3.5 Slowing of growth
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![]() Key Points - Case Study CJoanne is discharged early on day three and comes to see you for a follow-up on day five. The day following discharge her breasts became painful and hard and Rosie is again having difficulty latching on to the breast. Is this normal? What would you suggest Joanne do?
You see Joanne and Rosie again at 10 days. Joanne's breasts have settled and Rosie is feeding well. However, she has been feeding frequently at night and Joanne's husband, Tom, has suggested bringing the baby to bed with them. Joanne has heard that this increases the risk of SIDS. What would you tell her?
Joanne had been on the combined oral contraceptive pill before becoming pregnant. She intends to not use any contraception until she is six months postpartum. Is this a realistic option?
Joanne brings Rosie for immunization at four months. She is concerned about the composition of her milk. Although Rosie had been growing along the 50th percentile, her weight gain has started to slow.
Is there any concern about a slowing of growth around this time?
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Is there any concern about a slowing of growth around this time?
Infant growth is highest in the first few months postpartum and then begins to slow so a decrease in the rate of growth at this age is normal. Additionally, after three months of age breastfed infants gain weight at a slower rate than formula-fed infants, so that by six months they are lighter1 and this is maintained until at least twelve months2.
Most growth charts in use were developed in the United States from cross-sectional data of cohorts of infants who were mainly formula-fed, or contained a mixture of formula-fed and breastfed infants. On these charts, breastfed infants often began to deviate from a specific percentile after four to five months although they continued to thrive otherwise. In 2006 the WHO released new growth standards based on longitudinal data of healthy breastfed infants and children from seven countries. These charts reflect how well-nourished breastfed infants 'should' grow rather than the actual growth in a given population. In comparison to the CDC charts commonly used, the mean weight in the WHO standards is higher for the first six months but is lower from 6 to 32 months3. WHO standards for infant BMI are also available to allow for difference in growth parameters between different racial groups.
Notes
- # Dewey KG et al. (1992) Growth of breast-fed and formula-fed infants from 0 to 18 months: The DARLING study
- # Dewey KG et al. (1993) Breast-fed infants are leaner than formula-fed infants at 1 y of age: the DARLING study
- # de Onis M et al. (2007) Comparison of the WHO Child Growth Standards and the CDC 2000 Growth Charts