Newborn Weight Loss Explained: Essential NHS Guidelines Every Parent Must Know!

A baby's birth weight is a crucial indicator of their overall health, and monitoring weight changes in the days and weeks following birth is an essential part of newborn care. This article provides a comprehensive overview of newborn weight loss guidelines within the NHS (National Health Service) framework, addressing typical weight loss patterns, potential causes for concern, and available support for parents.

Typical Weight Loss in Newborns

A baby's birth weight is an important indicator of health. The average weight for full-term babies (born between 37 and 41 weeks' gestation) is about 7 pounds (3.2 kg). Newborns come in a range of healthy sizes. Most babies born between 37 and 40 weeks weigh somewhere between 5 pounds, 8 ounces (2,500 grams) and 8 pounds, 13 ounces (4,000 grams). Newborns who are lighter or heavier than the average baby are usually fine. But they might get extra attention from the doctors and nurses after delivery to make sure there are no problems. Measurements like weight, length, and head circumference help your baby's health care provider get an idea of their overall health. They may also be measured using metric units, with centimeters (cm) instead of inches (in). Generally, a newborn's head is about half the baby's body length in cm plus 10 cm. So a baby that's 18 inches long would be 45.7 centimeters (18 x 2.54).

It's perfectly normal for babies to lose some weight in the first few days after birth. Newborn babies may lose as much as 10% of their birth weight during the first 5 days after birth. This is primarily due to the excretion of extra fluid they're born with. A healthy newborn is expected to lose 7% to 10% of the birth weight, but should regain that weight within the first 2 weeks or so after birth. This weight loss normally stops after day 4 of life and is normally regained after 3 weeks. During their first month, most newborns gain weight at a rate of about 1 ounce (30 grams) per day. They generally grow in height about 1 to 1½ inches (2.54 to 3.81 centimeters) during the first month. Many newborns go through a period of rapid growth when they are 7 to 10 days old and again at 3 and 6 weeks.

Factors Influencing Birth Weight

Several factors influence a baby's birth weight, including:

Gestational age: Babies born around their due date or later tend to be larger than those born earlier.
Parental size: Big and tall parents may have larger-than-average newborns; short and petite parents may have smaller-than-average newborns.
Multiple births: Multiples have to share their growing space in the uterus, and they're often born early, which leads to small size at birth.
Birth order: First babies are sometimes smaller than brothers or sisters born later.
Gender: Girls tend to be smaller, boys larger, but the differences are slight at birth.
Mom's health during pregnancy: Things that can lead to a lower birth weight include a mother with high blood pressure or heart problems; or one who used cigarettes, alcohol, or illegal drugs during the pregnancy. If the mother has diabetes or is obese, the baby may have a higher birth weight.
Nutrition during pregnancy: A poor diet during pregnancy can affect how much a newborn weighs and how the infant grows. Gaining a lot of weight can make a baby more likely to be born bigger than average.
Baby's health: Medical problems, including some birth defects and some infections during the pregnancy, can affect a child's birth weight and later growth.

Monitoring Your Baby's Weight

Your newborn will be weighed in the hospital and at all check-ups. You'll be given a personal child health record (PCHR) for your baby. This usually has a red cover and is sometimes called the red book. Take this book with you every time you visit the baby clinic, health visitor or GP. They will use it to record your baby’s weight, height, immunisations and other important information such as test results. It’s also helpful to update the developmental milestones section of the book too. You can also add other information if you want, such as any illnesses, medicines or accidents.

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Your baby will be weighed during their first 2 weeks to make sure they're regaining their birthweight. In the first few days of life, it is considered acceptable for babies to lose up to 10% of their birth weight whilst they establish feeding.

When to Seek Advice

Your midwife or health visitor can help you if your baby loses a large amount of weight or doesn’t regain their birthweight by 3 weeks. They will ask you how feeding is going and look at your baby’s health in general. They may ask to watch you breastfeed, if you’re breastfeeding.

Understanding Faltering Growth

Faltering growth (also known as failure to thrive) describes when a child is not growing as expected. This may reflect underlying poor health or nutrition. By routinely assessing a child’s height and weight throughout childhood, growth measurements can be plotted over time on centile charts and faltering growth can be identified. In the first year of life, rapid growth occurs. In red, growth points plotted show weight gain for an infant male, but the centile has dropped from between the 50th-85th to between the 3rd-15th centile.

Potential Causes of Faltering Growth

Causes can be categorised broadly into inadequate nutritional intake, inadequate nutrient absorption, excessive nutrient loss and increased metabolic demand.

Inadequate Nutritional Intake: Difficulty supplying breast milk, poor milk production due to breast surgery, anaemia, endocrine issues or can be idiopathic, poor milk let-down due to smoking, psychological factors, difficulty feeding, genetic conditions associated with abnormal facial structure e.g. Pierre Robin syndrome Tongue tie (assess using TABBY tool)Cleft lip/palate Poor suck e.g. cerebral palsySwallowing issues - this can be due to prematurity, or neurological problems such as congenital myopathy or spinal muscular atrophy (SMA)
Inadequate Nutrient Absorption: Pancreatic exocrine insufficiency, e.g. Cystic fibrosis, Schwachman-Diamond syndromeCow’s milk protein allergy (must be severe to cause faltering growth)
Excessive Nutrient Loss: Vomiting, Gastro-oesophageal reflux disease (must be severe to cause faltering growth)Pyloric stenosis - typically presents at 5-6 weeks of age with projectile vomiting and metabolic alkalosis + hypochloraemiaDiarrhoeaInfection
Increased Metabolic Demand: Small for gestational ageCongenital heart disease (Most commonly undiagnosed VSD)Metabolic diseaseHyperthyroidism / HypothyroidismType 1 diabetes mellitus Chronic systemic disease e.g. cystic fibrosisChronic infection e.g. HIV, immunodeficiencyMalignancy, e.g. Early Onset Neonatal SepsisMaternal sepsis treated with IV antibioticsInvasive group B streptococcal infection in previous baby or maternal group B streptococcal colonisationIntrapartum feverPrematurity (<37 weeks)Prolonged rupture of membranes (>24h if term or >18h if preterm)Chorioamnionitis [11] Late Onset Neonatal SepsisPrematurity (<37 weeks)History of invasive procedures e.g.

Assessment and Management of Faltering Growth

Take a feeding history, including feed type (i.e.
Ask about stool and urine outputLow urine and/or stool output indicates inadequate feedingBabies should have 2 wet nappies on day 2 of life, 3 wet nappies on day 3, and so on until 6 wet nappies from day 7 onwardsFrom day 5 onwards, babies should have 3 yellow stools a day.
Assess mum’s physical and mental health - consider if maternal support (e.g.
Assess for signs of cardiovascular and respiratory disease e.g.
Plot child length, weight and head circumference on the growth chartEnsure the correct growth cart is used.
Consider specialist investigations e.g.
If breastfeeding, support from midwives and/or health visitors may help. If the mother wishes to continue breastfeeding, they should be advised to breastfeed before top-up feeds, and express breast milk when not feeding. Having a mum express breast milk is very useful in determining how much milk baby is getting. If the mother’s milk supply is good and she expresses a lot of milk, but baby is not gaining weight, the issue is more likely to be related to difficulty feeding, such as poor suck/latch. In severe cases, enteral tube feeding may be considered. However, it is essential to establish clear goals (e.g.

Additional Newborn Checks and Screenings

Soon after your baby is born, a doctor, midwife, or nurse will check your baby is doing well. They will offer a thorough physical examination within 72 hours of your baby being born. This will usually happen before you leave the hospital but may also be done at a local clinic or home. They will usually check your baby's eyes, heart, and hips. Baby boys are checked to make sure their testicles are in the right place. The aim is to spot any problems early, so treatment can be started as soon as possible if necessary. If the health professional carrying out the examination does find a possible problem, they may refer your baby for more tests.

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Eyes: The health professional will check the appearance and movement of your baby's eyes. They are looking for cataracts, which is a clouding of the transparent lens inside the eye. However, this examination won’t be able to tell you how well your baby can see. Your baby can be referred to the hospital’s ophthalmology (eye) department if they need any more tests.
Heart: The health professional will check your baby's heart. Sometimes heart murmurs are picked up in the test. This is when the heartbeat has an extra or unusual sound. These are common in babies and the heart is normal in almost all cases when a murmur is heard.
Hips: Some newborn babies have hip joints that aren’t formed properly. This is known as developmental dysplasia of the hip or DDH. If this is left untreated, it can cause difficulty walking (a limp) or joint problems. Only about 1 or 2 in 1,000 babies have DDH that needs to be treated with surgery. If your baby was born before 37 weeks, they may need extra tests and checks in the neonatal unit. This is to check for developmental dysplasia of the hip (DDH), which is where the ball and socket joint of the hip doesn’t form properly. Even if your baby’s hip stabilises before the scan is due, they should still be checked to make sure. If your baby is diagnosed with DDH, they will usually be treated with a fabric splint called a Pavlik harness. This secures both of your baby's hips in a stable position and allows them to develop normally. Your hospital team will provide instructions on how to look after your baby if they are wearing a harness. Sometimes, hip problems can develop after these checks. The charity Steps offers information and support if your baby has been diagnosed with DDH.
Testicles (boys): Baby boys are checked to make sure their testicles are in the right place. During pregnancy, the testicles form inside the baby's body. In about 1 in 25 baby boys, the testicles only descend partially or not at all. Most of these will naturally move down by the time the baby is 6 months old.

Newborn Hearing Screening Test

The newborn hearing screening test is done soon after your baby is born. It helps identify babies who have permanent hearing loss as early as possible. This means you can get any support and advice straight away. If you give birth in hospital, you may be offered the test before you and your baby are discharged. If the screening test results do not show a clear response from 1 or both of your baby’s ears, your healthcare professional may repeat the test at a later date. Some newborns may not pass their first hearing test, even if their hearing is normal. Research has shown that this may be especially true for babies born by c-section. If the screening test results are still not clear, your baby will be given an appointment with a hearing specialist at an audiology clinic.

Newborn Blood Spot (Heel Prick) Test

When your baby is 5 to 8 days old, a healthcare professional will collect the blood sample by pricking your baby's heel, which is why it is sometimes called the heel prick test. They’ll collect a few drops of blood onto a blood spot card and send it for testing. This may be uncomfortable, and your baby may cry, but it is very quick. You can help soothe your baby by cuddling and feeding them, and making sure they are warm and comfortable. Try not to worry if you are contacted to do the test again. You should receive the results by the time your baby is 6 to 8 weeks old. You'll be contacted sooner if your baby screens positive for any of the conditions. This doesn't mean they have the condition, but they're more likely to have it.

Vaccinations

Your baby needs their first injections at 8 weeks, then 12 weeks, 16 weeks and 1 year. Sometimes the area where the needle goes in can be sore and red for 2 to 3 days. Some babies may also develop a high temperature for a day or two. A normal temperature in babies and children is about 36.4C, but this can vary slightly from child to child. A high temperature is usually considered to be 38C or more. It's recommended that you give your baby infant paracetamol after the MenB vaccine to reduce the risk of a high temperature. Make sure you follow the instructions that come with the medicine. If you're unsure, ask a pharmacist for advice. A high temperature after a vaccination should go away quite quickly by itself. You may find it useful to buy a digital thermometer to check your baby’s temperature accurately. Ideally, use an armpit thermometer, as these give the most accurate results for children under 5 years. You can buy these at any supermarket or pharmacy.

Addressing Parental Anxiety

Watching your newborn have all these tests and check-ups can cause some anxiety. Having anxious thoughts and worries now and again are natural, particularly in the early weeks after having a baby. Talk to your midwife or health visitor if you have any questions or concerns about your baby’s tests or the results. You can also talk to them about how you’re feeling. If your anxiety is constant and affecting your daily life, you may need some help. If you’re worried that your baby has missed any of the recommended tests, checks or other appointments, speak to your midwife, health visitor or GP. If you’re struggling to make it to appointments, let your healthcare provider know. If you have any concerns about your baby’s health, contact your midwife, health visitor or GP as soon as possible. If you can’t get hold of your regular healthcare professionals, and want health advice right away, call NHS 111.

Exclusive Breastfeeding and Weight Loss

Almost all newborns lose weight from birth to discharge [1]. During the first days of life, exclusively breastfed neonates lose around 6% of their birthweight prior to beginning consistent weight gain [2, 3]. Based on a simplistic view, measuring newborn weight change would portend insufficient milk supply. However, assessment of effective breastfeeding must be founded on more than early weight loss in order to avoid the well-known association of pronounced birthweight loss and exclusive breastfeeding cessation [4]. This subject has a lot of interest because one needs to move away from the danger zone of insufficient mother’s milk intake without escalating towards the danger zone of discouraging breastfeeding. Dehydration and hyperbilirubinemia are more common in breastfed infants. Consequently, weight monitoring has been used to assess the adequacy of breastfeeding and the need for formula supplementation, which prompts breastfeeding cessation [5,6,7]. Lactation failure, as well as remedies for this condition are known since the Papyrus Ebers (Egypt, 1550 BC) but current knowledge cannot support that any pronounced birthweight loss points at breastfeeding failure [8]. Weight charts to identify infants who need breastfeeding support have been recently developed [9]. However, they cannot be used to project individual weight changes in neonates.

Research Findings on Breastfeeding and Weight Loss

One study explored the relationship of common clinical variables and exclusive breastfeeding recorded during the hospital stay with cessation of exclusive breastfeeding from day one until day 100 of life. We enrolled a convenience sample of 788 stable infants between 37 and 42 weeks of gestation. After birth, mothers were encouraged on demand breastfeeding. Infant feeding policies at the birth center and pediatric centers were based on the World Health Organization’s Ten Steps to Successful Breastfeeding standards [19]. The study found that newborns whose birthweight loss at discharge from the maternity ward was below the median were more likely to discontinue exclusive breastfeeding by days 15, 30 or 100 of life, but not by day 7 of life.

Factors Influencing Breastfeeding Success

From the physiological standpoint it is unknown whether extreme weight loss results solely from voiding and insensible water loss during those days when milk oral intake is still low or it is due mainly to inadequate intake [21]. However, it is worth remembering that the average amount of breastmilk ingested during the first day of life by full term neonates is 15 mL [22]. In addition, very recent research [4] shows that once newborns started gaining weight, similar patterns of weight gain emerged between the group above and the group below the threshold for extreme weight loss. Moreover, not only delayed onset of lactogenesis, but also intrapartum fluid net balance and infants’ rooting movements on day two of life may be involved in food intake regulation and predict birthweight loss [15, 16, 23].

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