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Why is my son not gaining weight?

Q: My child is 4 months (17 weeks & 4 days) old. He is not gaining weight according to the children's BMI chart. His weight gain is in following manner: at birth = 3.3 kg; at 3 weeks = 3.9 kg; at 6 weeks = 4.9 kg; at 8 weeks = 5 kg; at 11 weeks = 5.06 kg; at 13 weeks = 5.21 kg; at 17 weeks = 5.29 kg. His development in other activities is satisfactory. He can hold his head in upright position. He can put weight on his arms when he is lying on his tummy and roll on sides. He can turn on his tummy from his back and vice versa. I am exclusively breast-feeding him. He drinks around 10 times a day out of which, 1-2 times at night. He drinks for around 20 minutes and plays well after that. But is not gaining any weight. What could be the reason and what should I do in this case?

A:Weight gain in the first 6 months of life is as follows: 1. 5 to 10% of birth weight is lost in first 10 days, followed by return to birth weight at 7 to 10 days of age. 2. Daily weight gain in the first 3 to 4 months: 20 to 30g (140 to 210g / week) 3. Daily weight gain from 3 to 6 months: 10 to 20g (70 to 140g / week)) 4. Double birth weight happens at 5th month. Hence, normally all babies show a slower rate of weight gain with increase in age. Also, many babies do not follow the above rules stated in textbooks. Overall, intervention is needed only if the child 1. Drops percentiles consistently for 2 months or more 2. Has other illnesses or delay in milestones In this case, there seems to be a slight slowing of weight gain that needs close follow-up only if the baby is otherwise well. It is preferable to breastfeed exclusively for 6 months. If percentiles drop over the next few weeks based on growth charts, review of breastfeeding and need for supplementation / weaning foods should be discussed with the paediatrician.

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