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Journal of Human Lactation
1 –7
© The Author(s) 2015
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DOI: 10.1177/0890334415597681
jhl.sagepub.com
Review
Background
It is well established that some degree of early neonatal
weight loss is normal. For the first 2 days of life, breastfeed-
ing infants receive only small amounts of colostrum from the
breast. After lactogenesis stage II (secretory activation)
begins, usually on the third day of life, most infants will
begin to gain weight steadily. For a small percentage of
infants, too much weight loss may indicate a problem.
Potential problems may include poor breastfeeding manage-
ment, undiagnosed metabolic disorders, neurological disor-
ders, or other infant morbidities that cause poor feeding.1 A
serious outcome of unrecognized feeding problems and too
much weight loss can be hypernatremic dehydration.
Complications of hypernatremic dehydration may include
renal and liver failure, disseminated intravascular coagula-
tion, intracranial hemorrhage, seizure, and death.2
For many years, 5% to 7% loss of birth weight has been
considered the normal and expected amount of physiological
weight loss for breastfed infants.3-5 This figure is now being
challenged. Researchers are suggesting that little is actually
known about weight changes in term babies during the first 2
weeks of life.6,7 Until recently, the growth of breastfed babies
was judged by a standard that was derived from data col-
lected on children who had largely been artificially fed.6,8 It
was not until 2010 that updated growth charts were dissemi-
nated by the World Health Organization (WHO)9 and reflect
growth patterns among children predominantly breastfed.
Indeed, health differences between breastfed and formula-
fed infants have become increasingly clear. Breastfeeding is
positively associated with fewer respiratory, gastrointestinal,
and ear infections.10,11 Later in life, breastfed infants experi-
ence less Type I and II diabetes, heart disease, and obesity.12
There are several well-documented factors associated
with increased infant weight loss after birth. These factors
include higher weight at birth, female sex, advanced mater-
nal age and education, cesarean delivery, and jaundice.13,14
Delayed lactogenesis has also been demonstrated to correlate
strongly with increased weight loss.3 Recently, studies have
also shown that intravenous fluid given during the antepar-
tum period can affect the amount of weight loss in the neona-
tal period.1,15
597681JHLXXX10.1177/0890334415597681Journal of Human LactationThulier
research-article2015
1College of Nursing, University of Rhode Island, Wakefield, RI, USA
Date submitted: November 12, 2014; Date accepted: July 4, 2015.
Corresponding Author:
Diane Thulier, PhD, RN, University of Rhode Island College of Nursing,
39 Butterfield Rd, Kingston, RI 02881, USA.
Email: dianethulier@uri.edu
Weighing the Facts: A Systematic Review
of Expected Patterns of Weight Loss in
Full-Term, Breastfed Infants
Diane Thulier, PhD, RN1
Abstract
All breastfeeding infants lose some weight in the early days of life. Conventionally, 5% to 7% loss of birth weight has been
accepted as the normal and expected amount of weight loss before infants begin to gain weight steadily. When infants lose
more than 7% of their birth weight, breastfeeding adequacy is sometimes questioned and formula supplementation is often
given. Despite the fact that 5% to 7% is well known and commonly cited, little reliable evidence exists that supports use
of this figure as a guide to practice. A systematic review of studies that focused on infant weight loss was conducted. The
main objective was to determine the mean amount of weight loss for healthy, full-term exclusively breastfed infants after
birth. One previous review and 9 primary studies published since 2008 were examined. The reported mean infant weight
loss ranged widely among studies from 3.79% to 8.6%. The point at which most infants have lost the most amount of weight
occurs 2 to 4 days after birth. Close examination of the studies, however, revealed significant methodological flaws in the
research. Study limitations commonly included gaps in data collection, lack of documented feeding type, sample groups that
lacked adequate numbers of exclusively breastfed infants, and the exclusion of breastfed infants who lost the most weight.
Well-designed clinical studies that address these limitations are needed.
Keywords
breastfeeding, infant, weight, weight loss
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2 Journal of Human Lactation
Currently, different opinions exist about what constitutes
normal infant weight loss and when this weight loss is con-
sidered to be excessive. Controversy also exists about when
interventions, such as formula supplementation, should be
initiated.1,7 The International Lactation Consultant
Association16 and the Academy of Breastfeeding Medicine17
both suggest that breastfeeding management should be eval-
uated in those infants who exceed a 7% loss. The 2012
American Academy of Pediatrics8 policy statement
“Breastfeeding and the Use of Human Milk” also notes that
breastfeeding infants should have a weight loss of no more
than 7%.
Some researchers use 7% as a marker for excessive
weight loss,18,19 whereas others use 10%.15,20,21 In a system-
atic review of infant physiological weight loss, Noel-Weiss
et al7 noted that the choice of 7% or 10% appears to be an
arbitrary demarcation of substantial weight loss. Despite
these differing professional opinions and lack of evidence,
the percentage of weight lost after birth remains 1 of the most
frequently used measures to assess infants’ well-being. What
is well known, however, is that administering supplemental
formula when not medically indicated interferes with the
establishment of effective breastfeeding.22 This is especially
true in the early days of life before lactogenesis is well estab-
lished. Therefore, to prevent unnecessary formula supple-
mentation, clinicians need to know the difference between
normal and abnormal weight loss.2
Methods
A systematic review of the literature was conducted to
answer 2 research questions: (1) What is the mean amount of
weight loss for healthy, full-term, exclusively breastfed
infants after birth? (2) When do most breastfed infants reach
their nadir or greatest point of weight loss after birth?
To answer these questions, a database search was con-
ducted through the University of Rhode Island Library. Four
electronic databases were searched including the Cochrane
Database of Systematic Reviews, MEDLINE, CINAHL, and
PubMED. Primary keywords included breastfeeding, infant,
weight, and weight loss. Inclusion criteria were English-only
reviews and primary studies whose main objective was to
determine normal patterns of weight loss for healthy, full-
term infants. All research designs and all countries of origin
were considered for inclusion. The last systematic review of
the same topic was conducted in 2008,7 and therefore, the
search was limited to publications dated from 2008 to 2015.
In addition to the review by Noel-Weiss, 9 primary studies
were found that met these inclusion criteria.
Results
In 2008, Noel-Weiss and colleagues7 completed a systematic
review on physiological weight loss in the breastfed neonate.
The objective of that review was to establish the reference
weight loss in the first 2 weeks of life for exclusively
breastfed neonates. Authors included in this review primary
research studies with weight loss data for healthy, full-term,
exclusively breastfed neonates. They found 11 studies that
met the criteria; 6 of the studies researched nonweight topics
but provided data about weight change patterns. The studies
consisted of works from several different cultures; the sam-
ple sizes varied from 21 to 937 with a median of 120 partici-
pants. Results indicated that mean weight loss for healthy
term infants ranged from 5.7% to 6.6%, with a standard devi-
ation around 2%. Days 2 and 3 following birth appeared to
be the days of maximum weight loss, and the majority of
infants regained their birth weight within the first 2 weeks
after birth.7 Since 2008, 9 primary studies with a focus on
determining normal patterns of infant weight loss in full-
term infants have been published (Table 1).
In 2008, Crossland and colleagues6 completed a prospec-
tive study to explore weight changes in 253 healthy, full-
term, singleton infants. Infants were born in the Sunderland
Royal Hospital in the United Kingdom and cared for by mid-
wifery teams that routinely practice skin-to-skin care after
birth and encouraged on-demand breastfeedings. Infants in
the study were born via vaginal and cesarean section (CS)
delivery. Weights were collected in the hospital and the
mothers weighed infants daily at home for 2 weeks or longer,
until the infant returned to birth weight. A total of 46 infants
were dropped from the study due to consecutive missing
weights. Among the breastfed infants who were dropped, 13
had switched to formula feeding. This resulted in a total of
111 exclusively breastfed infants and 142 formula-fed infants
in the study.6 Data showed that the mean weight loss for
exclusively breastfed infants was 6.4% (5.5%-7.3%). The
mean weight loss for formula-fed infants was 3.7% (2.7%-
4.7%). For both groups, the nadir of weight loss was day 3 of
life. A total of 85% of all infants regained their birth weight
by 2 weeks of age.
In 2010, Mulder and colleagues18 studied excessive
weight loss in 53 breastfed infants born at a midwestern
community hospital in the United States. A secondary analy-
sis of data from a psychometric study examining the Mother
Infant Breastfeeding Progress Tool was completed. This con-
venience sample included women who were “attempting” to
breastfeed and who delivered stable infants between 35 and
42 weeks gestation. A total of 31 (59.6%) infants in the study
were born via vaginal delivery and 20 (38.5%) were born via
CS. Infant weights were collected for 2 days. The reported
mean weight loss that occurred on days 1 to 2 was 3.79% ±
1.25%. The researchers also reported that 20.8% of infants
lost 7% of their birth weight by day 2 of life.18
Also in 2010, Flaherman and colleagues23 evaluated the
relationship between weight loss at < 24 hours and subse-
quent in-hospital weight loss > 10%. The authors described
how targeting infants at risk for greater weight loss could
allow for the provision of more supportive care. A retrospec-
tive analysis was completed that included 1050 term infants
born at the University of California, San Francisco.
Exclusively breastfed infants were categorized with mixed
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Thulier 3
feeding infants, and the reported mean weight loss was 6.1%
± 2.1% and the mean time to weight nadir was 38.7 ± 18.5
hours. The researchers were able to demonstrate that infants
who lost 4.5% birth weight at < 24 hours were at greater
risk for weight loss of 10%.23
A prospective study by Grossman et al24 sought to deter-
mine the weight-loss nadir among infants born at Boston
Medical Center, a Baby-Friendly hospital in Boston,
Massachusetts. The objective was to identify predictors of
weight loss in the first week of life. A total of 121 healthy,
term infants born via vaginal and CS were included in the
study. Hospital weights were recorded; in addition, research
assistants collected daily weights for 1 week following birth.
In this study, a total of 32 infants were exclusively breastfed
(received 100% breast milk), 66 infants were mainly breast-
fed (received 50% breast milk), 16 infants were mainly
formula fed (received > 50% formula), and 7 infants were
exclusively formula fed (received 100% formula). The
results indicated that the exclusively breastfed infants lost
5.5% ± 2.0%, the mainly breastfed infants lost 5.5% + 2.1%,
the mainly formula-fed infants lost 2.7% + 1.7%, and the
exclusively formula-fed infants lost 1.2% + 1.0% (P < .001).
The mean time to nadir was 2.5 days after birth and ranged
from 0 to 7 days. Feeding category, gestational age, and
insurance were the greatest predictors of percentage weight
loss.24
In 2012, Preer and colleagues25 published a study of
200 infants also delivered at Boston Medical Center. The
objective of that study was to determine average weight
loss among exclusively breastfed infants delivered by CS
and to identify correlates of greater than expected weight
loss. Delivery by CS leads to longer length of stays and a
longer time frame to monitor weight loss. In this study, the
hospital staff was therefore able to collect daily weights
for 3 to 4 days. Researchers found that the mean weight
loss for full-term, exclusively breastfed infants delivered
Table 1. Neonatal Weight Loss Studies.
Study Sample No. Weights Results Limitations
Flaherman et al27
(retrospective)
108 907 exclusively
breastfed, healthy infants
born via vaginal and
cesarean delivery, 36
weeks gestation
Daily weights × 1-4 days
until hospital discharge
Vaginal delivery: median
weight loss 4.2%, 7.1%,
and 6.4% at 24, 48, and
72 hours, respectively.
Cesarean delivery: 4.9%,
8.0%, 8.6%, and 5.8% at
24, 48, 72, and 96 hours,
respectively
72% of the sample had only 1
weight recorded in addition
to birth weight. Infants who
received formula due to
excessive weight loss were
excluded.
Bertini et al20
(retrospective)
1760 healthy, term
singletons born via vaginal
delivery
Weighed every 12 hours
until discharge 2-4 days
5.95% ± 1.73% mean weight
loss; time to nadir: 43.72 ±
11.6 hours
65% of sample had the
weight collected for less
than 48 hours. Type of
infant feeding was not
documented.
Fonseca et al13
(prospective)
1288 healthy, term
singletons born via vaginal
and cesarean delivery
One weight collected in
addition to birth weight
6.7% ± 2.3% mean weight
loss
61% of sample had the weight
collected for less than 48
hours.
Grossman et al24
(prospective)
121 healthy, term singletons
born via vaginal and
cesarean delivery
Daily weights by research
assistant × 1 week
Exclusive breastfeeding
(n = 32) 5.5% ± 2.0%
mean weight loss; mainly
breastfed (n = 66) 5.5% ±
2.1% mean weight loss
74% of infants were fed
formula in varying amounts.
Preer et al25
(retrospective)
200 exclusively breastfed,
healthy, term singletons,
born via cesarean only
Daily weights × 3-4 days
until discharge
7.2% ± 2.1% mean weight
loss
Infants who received formula
due to weight loss were
excluded from the study.
Flaherman et al23
(retrospective)
1049 term, healthy infants
born via vaginal and
cesarean delivery
Daily weights × 1-4 days
until hospital discharge
6.1% ± 2.1% mean weight
loss; time to nadir: 38.7 ±
18.5 hours
Combined exclusive
breastfeeding and mixed
feeding infants
Mulder et al18
(secondary
analysis)
53 stable infants born via
vaginal and cesarean
delivery, 35-42 weeks
gestation
Weights × 2 days 3.79% ± 1.25% mean weight
loss
Formula supplementation
not recorded; included late
preterm infants
Crossland et al6
(prospective)
253 healthy, term singletons
born via vaginal and
cesarean delivery
Daily weights × 2 weeks or
longer until a return to
birth weight was achieved
Exclusive breastfeeding 6.4%
(5.5%-7.3%) mean weight
loss
Breastfed infants who
switched to formula were
not included.
Davanzo et al14
(retrospective)
1003 healthy, term
singletons born via vaginal
and cesarean delivery
Daily weights × 2-4 days
until hospital discharge
Breastfed group: 6.3% ±
2.0% mean weight loss
If neonatal weight loss was
8%, infants were often given
supplemental feedings.
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4 Journal of Human Lactation
by CS was 7.2% ± 2.1%. A total of 75% of the infants
reached their nadir of weight loss prior to discharge (day
3 or 4). In addition, absence of labor prior to CS
(P = .0004), lower gestational age (P = .0004), and higher
birth weight (P < .0001) were all associated with greater
than expected weight loss.25
A retrospective chart review was completed by Davanzo
and colleagues.14 Researchers studied 1003 full-term infants
who had been admitted to the regular newborn nursery of the
Institute of Maternal and Child Health in Trieste, Italy. This
is a level III maternity hospital where rooming-in is prac-
ticed. The objective was to assess the extent of neonatal
weight loss and its association with selected clinical vari-
ables. Infants were weighed daily until discharge on days 2
to 4; infants born via vaginal and CS were included. A mean
percentage weight loss of 6.3% ± 2.0% for the breastfed
group and 7.5% ± 2.4% for the formula-fed group was
reported. For all infants, the weight loss during hospitaliza-
tion ranged from 0% to 13.2%. Any formula feeding, CS, hot
season, and jaundice were independently associated with
neonatal weight loss 8%.14
Fonseca and colleagues13 also examined the determinants
of weight changes for infants during the first 96 hours of life.
They prospectively sampled 1288 full-term infants born in 5
different metropolitan hospitals in Porto, Portugal. Infants
were weighed twice—once at birth and then again before
discharge—to determine total weight loss. For 61% of the
total sample (n = 1288), this second weight was collected at
or prior to 48 hours of life. Exclusively breastfed infants
made up the breastfed category (n = 291, 52.2%); all other
infants were part of the formula/mixed-feeding group. The
mean weight loss for all infants was 6.7% SD ± 2.32; weight
loss ranged between 0% and 18.2%. Excessive weight loss
(defined as 9.4%) was positively associated with maternal
age > 40 years, maternal education, cesarean delivery, and
phototherapy-treated jaundice.13
In 2014, Bertini and colleagues20 published a retrospec-
tive chart review of data from 1760 infants. All healthy, full-
term, singleton infants born via vaginal delivery at the
Margherita Birth Center at the University Hospital in
Florence, Italy, were enrolled. The infant feeding policies
and procedures at this hospital complied with the WHO’s Ten
Steps to Successful Breastfeeding.26 The objective of the
study was to construct a percentile chart of neonatal weight
loss. Weight was recorded at birth and every 12 hours until
discharge, which usually occurred between 48 and 72 hours
of life. Results showed a mean weight loss of 5.95% ± 1.73%
(range, 0.0%-9.9%). No infants in this study lost > 10% of
their birth weight. The mean time to nadir was 43.72 ± 11.6
hours after birth and ranged from 12 to 72 hours.20
Most recently, Flaherman et al27 introduced early weight
loss nomograms for exclusively breastfed newborns based
on delivery mode. The researchers retrospectively extracted
recorded weights from the charts of 108 907 singleton infants
born 36 weeks gestation at Northern Kaiser Permanente
hospitals. The authors found that differences in weight loss
by delivery method became evident 6 hours after delivery
and persisted over time. For infants delivered vaginally, the
median weight loss was 4.2%, 7.1%, and 6.4% at 24, 48, and
72 hours of age, respectively. For infants born via CS, the
median percentage weight loss was 4.9%, 8.0%, 8.6%, and
5.8% at 24, 48, 72, and 96 hours after delivery, respectively.
Hour-by-hour nomograms were created to assist in early
identification of infants who might be on a trajectory for
excessive weight loss and associated adverse outcomes.27
Five of the primary studies presented in this review were
conducted in the United States and 4 were completed in
Europe. Two of the US studies took place in a Massachusetts
hospital that had been designated as Baby-Friendly.24,25 The
Baby-Friendly Hospital Initiative is a global program sup-
ported by the WHO and the United Nations Children’s Fund
that recognizes hospitals and birth centers that give optimal
breastfeeding support. Many Baby-Friendly policies and
practices affect the likelihood that a breastfed infant will not
receive formula in the first 2 days of life.28 Among the
European studies, 3 of the authors described routine prac-
tices such as rooming-in and skin-to-skin care, which are
also known to improve breastfeeding outcomes.6,14,20
The sample sizes in the 9 studies in this review ranged
from 53 to 108 907 participants. The mean infant weight loss
ranged from a low18 of 3.79% ± 1.25% to a high25 of 7.2% ±
2.1%. When reported in hours, time to nadir ranged from a
low23 of 38.7 ± 18.5 hours to a high20 of 43.72 ± 11.6 hours.
Other researchers reported that the time to reach nadir was
longer, taking on average 3 to 4 days.6,25 Overall, as com-
pared to the findings in the review by Noel-Weiss et al, there
is a slightly greater amount of reported weight loss and a
slightly longer time to nadir. Close examination of these 9
studies, however, reveals several reasons that there is still
insufficient evidence to determine normal physiological
weight loss and time to nadir for breastfed infants.
Discussion
In 2008, Noel-Weiss and colleagues7 reported consistent
problems with methodology in the breastfeeding studies
included in their review; specifically, there were major gaps
in data collection. In most of the studies, infant weights were
not measured daily after discharge. Lack of measurements
made determining the lowest weight and normal patterns of
weight loss impossible. Another limitation was a lack of clar-
ity among feeding groups. Most of the studies in the 2008
review did not identify when infants received supplemental
formula feedings. This is an important consideration as new-
born infants who consume formula lose less weight com-
pared to infants who are breastfed.
It is unfortunate that these same problems continue to be
present in the current literature. Specifically, the gap in daily
weight collections is a major limitation. In several of the
studies, researchers reported that weights were measured for
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Thulier 5
2 to 4 days after birth. Yet, the majority of infants in all of
these studies had hospital weights collected for only 2 days
or less.13,14,20,25,27 Most of the infants were vaginally deliv-
ered and so were discharged from the hospital by the first or
second day of life. In the largest study, published by
Flaherman et al,27 a total of 83 433 (76.6%) infants were
born vaginally and 25 474 (23.4%) were delivered by CS. In
this study, 72% of the vaginally delivered infants had only 1
weight recorded in addition to their birth weight. In addition,
75% of the infants delivered by CS had 2 weights recorded
prior to discharge.27 It is interesting that in the work by
Mulder et al,18 weights on all infants were collected for only
2 days no matter the type of delivery. It is not surprising that
this study generated the lowest mean percentage of weight
loss (3.79% + 1.25%).18 The majority of infants in that study
had probably not reached their nadir of weight loss before
data collection ceased.
Lack of measurements also affects the reported time to
nadir. The only way to accurately determine time to nadir is
to weigh infants daily until they begin to gain weight.
Crossland et al6 demonstrated this very strategy and weighed
infants daily for a minimum of 14 days after birth. These
authors found that most infants reached the nadir of weight
on day 3, later than was reported by Bertini et al20 and
Flaherman et al.27 If weights are not recorded daily until the
time when infants begin to gain, researchers are left making
best guesses as to when the maximum amount of weight loss
has occurred.
Problems with the clear identification of infant feeding
groups also continue to be prevalent in the literature. Mulder
et al18 included women who were “attempting” to breastfeed
their infants. They did not indicate if breastfeeding was suc-
cessful or if formula was given. Similarly, in the large study
(n = 1760) done by Bertini et al,20 researchers described how
the infant feeding policies and procedures at the hospital
complied with the WHO’s Ten Steps to Successful
Breastfeeding.26 They suggested that all infants in this study
were exclusively breastfed, but they did not collect data
regarding feeding type. It is unfortunate that birth in an envi-
ronment supportive of breastfeeding is not an assurance that
the infants born there are actually breastfed. It is very likely
that many infants in both of these studies consumed formula
in varying amounts.
Other researchers recorded infant feeding type but com-
bined feeding groups for data analysis. Flaherman et al23
sampled 1050 infants; 853 (86%) were exclusively breast-
feeding, 144 (14%) were given mixed feedings, and 53 (5%)
were given formula. For data analysis, they collapsed the
exclusive and mixed-feeding infants, which resulted in a
mean weight loss of 6.1% ± 2.1%. It is possible that the
inclusion of infants who consumed supplemental formula
decreased the total amount of weight loss. The study by
Davanzo et al14 used a similar approach. The authors used
the WHO breastfeeding definitions29 but combined exclusive
and predominant breastfeeding infants into 1 category. They
also combined complementary breastfed infants together
with formula-fed infants. It is interesting that this was the
only study that has ever reported a greater percentage of
mean weight loss among formula-fed versus breastfed infants
(7.5% ± 2.4% vs 6.3% ± 2.0%, P .001).14 The combination
of complementary (mixed) breastfed infants together with
infants who were formula fed may have affected the results.
Some of the complementary breastfed infants were likely
given formula due to excessive weight loss, which may have
increased the total weight loss for that group.
Lack of clarity among infant feeding groups is a challeng-
ing problem, particularly for studies focused on infant
weight. At first glance, the solution may appear simple;
researchers must carefully control their sample and include
adequate numbers of exclusively breastfed infants. This
seemingly simple solution, however, presents a complex set
of challenges. If breastfed infants lose too much weight, they
are often given formula supplementation. Yet, to determine
patterns of weight loss among the exclusively breastfed,
infants fed formula must be excluded from the sample group.
After excluding supplemented infants, the end result may be
a sample that is biased as it contains only those infants who
did not lose much weight. This exact scenario was demon-
strated in several of the studies.14,25,27
Preer et al25 described how breastfeeding infants with
excessive weight loss were given formula supplementation
and excluded from their study. As described by the authors,
this resulted in a sample that was not representative of the
true population of breastfed infants.25 Similarly, Davanzo
et al14 noted that when neonatal weight loss was 8%, sup-
plemental feedings were often given. In the largest study,
Flaherman et al27 also described how 16 871 breastfed infants
(15.4%) received formula supplementation and were
removed from the study. In this study, formula was frequently
given to treat excessive weight loss. As a result, the amount
of weight loss in the exclusively breastfed population may
have been underestimated. Flaherman et al27 coped with this
limitation by implementing a sensitivity analysis that
matched censored to uncensored infants. The nomograms
were recreated based on this matching strategy and the
results indicated that removing these infants from the sample
group did not create a substantial source of bias. No other
published studies have used this matching strategy. In the
end, it may not be possible to create large sample groups in
which all infants are exclusively breastfed. Therefore,
researchers must do the next best thing. Sample groups must
be created that more accurately report what infants are
consuming.
Conclusion
In 2008, Noel-Weiss et al7 determined that the normal and
expected amounts of infant weight loss after birth could not be
accurately determined. In most of the 11 studies in their
review, infant weights were not measured daily after discharge
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6 Journal of Human Lactation
and infants were not clearly categorized into feeding groups.
At the time, these 2 methodological flaws in the research made
it impossible to determine a mean for normal physiological
weight loss in term breastfed infants.
The systematic review presented by this author was com-
pleted to determine if, since 2008, more scientific evidence
has become available. Specifically, this author sought to
determine the mean amount of weight loss for healthy, full-
term, exclusively breastfed infants after birth. In addition, a
second objective of this review was to determine when
infants reach their nadir of lost birth weight. It is unfortunate
that the current literature still does not provide enough evi-
dence to accurately answer these questions.
The same methodological flaws reported in 2008 con-
tinue to be found in the current literature. A limited number
of infant weights have been collected, feeding methods have
not always been well documented, and infant feeding groups
have been combined for data analysis. In addition, breastfed
infants who lost the most amount of weight have been
excluded from sample groups. As a result of these method-
ological flaws, an accurate mean percentage of infant weight
loss and the time to nadir remain elusive. In fact, given that
infants who received formula have been included whereas
infants who lost the most have at times been excluded from
sample groups, it is likely that the mean amount of infant
weight loss for breastfeeding infants is higher than has ever
been reported.
Professional guidance and care in the early weeks of life
can enhance breastfeeding duration.30 Alternatively, inaccu-
rate information and ill-founded advice can easily derail
breastfeeding efforts. Clinicians require accurate data to
make sound decisions. Well-designed clinical studies are
needed to determine the normal and expected patterns of
weight loss for the breastfed infant. It is only when clinicians
have this information that they can provide the best guidance
and care to promote, protect, and support breastfeeding
infants.
Acknowledgments
Many thanks to Dr Debra Erickson-Owens, PhD, CNM, RN, for her
unwavering support of this work.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, author-
ship, and/or publication of this article.
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