your baby is off the high end of the chart. And if your baby is doing great in every other area, it’s okay for him to be on the low end, too. My baby is in the 0.5 percentile for weight. That means he weighs more than only half a percent of healthy babies. But on the continuum of baby size, someone had to be down there! We can’t all have the biggest baby, someone’s baby has to be the smallest. Mine is trying to win that title.

4. It can take a long time to “settle” – This ties all of the above points together. What I’m going to talk about here is what our pediatrician told me to reassure me that my son is fine. So it’s here that I’m going to emphasize the importance of having a trustworthy and respectful doctor that will look at the whole child, not just what the computer says.

My baby came out above average. Even with his weight loss, he was in the 45% at one week. At one month he had dropped to 17%. By 2 months he was at 4%, and by 4 months he was down to 0.5%. He has hovered around that half a percent since. With each massive drop in percentage, our doctor repeated the same consoling words: “It can take awhile for baby’s weight to settle into his genetics. It doesn’t matter where he is on the curve, but we want to see him following his own curve eventually.” With a short and skinny mom and dad, he was destined to be on the low end.

He started so far above average that it took 4 whole months to settle into what his genetics wanted – and he was only 3 pounds above his birth weight!

5. Weight gain is not the gold standard – It was around 2 months that I started to really worry about my son’s weight, and started to really research weight gain. Everything I came across had the same recommendations for assessing health of a newborn: gaining so many pounds a month (he was not) and how many diapers they output (more on that below). At the same time as I was panicking, I couldn’t believe my happy, healthy, active baby could be evaluated solely on how much weight he was putting on. Eventually I found this article, and my heart rested.

Especially when an above average baby needs to “settle” into a below average weight, weight gain can appear to be much slower than what is considered “normal.” If this is the case, look at other factors:

• Is baby nursing well?
• Is baby producing enough diapers?
• Is baby alert when awake, and not lethargic?
• Does baby look healthy and move vigorously?
• Are baby’s nails growing?
• Is your baby meeting developmental milestones?
• Is your baby’s overall disposition happy and playful?

All of these were true for us, especially the milestones. My son was actually meeting his developmental milestones up to a week and a half early thanks to the boost going overdue gave him.

6. Poop means nothing – Output is important, it is. Your baby should be having the recommended number of wet diapers a day. Ours didn’t until my milk came in, and that was a legitimate cause for concern (see #7). But poop recommendations sure seem to be contradictory! While they may tell you your baby isn’t getting enough milk if he isn’t pooping 6 times a day, they will also tell you it is normal for a breastfed baby to go up to a week without pooping! So what’s right?

Well, I can tell you our baby went a week without pooping after pooping about 5 times at the hospital. Our doctor was more concerned about his comfort and GI tract working properly than he was about what this meant for milk intake. He never went over a once a day frequency. And that’s normal! So as long as your baby is peeing enough and seems to have a good quantity of poop relative to his frequency, take a breather and enjoy the reduced number of dirty diapers.

7. Supplementing doesn’t have to be necessary – Doctors and nurses love to break out the formula at the slightest hint of problems. Weight loss and low diaper output were the triggers for us. My milk didn’t come in until Day 5, so when a nurse called on Day 3 to check on me and mentioned formula, you can bet I spent the rest of the day bawling my eyes out. Luckily, I had a robust support system, which included nurses and doctors who were 100% supportive of breastfeeding.

• While in the hospital, every time we nursed, someone would come in to check his latch and help fix it (his latch was very painful at first, but after Day 4, I never needed nipple cream because his latch was so good I couldn’t even feel him nursing). He was checked for lip and tongue ties before leaving.
• On Day 3, I was told to pump after each feeding and feed him what I pumped with a syringe. This would help my milk come in and ensure he was getting as much milk as possible.
• On Day 4, a home health nurse came to check on us. She checked out nursing, and confidently told me my milk would be in soon. She encouraged me to continue pumping after nursing.
• Day 5, we went to the pediatrician for a weight check. This was just the on-call doctor, but he encouraged me to keep doing what I was doing. Baby boy had already gained 2 ounces from the previous day!
• On Day 7, we met with his pediatrician. He had gained 4 more ounces, and I was once again encouraged to keep up with the breastfeeding.
• As the months went on, I was blessed with an understanding pediatrician who looked at the whole baby, and never once made me feel like we should offer formula (or solids before his time) for the purpose of increasing his weight.
• At 7 months, my happy baby is crawling around, fueled totally by my milk.

If I didn’t have my support system, or I wasn’t so committed to making breastfeeding work, there were many steps along the way where I could have given up and supplemented with formula. And while there legitimately are some women who need to supplement, there are many things you can do in those early days to set you and your baby up for a wonderful nursing relationship.

8. It’s ok to be small – Who says babies need to be big and chunky anyway? I love my strong and lean little guy! He’s light and easy to carry around. My back doesn’t hurt after a long front carry. He’s sweet and adorable and perfect in my eyes. Plus he fits into one size of clothing for much longer!

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