Postnatal Baby Weighing guidelines
Introduction
This guideline is not intended to discourage women from breast feeding but to help
prevent the rare, but potentially fatal consequences of dehydration.
There is little evidence about initial weight loss in the newborn period but weight gain
is a useful indication of effective feeding and wellbeing in the neonate.
Excessive weight loss in breastfed babies causes great anxiety to parents, carers,
families and staff. It can lead to the cessation of breastfeeding and possible readmission to hospital.
Background
Neonatal weight loss can be expected in the first few days of life as part of the normal
physiological process where excess extra cellular fluid is excreted. This weight loss
has been expected to be up to 10% of the birth weight, although this expectation was
never evidence based. In fact this belief came from a time when breastfeeding
practices were entirely different from today where feeds were timed and mothers were
routinely separated from their babies. Recent studies have indicated that normal
weight loss in the majority of babies is more likely to be between 5 and 7% of birth
weight, however a small group of babies may be vulnerable to greater loss. (Dewey et
al 2005, Macdonald 2002).
Most studies state that weight gain should be measured from the lowest weight after
birth. The NICE guidance (2008) recognises that babies should be weighed again at
day 5 and day 10 postnatal to ensure feeding is adequate and to exclude underlying
causes where weight gain is abnormal.
Aims




To identify healthy neonates and weigh accordingly
To identify neonates at risk and weigh accordingly
To support staff in their ability to care for a baby who has had an excessive weight
loss, giving them knowledge and research to be confident in their practice.
To enable staff to detect excessive weight loss and plan proactive management
with the mother and paediatrician.
Definitions
Healthy neonates are defined as:
Term babies
Birth weight of 2.5kgs or above
High Risk Neonates are defined as:
 Term babies who show signs of inadequate nutritional intake. That is decreased
urinary output, infrequent stools, delayed or prolonged passage of meconium.
 Infants that show signs of dehydration (see appendix for indicators of a healthy
neonate)
 Birth Weight less than 2.5kgs
 Pre term babies (babies less than 37 weeks completed weeks of pregnancy)


Jaundiced babies who require serum bilirubin levels or who are lethargic/poor
feeders
Babies with congenital abnormalities that may affect feeding such as cleft palate,
downs syndrome.

Any baby who appears clinically unwell.
Procedure for weighing all babies
All babies should be weighed at birth on electronic scales and documented
accordingly.
Rationale
This will provide a base line record for future weighing
To comply with Nursing and Midwifery Council Record Keeping Guidance (NMC
2009)
During the initial examination of the newborn the midwife/doctor should explain to
the mother about the normal weight loss and the normal weight gain and how to
recognise the thriving neonate.(see appendix) The recommended weighing schedule
should also be explained. (NSC 2008)
Rationale
To provide relevant information to parents.
All breast fed babies must be weighed routinely (in grams) on electronic scales at the
following times:
 At birth (including home births)
 Between 4-7 days (around the time PKU is done)
 Around day 10 to 14
All infants should have regained their birth weight by two weeks. A baby who has not
regained their birth weight should be referred to the GP and then be referred to
consultant paediatrician.
Rationale
To ensure the infant is feeding effectively
To monitor weight loss and weight gain
To recognise infants who may be suffering from underlying illness
The high risk neonate should be weighed on the third postnatal day. An individualised
care plan should be devised following discussion with the paediatricians.
Rationale
Babies with medical conditions require closer monitoring of weight.
Weight loss must be recorded as a percentage (RCPCH 2009) using the following
formula:
Weight loss (Grams) X 100 = weight loss %
Birth weight Grams
This must be recorded in both the postnatal records and the personal Child Health
Record (“ Red Book”)
Rationale
To provide an accurate record of weight loss.
To comply with NMC Record Keeping guidance (2009)
If a baby has a weight loss of between 7% - 10% then the indicators of well being
must be assessed (appendix) and documented clearly in the notes .
A full breast feed must be observed by the midwife and the sucking pattern observedthis should be short initial sucks followed by deep slow rhymic sucks with pauses and
audible swollows.
Rationale
To ensure correct postioning and attachement
To ensure effective milk transfer is taking place.
Inform mothers what to look for and what is normal feeding and sucking pattern
Rationale
To enable mothers to inform staff of patterns that are not normal.
Additional support should be given with feeding and the baby weighed five days after
the weight loss to establish weight gain.
If the baby has lost more than 10% after five days then referral to the consultant
paediatrician should be made.
In hospital the first feed following birth should be observed and all relevant
documentation will be completed. A second feed will be observed on the maternity
ward and all relevant documentation completed.
On transfer to the community the first visit will include an observation of a feed.
If the mother requests that her baby is not disturbed then appropriate questions will be
asked with regard to feeding and indicators of well being assessed (Appendix)
Rationale
To ensure the baby is correctly positioned and attached at the breast therefore
allowing effective milk transfer.
If the weight gain is normal, the mother should then be encouraged to take her baby to
the clinic for weighing.
Healthy neonates should then be weighed (naked) no more than fortnightly and then
weigh at routine immunisations/reviews at 8 weeks, 12 weeks and 16 weeks (RCPCH
2009 NICE 2008).
Appendix
INDICATORS OF A HEALTHY NEONATE
BREAST
FEEDING
FEEDING
BOWELS
URINE
Fixing &
positioning/breastfeedi
ng comfortable
Audible swallowing
Frequency of feeds
Day 1-3 dark
green/black
Day 4-6
lighter/changing stool
Day 6+ 2-5 substantial
yellow stools/24 hours
Day 1-3 two/three
slightly damp
nappies
Day 4-5 nappies
wetter & increasing
Day 5-6 five/six wet
nappies per day, pale
coloured urine
FORMUL
A
FEEDING
Frequency of feeding
Amount taken
Any vomiting
Safe
storage/preparation of
formula
Day 1-3 dark
green/black
Day 3-5 browny/yellow
REFERENCES
National Institute of Clinical Excellence (2008). Improving the nutrition of
pregnant and breastfeeding mothers and children in low-income
households. NICE public health guidance 11.
Nursing and Midwifery Council (2009) Record Keeping: Guidance for nurses
and midwives. London.
Macdonald P., Ross S. Grant L Young (2003) Neonatal weight loss in breast
and formula fed infants. Archives of Diseases in childhood Fetal Neonatal
Edition 88 F349
Dewey K et al (2003) Risk factors for Suboptimal Infant Behaviour, Delayed
onset of lactation and Excess Neonatal Weight Loss. Paediatrics 112 (3),
607-617
Royal College of Paediatrics and Child Health (2009) Using the new UKWHO Charts with newborn infants. www.growthcharts.rcph.ac.uk

Roberton, NRC.(1992) Care of the Normal Term Newborn Baby. In
Roberton NRC (ed). Textbook on Neonatology, 2nd Edition Churchill
Livingstone, Edinburgh.