Exam 4 - Weight Gain/Loss in the Neonate

Question 1

How much weight do infants lose during their first few days of life?

Answer 1

Lose 5-8% of birth weight

• Important to calculate how much weight they’ve lost and their % of weight loss

Question 2

What weight changes are associated with infants at 2 weeks of life?

Answer 2

Breastfed infants return to their birth weight

Question 3

When should providers be concerned about FTT?

Answer 3

By 3 weeks - lack of return to birth weight

Question 4

Weight changes seen at 5-6 months of age

Answer 4

Double their birth weight

Question 5

Weight changes by 1 year

Answer 5

Triple their birth weight

Question 6

What is the normal rate of weight gain in infants?

Answer 6

0.5-1.0 oz/day

Question 7

When working with breastfed infants, should providers use CDC or WHO growth charts?

Answer 7

WHO growth charts

• Uses standards that are based on international populations where majority of infants are breastfed

Question 8

When will the provider consider using CDC growth charts rather than WHO growth charts?

Answer 8

After age of 24 months in infants who are still breastfeeding

Question 9

Signs and symptoms of healthy breastfed infants

Answer 9

• Active and alert state
• Making developmentally appropriate progress
• Have age appropriate height and head circumference
• Good skin turgor and color
• Sufficient output (6+ diapers/day)
• Content and satisfied behavior after feedings

Question 10

Signs that an infant is going through a growth spurt?

Answer 10

• Hungry (more than usual)
  
  • Feed every 1-2 hours
  • Avoid supplementation
• Sleeps more than usual
• Grumpy

Question 11

How long are growth spurt intervals?

Answer 11

2-4 days

Question 12

Contributing factors of poor weight gain in newborns

Answer 12

• Infrequent or inadequate feedings
• Inadequate milk production
• Genetic predisposition
• Infection
• Organic disease
• Physical anomaly that prevents good suck/swallow

Question 13

Poor weight gain in the newborn: clinical findings

• Infant factors

Answer 13

• Continued weight loss after 5-7 days
• Failure to regain birth weight by 2-3 weeks
• Failure to maintain ongoing weight gain of 0.5-1.0 oz/day
• Weight below 3rd percentile
• Lethargic, sleepy, inactive, unresponsive
• Sleeping 4+ hours between feedings (one 5 hour stretch at night may be normal)
• Dry mucous membranes
• Poor skin turgor

Question 14

Poor weight gain in the newborn: clinical findings

• Technique factors

Answer 14

• Ineffective latch or sucking
• Short time at the breast (reduces hindmilk consumption)
• Preset schedule that ignores hunger cues
• Giving water between feedings
  
  • No water until 6 months of age
• Infant allowed or encouraged to sleep through the night before 8-12 weeks old
• Fewer than 8 feedings in 24 hours
• Infant fed in distracting environment

Question 15

Poor weight gain in the newborn: clinical findings

• Maternal factors

Answer 15

• Does not respond to or recognize the infant’s hunger cues
• Hectic schedule with limited time for breastfeeding
• Recent illness with weight loss
• Use of COCs or other hormones
  
  • Progestin-only pills for contraception

Question 16

Management for poor weight gain in the infant

Answer 16

• Collect a thorough history (including maternal)
• Assessment of breastfeeding techniques
• Refer for treatment for physical or organic cause (e.g. cleft palate)

Question 17

At what percentages can providers tolerate weight loss in a breastfeeding child?

Answer 17

10-12% - as long as there is no clinical exam findings suggestive of dehydration

Question 18

Complications of poor weight gain on the infant

Answer 18

• Developmental delay
• Poor bonding
• Severe dehydration