Physiological loss of body weight. Weight gain in a newborn
The body weight of a healthy full-term baby is on average 3400-3500 g for boys and 3200-3400 g for girls. But there can be significant fluctuations in the direction of both its decrease and increase. With multiple pregnancies, the body weight of newborns is much lower - 1200-2000 g. Children of multiparous women are usually larger in weight and height than children of primiparous. The individual characteristics of the parents, their age, health, social and living factors are important. In recent years, the indicators of the physical development of children have significantly increased, children with a body weight of 4000 g or more are often born.
PERIOD OF NEWBIRTH.
Physiological weight loss
In the first days after birth, the weight of the child decreases by about 150-200 g. This decrease in body weight, as a rule, is natural and is not considered pathological; it is called physiological weight loss.
Depending on the individual characteristics of the child and a number of external factors, the initial weight loss in individual newborns can fluctuate within fairly wide limits, but it is relatively rarely less than 100-150 g. A weight loss of 500-700 g should be considered outside the normal range; it is usually caused by prolonged malnutrition or some illness in the newborn.
Weight loss continues for 3-4 days, its greatest loss occurs on the 1-2nd day of a child's life. After 4-5 days, body weight increases again and reaches the initial level by 7-10 days of life, and more often by 12-15 days of life.
Physiological weight loss and subsequent restoration of the original weight occur in newborns in two main types.
Nutrition of the newborn has a decisive influence on the reduction of the weight curve. A strong drop and late weight recovery are largely the results of some underfeeding of children in the first days of their life, which is associated with the characteristics of the mother's lactation, and with the characteristics of the child himself.
Approximately 70-75% of the initial weight loss should be attributed to the loss of water excreted by the kidneys, intestines, and mainly the lungs and skin, that is, by respiratio insensibilis. The newborn loses tissue water, water from the body's reserve depots and water, partially formed as a result of tissue breakdown. First of all, the reserves of glycogen in the liver are consumed, fats are partially destroyed; the possibility of decay and a certain amount of tissue proteins is not excluded.
The loss of 10-20% of the total weight loss can be explained by the excretion of urine and original feces (meconium), which are still formed in utero and are usually taken into account at the first weighing.
About 3-5% of the total weight loss should be attributed to vomiting by amniotic fluid swallowed during childbirth, blood and other secretions of the mother's birth canal. To an even lesser extent, weight loss occurs due to the drying out of the remainder of the umbilical cord.
The size of weight loss in the first days of life and the time it returns to its original level, if, of course, do not go beyond normal fluctuations, do not affect the further physical development of the newborn.
BREAST AGE.
(period from 1 month to a year)
The weight of the child at the end of the neonatal period continues to grow: by six months, more often 5-5.5 months, it doubles, by the end of the year it triples. The energy of weight gain gradually weakens with each month of life.
Weight gain for each month of life can be roughly calculated using the following formula:
Monthly weight gain = 800 g - (50 x number of months of life).
For example, in the 2nd month of life, the child should put on weight by 800 - (50 x 2) = 700 g, for the 7th month - by 800 - (50 x 7) = 450 g, etc.
To determine the absolute weight of a child of any month of the 1st year of life, you can use the following simple, but, of course, also only a very rough calculation:
Baby weight (in g) = baby's weight at birth + (600 or 500 x per number of months of life)
For children of the first half of the year, the number of months of life is multiplied by 600 (the average monthly weight gain in grams during the first half of the year), for children older than 6 months - by 500 (the average monthly weight gain in grams of children of the 1st year of life).
For example, a baby with an initial weight of 3250 g at the age of 4 months should weigh: 3250 + (600 x 4) = 5650 g. The weight of the same child at the age of 8 months will be: 3250 + (500 x 8) = 7250 g.
In fact, the increase in weight in infants is far from always distinguished by such a pattern, and rather significant deviations from the indicated average norms are possible, which depends on the individual characteristics of the child and a number of external factors. Children with an initial low weight usually give relatively large weight gain, and it doubles and triples in them earlier than in larger children.
The infant's weight gain is particularly affected by the way the infant is fed: babies who are artificially fed from the day of birth double their weight about a month later than babies who are breastfeeding; the latter by the end of the 1st year of life weigh about 250 g more than the former. The greatest increase in weight is observed in late summer and autumn, the smallest - in spring and early summer, average gains - in the winter season.
Table 1 shows the average weight of children 1 year of life according to the data of S.M. Leviant.
Table 1. Weight of a child of the 1st year of life (in g)
(according to S.M. Leviant; Leningrad, 1958)
| Age | Boys | Girls | Age | Boys | Girls |
| Newborn | 3501 | 3376 | 6 months | 8209 | 7692 |
| 1 month | 4131 | 3914 | 7 months | 8735 | 8196 |
| 2 months | 5198 | 4805 | 9 months | 9663 | 9062 |
| 3 months | 6049 | 5613 | 10 months | 9963 | 9424 |
| 4 months | 6832 | 6412 | 11 months | 10269 | 9789 |
| 5 months | 7634 | 7095 | 12 months | 10556 | 10088 |
There is no doubt that the initial weight of the newborn and subsequent weight gain of children during the first year of life may give some deviations from the average figures given in Table. 1.
PERIOD OF MILK TEETH.
(period from 1 year to 6-7 years)
From table. 2 shows that in children over the age of 1 year, the energy of weight gains is significantly weakened. For the 2nd year of life, the child's weight increases by 2.5 - 3.5 kg, from the 3rd year, the annual weight gain is about 2 kg. By about 6-7 years, the weight of a one-year-old child doubles, and by 13-14 years, it increases 4 times.
Table 2. Weight of children (average for boys and girls) over 1 year old
(according to different authors)
| Age | Weight in kg | Age | Weight in kg | Age | Weight in kg |
| 1 year | 10,1 | 7 years | 21,5 | 13 years | 39,5 |
| 2 years | 12,5 | 8 years | 24,5 | 14 years old | 45,0 |
| 3 years | 14,5 | 9 years | 26,0 | 15 years | 50,0 |
| 4 years | 16,0 | 10 years | 28,0 | 16 years | 53,0 |
| 5 years | 17 | 11 years | 31,0 | 17 years | 55,0 |
| 6 years | 19 | 12 years | 35,5 | 18 years | 58,0 |
The rate of weight gain in children over 1 year old does not remain strictly uniform in different periods of life; weight gain in prepubertal and pubertal periods is especially vigorous.
PERIOD of adolescence and puberty.
(period from 7 to 18 years old)
In boys aged 14-15 years, the annual weight gain rises to 3-5 kg, and by the age of 16-17 it reaches 5.5 - 8 kg. In girls, this increase in body weight gain is detected earlier; at the age of 9-12 years, their annual weight gain reaches 2.5 - 4.5 kg, at the age of 13-15, there are maximum gains of up to 5-8 kg and again a significant decrease in the energy of accumulating body mass by the age of 16-17.
From fig. 3 it can be seen that up to 11-12 years old the weight of boys is slightly more than the weight of girls; with the onset of puberty, girls overtake boys in weight, and from the age of 16, the weight of boys again exceeds the weight of girls of the same age.
Rice. 3. Curves of weight and body length for boys (blue line) and girls (pink line).
The weight of a child of any age after a year (in kg) can be approximately calculated using the following formula:
Child's weight (in kg) = 9.5 kg + (2 kg x for the number of years),
that is, to the weight of a one-year-old child (9.5 kg), add 2 kg (average annual weight gain), multiplied by the number of years of the child at the moment.
Quantitatively and qualitatively, malnutrition, insufficient use of air and light, unfavorable living conditions, unfavorable sanitary conditions, lack or excess of physical and mental stress, diseases, etc., affect, to a greater or lesser extent, the normal weight gain in children. The weight of children of the same age can fluctuate quite widely.
Borderline conditions of newborns.
Adaptation to extrauterine life causes significant changes in the newborn's body. The external manifestations of these changes can be the so-called borderline conditions of newborns, which are not diseases and do not require treatment. And nevertheless, newborns with borderline conditions require more careful attention and some additional measures when organizing care for them.
The most common borderline conditions in newborns.
It occurs in 100% of newborns by 3 - 4 days of life and makes up a maximum of 10% of the initial body weight. Recovery occurs by 7-10 days of life.
Causes:
* malnutrition in the first days of life;
· Excretion of water through the skin and lungs;
• loss of water in urine and stool;
· Insufficient fluid intake;
Regurgitation of amniotic fluid;
· Drying of the umbilical residue.
Tactics:
· Early attachment to the breast;
· Feeding at the request of the child;
· Fight against hypogalactia;
· Control of the child's weight.
Transient erythema of the skin.
It manifests itself as a simple, less often toxic erythema.
Simple erythema- reactive redness of the skin, sometimes with a bluish tinge of the hands and feet.
Cause- reflex vasodilation of the skin due to the powerful effect of environmental factors on the skin receptors of the newborn. In mature full-term newborns, it lasts for several hours, less often for 1 - 2 days.
Toxic erythema is a kind of allergic reaction of the skin of a newborn. In contrast to simple erythema does not occur immediately after birth, but on the 2nd - 5th day of life. It manifests itself in the form of hyperemic spots, papules, vesicles on the entire skin, except for the palms and feet. The rash fades away after 2 to 3 days.
Erythema, as it fades, turns into peeling (often small, sometimes large).
Tactics:
· Thorough skin care;
· Hygienic bath with potassium permanganate solution.
Transient fever
It develops as a result of instability of water exchange and imperfection of thermoregulation. It manifests itself on the 3rd - 5th day of life in the form of fever with a temperature of 38 - 39 degrees, anxiety, thirst, dry skin and mucous membranes. After 1 - 2 days, the temperature will return to normal.
Causes:
· Insufficient amount of fluid intake into the body;
Overheating of the child;
· Ingestion of E. coli endotoxins during the initial colonization of the intestine with microflora.
Tactics:
Transient jaundice
The appearance of icteric coloration of the skin and mucous membranes without disturbing the state of health. It manifests itself on the 3rd day, reaches a maximum by the 4th - 5th day and disappears by the 7th - 10th day of life.
Cause- a combination of underdevelopment of the enzymatic functions of the liver, in which the death and processing of erythrocytes occurs, as well as massive destruction of fetal erythrocytes (the number of which in the fetus is very large). As a result of this combination of factors, the pigment of erythrocytes that did not have time to be processed accumulates in the skin and mucous membranes, staining them yellow.
Tactics:
· Control over the condition of the child;
· Additional drink of 5% glucose.
Hormonal crisis
It is caused by the transition of mother's estrogens into the fetal blood in the antenatal and intrapartum periods and their entry to the newborn with mother's milk.
It can manifest itself as:
1. Physiological mastopathy in boys and girls. In this case, there is a symmetrical engorgement of the mammary glands without signs of inflammation. There may be a grayish discharge from the nipples. It manifests itself on 3 - 4 days, reaches a maximum by 7 - 8 days and disappears by the end of 2 - 3 weeks.
2. Swelling of the scrotum in boys, which is also symmetrical and goes away without treatment.
3. Desquamative vulvovaginitis girls. At the same time, discharge from the genital fissure appears of a grayish-white, and sometimes brownish color. It manifests itself in the same way as the edema of the scrotum in boys, disappears in the 1st days of life and the 3rd day.
Tactics:
· Careful child care.
Uric acid renal infarction
This is the deposition of uric acid in the form of crystals in the lumen of the urinary tubules.
Causes:
· Increased decay of a large number of cells;
· Features of protein metabolism.
It is manifested by a change in urine. It becomes cloudy, yellowish brown in color. After such urine dries, brown spots and sand remain on the diapers. It is found on the 3rd - 4th day of life against the background of physiological oliguria (a decrease in the daily volume of urine). As the urine output increases and the crystals are washed out (within 7 - 10 days), it disappears.
Tactics:
· Additional drink of 5% glucose.
The listed conditions are called borderline, since all systems of the newborn are characterized by a state of unstable equilibrium, therefore, even minor changes in environmental conditions can lead to the development of diseases.
Hence, necessary:
· implementation of special careful care of the newborn in compliance with the rules of asepsis and antiseptics;
· observance of special hygienic conditions for its maintenance;
· correct organization of feeding a newborn.
So, your baby was born, and neonatologists tell you the height and weight of the newborn. But the readings of the scales during the daily examinations of the child by the specialists of the maternity hospital show that the baby is losing weight. The neonatologist should explain to you in detail why this is happening and reassure you that the process of loss is completely physiological and normal.
Why do babies lose weight?
Getting into an extrauterine aggressive environment, the child goes through a rather difficult period of adaptation. Almost all life processes now proceed differently than in the mother's stomach - the baby breathes with the lungs, his digestive and excretory systems begin their work.
In the process of adaptation, the newborn loses a lot of moisture, and it is mainly because of this that physiological weight loss occurs.
Moisture is consumed in the following processes:
- moisturizing breathing;
- excretion of meconium (first feces);
- urination;
- regurgitation;
- drying out the remainder of the umbilical cord.
Also, the newborn loses a large percentage of fluid through the evaporation of moisture from the skin.
Replenishment of moisture loss occurs with the help of breast milk or artificial mixtures. But since the mother is not yet sufficiently lactating, the amount of colostrum that the baby receives is not enough to equalize the loss and intake of moisture. In addition, the newborn is still learning to eat, and drinking a small amount of the first breast milk, he gets tired and falls asleep. As a result, temporary dehydration occurs, and the baby loses weight.
What can make weight loss worse?
Some children lose more weight than they should. This is due to the circumstances of childbirth, the lactation process and conditions in the ward:
- premature babies adapt to extrauterine life longer and more difficult;
- children born in prolonged labor;
- a long break between the passage of water and the moment the baby is born;
- children with birth trauma;
- insufficient volume of colostrum in the mother;
- dry air in the ward;
- high air temperature in the ward;
- babies weighing more than 4 kg.
What is the normal rate of weight change in the first week?
The weight loss of the newborn is calculated as a percentage of the body weight recorded at birth. The maximum loss, as a rule, is noted on the 3-5th day of a child's life and amounts to 10%. So, if a baby was born with a weight of 3600 grams, then his critical loss will be equal to 360 grams. If the baby's weight does not fall below 3240 grams. and on the 5-6th day he will start to recruit it, so everything is fine with him.
As a rule, if the volume of colostrum or formula for the child is sufficient, it will not come close to critical numbers, and the percentage of weight loss will be only 6-8%. Under favorable conditions, weight gain will begin quite quickly, and by 6-7 days, the loss will recover by 80%.
In premature infants, as well as in newborns weighing more than 4 kg, the rate of recovery of the lost body weight is somewhat slower.
How to help?
You can help the newborn and create an environment that will reduce moisture loss and, as a result, weight.
- If possible, create optimal temperature conditions (22-24 degrees) in the room in which you are with your baby.
- If the air is dry by heating devices, humidify it using a special device or by placing a container of water near the bed.
- Latching the newborn to the breast often will stimulate lactation and prevent the baby from losing too much weight.
- Do not wrap the baby and check, feeling his neck, if he is hot, because sweating will increase the loss of moisture.
Further weight gain
During routine examinations of a pediatrician from a month to a year, the child will be regularly weighed on the scales. The doctor will compare the early data from the hospital, take into account the loss of body weight of the baby after birth and its subsequent increase from. They indicate the rate of how much the baby should add to his weight over a certain period.
Pediatricians rarely have complaints about artificial people, since such children eat a certain amount of the mixture, which can be visually controlled. Breastfed babies suck an unknown amount of milk from their mother's breast. Moms, together with doctors, can judge whether it is enough, by weight gain or loss, as well as by the general condition of the child. That is why regular weighing of the baby's body up to a year is so important.
If your baby is slightly ahead of his peers in terms of weight gain, or the doctor determines that you are underweight, do not be discouraged. The pediatrician will advise you on how to adjust the feeding process so that the baby's weight returns to normal. You may need to weigh your baby before and after meals to find out how much milk he is drinking and write these numbers down. You will show the obtained data to the pediatrician. If the shortage is caused by a lack of a product of your lactation, the doctor recommends that you feed the baby more often in order to strengthen it, or decide on feeding the baby with a formula.
But not always weight loss occurs due to a lack of breast milk:
- A slight underweight may be associated with hereditary factors: one of the child's relatives could not grow up and gain weight up to a year as intensively as their peers; in addition, if a child has miniature parents, you should not expect a quick mass gain from him.
- Children under one year old develop in leaps, they can show a shortage on the scales for some time, and then "overfulfill" the plan, such a non-smooth weight gain, as well as growth closely related to it, is a physiological norm.
Increase rates
In 2004, WHO released tables for estimating height and weight gain in children. It differs from the previous version in that the rate of development of artificial people in it differs slightly from the rate of babies on HB.
In the first six months, the child's increase rate averages 600-800 grams per month. Further, due to the increase in physical activity, the baby will gain weight more slowly - about 400 grams per month for up to a year.
If in one of the first 4 months the body weight gain is less than 500 grams, there is an obvious shortage, the doctor will definitely recommend feeding the child, indicate how much it should be in volume, and select the appropriate one. There is no need to expect that everything will work out by itself - any problems in the nutrition and development of a baby under one year old will inevitably affect his health.
From the age of five months, the baby moves more actively, and this consumes quite a lot of energy obtained from nutrition. Small failures and underweight during this period is a physiological norm.
Every newborn baby loses weight after birth. Of course, the weight loss of a newborn in the first days after birth is of great concern to many young parents. In order not to worry, you need to have an idea of what weight loss in a newborn is normal and what pathology.
In the medical documents of a newborn baby, two weight indicators are recorded, the one with which he was born and the one with which he is discharged from the hospital. The second indicator is usually slightly lower than the first. This is due to the fact that a natural process occurs with the newborn, which leads to minor weight loss and this loss is not a pathology. In the event that weight loss is within the normal range, then such a loss in medicine is called the physiological weight loss of a newborn.
What are the reasons for newborn weight loss? First of all, this is due to the fact that the baby loses fluid through the skin and lungs during breathing, excretion of urine and meconium, and the umbilical cord remains dry. Since the newborn at this stage still receives a small amount of milk from the mother, there is some discrepancy between the amount of fluid received and released by the baby's body. A huge role in the loss of fluid in a baby is played by the temperature and humidity of the air in the room.
As a rule, on the third day after birth, the newborn has maximum weight loss. Normal limits for weight loss are in the range of no more than 5-10% of body weight at birth. For example, if on average a newborn baby weighs 3.5 kg at birth, then a loss in the range of 75-350 g will be considered normal weight loss.
In the event that there was a premature birth, then the weight loss of the newborn can reach up to 15% of the initial body weight. Prolonged labor, birth trauma, complications in childbirth or the birth of a baby with a large body weight can be the reason for a greater weight loss in a baby. Some experts believe that pathological weight loss newborn the baby is mainly due to childbirth stress or improper care child com.
Parents need to remember that a newborn's weight loss is independent of the sex of the baby.
When should a newborn's weight recover and return to normal? In most cases, the restoration of the original body weight, which was recorded at birth, in healthy babies occurs closer to 7-10 (maximum 14) days of life.
If a newborn is breastfed normally, then in the first two weeks of life he should regain weight and gain an additional 125-500 grams.
Parents should be alerted to the situation when the newborn child significantly loses weight or when the restoration of the initial initial body weight of the child is delayed. This may be due to the child's health problems or may indicate a congenital pathology.
How to prevent pathological weight loss in a newborn baby? To do this, it is necessary to organize and plan the care of the baby as correctly as possible, to ensure the optimal temperature regime, and also to adjust the drinking regime, if the baby is needed. In order for a newborn's weight loss to be minor, it is very important to ensure that it is attached to the breast earlier and, best of all, if this occurs no later than 20 minutes after birth.
In addition, sufficient air humidity in the room where the newborn is located is of great importance, since the drier the air in the room, the more moisture the baby will lose with breathing and through the skin. Do not forget that the loss of fluid can lead to a violation of heat exchange in the baby, dry skin, mucous membranes of the nose, mouth, lungs, as well as to a violation of the body's defense mechanisms against viruses and bacteria.
That is why, it is necessary to make maximum efforts to ensure that the temperature in the nursery is at the level of 22-24 ° C, and the air humidity is at least 50%.
Occurs in 100% for 2-4 days of life and is normal 5 – 7 - 8% (maximum up to 10%) loss of weight at birth (in premature babies 9-14%). Recovery body weight by 7-10 days(in premature babies 2-3 weeks).
CAUSES:
Malnutrition in the early days
Excretion of water through the skin and lungs
Water loss in urine and feces (meconium)
Inadequate fluid intake
Regurgitation of amniotic fluid
Drying (shrinking) of the umbilical cord
Early breastfeeding
Feeding on demand
Prevention of hypogalactia
Body weight control
2. Physiological catarrh of the skin (transient erythema of the skin).
It appears as:
1.simple erythema
2.toxic erythema
SIMPLE ERYTHEMA.
This is a reactive redness of the skin (sometimes with a slight bluish tinge to the hands and feet).
CAUSE: reflex paretic expansion of skin vessels due to the powerful effect of environmental factors on the skin receptors of the newborn.
Appears in the first days of life, in mature full-term it lasts several hours, less often 1 - 2 - 3 days.
TOXIC ERYTHEMA.
This is a kind of allergic skin reaction of a newborn.
Arises on the 2nd - 5th day of life... It manifests itself in the form of a rash - hyperemic spots, papules, vesicles on the entire skin, except for the palms and feet. Disappears after 2 - 3 days. After erythema, small peeling occurs, sometimes large.
TACTICS of a midwife (nurse, paramedic):
Skin care
Hygienic bath with potassium permanganate solution
3.Physiological (transient) fever.
CAUSES:
Imperfection of thermoregulation
Insufficient fluid intake
Unstable water exchange
Overheating baby
Ingestion of E. coli endotoxins during primary colonization of the intestine
Appears on the 3rd - 5th day of life. Disappears after a few hours or 1 - 2 days.
SIGNS: T 38-39 degrees, anxiety, thirst, dry skin and mucous membranes.
TACTICS of a midwife (nurse, paramedic):
Uncover baby
Control of body temperature, condition
4. Physiological (transient hyperbilirubinemia) jaundice.
CAUSES:
Immaturity of liver enzyme functions
Massive destruction of fetal red blood cells (there are many of them in the fetus)
Elevated levels of bilirubin in the blood
The pigment of erythrocytes accumulates in the skin and mucous membranes, stains yellow
Appears for 2 - 3 days, maximum for 4 -5 days. Disappears by 7-10 days of life.
SIGNS: icteric staining of the skin and mucous membranes without disturbing the state of health.
TACTICS of a midwife (nurse, paramedic):
Additional drink of 5% glucose solution
Monitoring the child's condition
5. Hormonal (sexual) crisis.
CAUSE: the transition of the mother's estrogens into the baby's blood and milk
SIGNS:
1. PHYSIOLOGICAL MASTOPATHY(in boys and girls) - symmetrical engorgement of the mammary glands without signs of inflammation. There may be a grayish discharge from the nipples.
Appears on the 3rd - 4th day of life,disappears by the end of 2 - 3 weeks.
2. SCREAM SWEEPER in boys - symmetrical changes, appears in the first days of life, disappear without treatment by the 3rd day of life.
3. DESQUAMATIVE VULVOVAGINITIS in girls - gray-white, sometimes brown discharge from the genital fissure, appears in the 1st day of life, disappears by the 3rd day.
TACTICS of a midwife (nurse, paramedic):
In case of engorgement of the mammary glands - gentle care (do not injure this area)
Dry heat to the glandular area
With vulvovaginitis - washing girls
6. URINE KIDNEY INFARCTION.
This is the deposition of uric acid in the form of crystals in the lumen of the urinary tubules.
CAUSES:
Discharge of small amounts of urine
Enhanced decay of a large number of cells
Features of protein metabolism
SIGNS:
Changes in the appearance of urine (cloudy, yellowish-brown), after drying, brown spots and sand remain on the diapers
Decrease in the daily volume of urine output (physiological oliguria).
Appears on 3 - 4 days of life, disappears after 7 - 10 days(with an increase in urine output and leaching of crystals)
TACTICS of a midwife (nurse, paramedic):
Additional drink of 5% glucose solution
FEATURES OF PHYSIOLOGICAL STATES IN PREMATURE CHILDREN.
1.Physiological weight loss- 9 -14%, weight loss extended over time, recovery by 2 - 3 weeks of life
2. Physiological jaundice- occurs more often than in full-term (59 - 90%), the bilirubin content is higher (85 μmol / l), slower accumulation of bilirubin, slow maturation of enzyme systems creates a threat of bilirubin intoxication.
Kernicterus can be with indirect bilirubin 170 μmol / l; the decrease in bilirubin is slow, jaundice lasts 2 weeks or more.
3. Physiological erythema(toxic) lasts a long time.
4. Hormonal crisis practically not observed.
5. Transient hypothyroidism.