30 Sep

Baby Weight Charts

A couple of weeks ago, The Times reported that the UK baby weight charts were “skewed to promote breastfeeding.” The Times article is behind a paywall, but I picked up on it on another website. According to these reports, using weight charts based on exclusively breastfed babies will make formula fed babies seem to be overweight; the overall impression was a rather paranoid assumption that this was being done in order to make mothers breastfeed.

My first response to this was to sigh. My second was to list all the points I found wrong with the reports:

  1. The weight charts in current use were issued in 2006. This is not news.
  2. Breastfeeding is the biological norm, so it makes complete sense to use this as the baseline. If formula fed babies do grow faster [note that “if”] then should parents and health professionals not be aware that this is not the norm? To use a controversial example, if a large percentage of the population smoked, would it make sense to change the assessment of lung capacity to account for that? Or to use the biological normal, healthy lung as your baseline? And I hereby apologise for that comparison, since my intention is absolutely not to equate formula feeding with smoking.
  3. Now let’s go back to that “if.” In fact, healthy breastfed babies tend to grow more rapidly in the first two to three months than formula fed babies, and then growth slows down. Since breastfeeding is the biological norm, this represents a completely normal pattern of growth. However, when health professionals and parents see the weight gain start to slow down, this can sometimes cause concern, undermine confidence in breastfeeding, and lead to weaning perhaps earlier than the mother intended.
  4. There is more to measuring a baby’s growth than which set of charts you use. The “new” [since 2006] charts are based on breastfed babies, thus giving a coherent global approach. Interestingly, while feeding patterns and body sizes vary from culture to culture, growth patterns are remarkably consistent. The charts are a tool, but training health professionals to give them a solid evidence-based understanding of normal breastfeeding is a more important one; and discouraging the mothers of healthy babies from weekly weighing is another. When chats with the Health Visitor focus on weight, bigger issues may be missed or misunderstood.
  5. Finally, this idea that all this is a great conspiracy to force women to breastfeed; where do I begin? There is a difference between encouraging mothers to breastfeed and not discouraging them. Using data based on breastfed babies is about normalising breastfeeding, and the fact that many babies are not exclusively breastfed is irrelevant. Formula feeding parents may have had some difficult decisions to make, so let’s not assume that we are talking about a majority of exclusively formula fed babies, either. In fact there is a huge percentage of babies who are partly breastfed, partly formula fed; it would be impossible to take account of every possible different circumstances. We need a biologically normal baseline, and health visitors who understand how to talk to parents about their babies’ development.

The Department of Health recommends that you weigh your baby at the health visitor clinic about once a month, unless there is a real concern about his or her development. If your formula fed baby is growing faster than the curve on the chart suggests, of course this does not necessarily mean they are unwell or obese. Each individual baby needs their own individual assessment. It is unnecessarily emotive to put it about that a weight chart is being used to judge mothers’ feeding decisions.