From the Guidelines
Significant infant weight loss requires prompt medical evaluation and intervention, following the guidelines for infant feeding and care as outlined in the pediatric health guidelines from 0 to 18 months 1. For infants with significant weight loss, it is crucial to assess feeding techniques, frequency, and adequacy of milk transfer.
- For exclusively breastfed newborns, weight loss exceeding 7-10% of birth weight or for formula-fed infants exceeding 7% warrants immediate attention.
- Increase feeding frequency to 8-12 times daily for breastfed infants or ensure formula intake of 2-3 ounces every 2-3 hours, as suggested by the guidelines for infancy (0–12 months) 1.
- Monitor hydration status by tracking wet diapers (aim for 6+ daily), assessing skin turgor, and checking fontanelles.
- Supplementation may be necessary using expressed breast milk (preferred), donor milk, or formula at 10-30ml per feeding after breastfeeding attempts.
- Weigh the infant daily until consistent weight gain of 20-30g/day is established.
- For dehydration signs (decreased urine output, lethargy, dry mucous membranes), immediate medical care is essential as IV fluids may be required.
- Underlying medical conditions like jaundice, infection, or congenital abnormalities should be ruled out, and the infant's sleep and physical activity should be assessed to ensure they are meeting the recommended guidelines for infancy (0–12 months) 1, which includes 14–17 h of quality sleep and a variety of interactive activities/movement and floor-based play.
From the Research
Guidelines for Managing Infant Weight Loss
To manage an infant with significant weight loss, the following guidelines can be considered:
- Monitor weight loss closely, as a loss of 7% to 8% of birth weight or greater by the third day after birth is common among healthy, full-term, breastfed newborns 2
- Exclusive breastfeeding is recommended, as rates of exclusive breastfeeding decrease when newborns lose greater amounts of weight 2
- Be aware that overfeeding on the first day of life may be associated with an increased risk of future overweight and obesity in childhood 3
- Infants who are overfed on their first day of life are more likely to be overweight or obese at their 4th year well child check-up 3
Assessment and Evaluation
When assessing an infant with significant weight loss, consider the following:
- Evaluate for signs of dehydration, such as dry mouth, decreased urine output, and sunken eyes 4
- Assess for other potential causes of weight loss, such as infection, cardiac disorders, or neurologic disorders 4
- Consider the maternal prepregnancy BMI (ppBMI) and the infant's rapid weight gain (RWG) as potential risk factors for childhood obesity 5, 6
Management Strategies
To manage an infant with significant weight loss, consider the following strategies:
- Frequent weight checks to monitor for adequate weight gain 2
- Close monitoring for signs of dehydration or other potential causes of weight loss 4
- Counseling on appropriate feeding practices, including exclusive breastfeeding and avoiding overfeeding 2, 3
- Consideration of the maternal ppBMI and the infant's RWG when assessing the risk of childhood obesity 5, 6