A guide to appropriate weight-gain and what to look for if you suspect failure-to-thrive:
Weight Gain:
Birth – 2 weeks of age
 Regain birth weight plus some
2 weeks – 3 months of age
 Two pounds per month or one ounce per day
4 – 6 months of age
 One pound per month or one-half ounce per day (should double birth weight by 6 months)
One year of age
 2.5 to 3 times her birth weight
Failure to Thrive:
There is a difference between slow weight gain and failure to thrive. With slow weight gain, the gain is consistent. With failure to thrive, you will see a baby who continues to lose weight after 10 days of life, does not regain her birth weight by three weeks of age, or gains at an unusually slow rate beyond the first month of life. Things to watch for from the mother’s and baby’s side include:
Mother’s side
 Improper nursing technique (poor latch-on, etc.)
 Nature or lifestyle (not enough sleep, liquids, nutritional foods, etc.)
 Poor release of milk (related to let-down)
 Feeding too frequently (this can give the baby an abundance of foremilk and a lack of hindmilk; the latter of which is nutritionally and calorie rich)
 Feeding too infrequently (being a slave to the clock)
 Not monitoring growth signs
 Physical nurturing, holding, and cuddling
Infant’s side
 Weak sucking
 Improper sucking
o Tongue-thrusting, pushing the nipple out of her mouth
o Protruding tongue, her tongue will form a hump in her mouth, interfering with latching on
o Tongue-sucking, she sucks her own tongue and not on the nipple
 An underlying medical problem (if you suspect something, talk to your pediatrician immediately)
Getting the help you need
Lactation consultants can be very helpful in resolving issues related to latching on or inverted nipples, both of which can cause a problem with nursing. Allow the consultant to observe your baby nursing and note if there are problems in position, latching, or something else. Do not permit the consultant to dissuade you from your flexible routine if that’s what you’ve decided to do for your family. Remember: if flexible routines were unhealthy, NICUs wouldn’t use them for the most vulnerable of babies—preemies.
If you determine that your nursing difficulties cannot be solved or are more stressful on you as mommy than what you need, do not feel guilty about switching to a bottle. It is more important that your baby receive nutrition to grow and thrive than to fit someone else’s ideal of motherhood.