Friday, May 2, 2014

You baby's growth/link to growth chart

At every routine checkup one of the things that we do is to measure the weight, the height and for the first several years, the head circumference as we follow your child's growth. Of course measuring the growth rate  is only one aspect of the visits. We also will be monitoring developmental milestones and administering age appropriate vaccinations.
The first 3 years the routine visits are as follows:

NB (within several days of getting home from the hospital and then careful monitoring as needed until your baby is back to birth weight)
1 month
2 month
4 month
6 month
9 month
12 month
15 month
18 month
24 month
30 month (check with your insurance to see if this visit is covered)
36 months
and then yearly
Once your child is over 6 years of age, some folks opt to come in every other year if there are no issues or concerns, but you are welcome to do an annual visit.

We will check the weight at other visits as well, especially if there has been any vomiting, diarrhea or feeding issues.
Having a current weight on file is important in case the need arises to prescribe medications. Even giving an accurate dose of Tylenol depends on knowing the weight.

When your baby is born one of the things  that folks focus on is the baby's birth-weight. Although most of the time this data point quickly becomes irrelevant , it tends to be something we remember.
For the record,  my firstborn Lauren was 8 pounds ½ ounce at birth.
Three years later, when I was trying to figure out why it was taking so long to push out baby number two, along came Alana  at a whopping 9 pounds 8 ounces. (Nurse Judy takes a bow)

Here in the office we focus on the weight as a symbol that everything  is going in the right direction, your baby is getting fed and growing.
Many breastfeeding moms can find themselves feeling frustrated and somewhat vulnerable that they don't know exactly how much milk  their baby is getting.
*Can you hear a swallow when they are nursing?
*Are they peeing?
*Are they pooping? Are the stools  turning yellow and seedy?
*Are they having some calm alert time (even a few moments counts) in between feedings?
If you answer yes to these questions, most likely everything is great, but proof will be found on the scale.

Don't fret, it is typical for babies to lose a bit of weight during that first week.
If the weight loss is larger than 10% of the total weight, we pay closer attention and may feel the need to add supplement if you are breast feeding.

We like to make sure that someone is keeping tabs on things those first couple of weeks and that the weight is being monitored. If you have a home nurse visit, or a scale at home we don't necessarily need to see you in the office, we just want to be assured that the weight gain is steady.
After that initial drop, we like to see an increase of ½ ounce-1 ounce a day.
Once they are back to birth-weight, things usually start to roll in the right direction.
This rapid gain usually lasts for a few months before things tend to slow down a bit.
From 4-7 months you might see an increase of roughly 1 to 2 pounds a month

The scales in our office are calibrated and are accurate enough that  except for rare exceptions, it really doesn't matter which scale your baby is weighed on.   

If you come in for a lactation consult it is likely that will be weighed on Charity's special gram scale 

Human errors can occur, so if a weight seems really off, lets take the baby off the scale, make sure the scale is perfectly balanced and try again. Maybe this weight is accurate but the last one was off.
Keep in mind that a large stool or a big feeding can have a measurable impact on the weight.
If your baby just ate 2 ounces, expect them to be 2 ounces heavier. On the other extreme if they just had enormous poop, they will be lighter.
We usually measure the babies with no clothes or diaper for better accuracy.
Trust us, if we are worried about the result of the weighing , at that point we will double check it on the original scale if possible.

Once you are safely back to birth weight I am way less focused on the actual numbers.
Look at your baby, not the scale!! If the baby seems well, but the numbers aren't backing that up, relax and lets make a plan to recheck in a week or so.

Another measurement that we follow is the height.
Parents are often confused at the first visit if it looks like the baby has shrunk in the height department.
No one is going to accuse you have having put them in the dry cycle for too long.....
there are a few reasons that this happens.
If you had a vaginal birth, the heads can be elongated....remember the Cone Heads from the early years of Saturday Night Live???
As the head shape normalizes, your baby may actually lose an inch or so.
Also, I hazard a guess that newborn height measurements are somewhat inaccurate.
Often babies still tend to be more comfortable in fetal position, and rarely is it worth stretching them out fully if it is uncomfortable, the measurement simply isn't that critical.

As we collect these numbers we watch the trend of the height and the weight together as your child grows.
If there is a dramatic change in just one of them, it bears watching.
We track these by plotting the numbers on the growth chart that is kept in your child's file
Feel free to ask to see it during the visit. Many parents like seeing where the kids are on the curve.
In my experience about ⅔ of my patients actually follow the curve and by the time they are 2 or so we can roughly predict how tall they will end up.
On the other hand, about ⅓ of the patients don't like to follow the rules and they bounce up and down the chart, having slow growth periods that make the parents nuts and then having wild growth spurts.
Again, what we are watching is that the height and weight are increasing with the same tendency.

We also measure the head circumference. This one can be challenging on an uncooperative baby, and therefore the measurement might vary somewhat. The Head circumference should be measured  from the middle of the forehead  around to the widest part of the head.
This measurement is not usually critical at birth but becomes more important as your child grows.
What we are looking for is the rate at which the head is growing. If it seems like it is growing out of proportion the the height and the weight, that could indicate some fluid in the head that shouldn't be there and would need further evaluation. Big heads are fine. Big heads that are growing way more rapidly than the other measurements warrant attention.

More often than not, if we have a patient with a large head, they are perfectly normal. Look in the mirror, this runs in the family and usually one of the parents also has a big head (ego irrelevant).

It may be worth checking in with Grandma to see if there was anything interesting about mom and dad's growth rate. It is not unusual for your kids to follow the pattern of one of the parents. If one of you started out small and then sprouted as a teen, the apple may not have fallen far from the tree.

If you would like to print out a growth chart, you can find the appropriate one for you child's age and sex  by clicking on this link.

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