NOTES ON WEIGHT GAIN & HOW MUCH YOUR BABY NEEDS PER FEEDING 

According to the WHO, babies should gain 1 oz per day between 0-4 months of age. Some sources say it's ok for babies to gain .5 oz per day during this time, but this is incorrect, although occasionally daily gains of .5 oz are nothing to worry about.

However, babies who consistently gain .5 oz per day from 0-4 months will not stay on their growth curve and should be evaluated. Babies born female should double their birth weight by 4 months. Babies born male should double their birth weight a little sooner.

At around 4 months, if the baby has otherwise been regularly gaining 1 oz per day, it is normal and appropriate for weight gain to slow to .5 oz per day.

Here are links to WHO growth charts that should be used to track for breastfeed and formula fed infants.

Here are some guidelines:

  • Babies with birth weights < 9% should not fall more than one Z-score below their birth %.
  • Babies with birth weights between 9% and 91% should not fall more than 2 Z-scores below their birth %.
  • Babies with birth weights > 91% should not fall more than 3 Z-scores below their birth %.
  • Regardless of birth weight, any baby whose weight falls/falters below the 2% should be evaluated.

Here is more info on how infant growth should be evaluated.

This is my favorite app for tracking your baby's growth.

To determine the amount your baby needs per feeding, divide the total number of oz they need per 24 hours by their total number of feedings. The total number of oz a baby needs per 24 hours is found by multiplying their weight in pounds by 2-2.5 oz. To make the calculation easier, please click on the charts compiled by Ellen Chetwynd RN, BSN, IBCLC using data from Harriet Lane Handbook, 2009.

Please note, the amounts in the spreadsheet do not reflect what a baby who is underweight for their age group would need to grow and thrive and/or catch up—such an amount should be determined under the supervision of an experienced IBCLC.
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GUIDE TO SAFE HUMAN MILK STORAGE

Cleanliness Guidelines: The CDC website says: “... Aim for cleanliness but realize milk is a biologic substance and full of probiotic and commensal bacteria. If you are able, wash your hands or use hand sanitizer prior to pumping.”

In short, try to practice the same basic guidelines you use when preparing food. Each teaspoon of breast milk has upwards of 3 million germ-killing cells. Thus, for infants born at term, there’s no need to constantly sanitize everything that touches and/or contains your breast milk. The only time you need to sanitize pump parts/bottles is immediately after you remove them from factory packaging: boil everything in a big pot for 10 minutes. After that, you can wash pump parts/bottles in hot soapy water in a bowl in the sink. Do not wash these items directly in the sink because sink drains have been found to contain harmful bacteria. Read this article by Emily Oster about how panic around breast milk going bad is likely overblown.

Storage Guidelines: (source: Journal of Human Lactation) 

  • Room temperature: 6-8 hours
  • Blue ice pack: 24 hours
  • Refrigerator: 6-8 days 
  • Standard Freezer: 6 months optimal, 12 months is generally ok. 
  • Deep Freeze: 12 months 

Store milk from the same 24 hour period in the same bottle. Have separate bottles for separate 24 hour periods. To keep track of dates, you can use a dry erase marker or masking tape on the bottles. Contrary to common belief, you can add freshly pumped (warm) milk to cold milk in the fridge.

Thawing Milk: The best way to thaw milk is to leave it in the fridge overnight. Thawed this way, milk can stay in the fridge for 24-48 hours. Thawing milk on the counter in a cup of water (cool or slightly warm water) is ok if you are going to use the milk within 6 hours. Here’s a Video on thawing breast milk.

Milk Temperature: Give cold milk! According to the CDC, there's no need to warm up breast milk, plus giving cold milk from the beginning can prevent babies from developing a preference for warm milk (preferences don’t develop until a baby is around 3-4 months). Giving cold makes everything easier! However, if your baby has a preference for warm milk and/or you’d prefer to give the baby warm milk, the best way to heat a bottle is in a bottle warmer or mug of hot water. Don’t microwave breast milk.

The “backwash rule:” Once the baby has had some of the bottle, you can use it again at the next feeding—then, if the baby still hasn’t finished the milk, throw it away.

The “Fridge Hack:” Many of my patients and IBCLC friends use something called the “Fridge Hack.” The "Fridge Hack" is when you do not wash your pump parts after every time you use them. Instead, you would store your pump parts in Tupperware or a gallon-size freezer bag in between pumping sessions for 12-24 hours before washing them. For parents of full-term infants without underlying health conditions, I believe the “fridge hack” to be a reasonable choice; however, here’s a great video with information on whether or not it’s the right choice for your family.