Weighed feeds and why I don’t (usually) do them.

Lactation and infant feeding care is really in its infancy and we have many SOC (standards of care) that are built on NICU and inpatient practices which don’t really apply for outpatient and extended care. 

Weighed feeds can be an example of one of the practices which may apply for really young babies, in NICUs, and in patient settings but have limited usefulness in outpatient care. I rarely do weighed feeds and that is surprising to some parents. Why don’t I do weighed feeds that often?  Because they really only tell me one thing: how much milk baby took that one time. They don’t tell me how feeding is going overall as each feeding a bit different.  The first AM feeding is different than the late evening feeding.  The feeding on Monday is different than the feeding on Tuesday.

When we do a weighed feeding it’s often at a scheduled time which is not on the baby’s clock, in a place which is different than where baby may be feeding at other times, and since I’m standing right there, I’m making adjustments in the moment and giving suggestions which may impact the milk transfer.  It’s not a true measure of anything except how much milk baby took at that one feeding.

Honestly, it’s a little lazy to do a weighed feed and use it to make clinical recommendations.  We should be looking at feeding over time, growth, signs of satiety, stooling/voiding, infant behavior, and so much more.

When we do a weighed feed and baby takes a lot but their overall growth has been slow, we can’t use that data on its own to make a care plan.  Historically, that baby has not feeding well and once they go home we cannot be sure they will transfer that volume every time.  The most we can do is say, “That was a great feeding!  Let’s set a time for another follow up to see if this trend continues.” If baby takes a small feeding at our visit but has historically been growing well, parents are disappointed even though their baby has been growing well.  Approaches that focus on weighed feeds get parents looking at numbers and scales.  It increases anxiety and reduces parent child connection and watching non-verbal communication and signs of satiety.

Many parents buy scales and anxiously use them every day or before and after every feeding not knowing that typically available scales can be off by 1 or even 1.5 oz making them pretty useless for closely tracking weights.   If the only thing parents have to track their baby’s progress is a scale but not information to understand what an effective feed looks like & what a satiety baby behaves like they are stuck using an ineffective and inaccurate tool which often just feeds anxiety.

Now, all this is not to say that I never ever use weighed feeds.  They have a time and a place but if this is the biggest tool in your toolbox, please go explore and find some more to expand the work you can do.   Try leaning away from weighed feeds and see how it transforms your practice and how parents can grow and become more confident reading their babies.