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  3. Low Weight Gain — Assessment and Feeding Plan Adjustments
Course Content
Why Breastfeeding Matters (10 minutes)
Health and developmental benefits for infants Maternal benefits (physical and mental) Economic and community-level advantages Common myths and culturally specific misconceptions
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Health & Developmental Benefits for Infants from Breastfeeding
Maternal Benefits of Breastfeeding (Physical and Mental)
Economic and Community-Level Advantages of Breastfeeding
Common Myths and Culturally Specific Misconceptions about Breastfeeding
Newborn Feeding Cues & Anatomy (20 minutes)
Early vs. late hunger cues and what they mean Normal newborn feeding patterns and stomach capacity Brief breast anatomy (lobes, ducts, nipple, areola) in plain language Signs of effective feeding (swallowing, contentment, diaper output)
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Early vs. Late Hunger Cues in Infants
Normal Newborn Feeding Patterns and Stomach Capacity
Breast Anatomy (in Plain Language)
Signs of Effective Feeding in Breastfed Babies
Positions & Achieving a Good Latch (40 minutes)
Position options: cradle, cross-cradle, football/clutch, side-lying Stepwise approach to help baby latch (prepare — attach — assess) Signs of a good vs. poor latch (comfort, nipple shape, audible swallowing) Small-person adaptations (premature, small mouth, tongue-tie considerations) Safe positioning for mothers with C-section recovery
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Position Options for Breastfeeding
Stepwise Approach to Help Baby Latch
Signs of a Good vs. Poor Latch
Small-Person Adaptations in Breastfeeding
Safe Positioning for Mothers with C-Section Recovery
Protecting & Building Milk Supply (25 minutes)
Establishing supply in the first days and weeks (frequency, skin-to-skin) Night feeds and cluster feeding explained Lifestyle and medical factors that reduce supply (e.g., certain medications, stress) Relactation and increasing milk supply safely Nutrition and hydration myths vs. evidence
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Establishing Milk Supply in the First Days and Weeks
Night Feeds and Cluster Feeding
Lifestyle and Medical Factors That Reduce Supply
Relactation and Increasing Milk Supply Safely
Nutrition and Hydration Myths vs. Evidence in Breastfeeding
Expressing & Storing Breastmilk (20 minutes)
Hand-expression steps and common mistakes Choosing and using pumps (manual vs. electric) — practical tips Safe collection, labeling, storage, thawing and warming guidelines (low-resource options included) Cleaning and hygiene for bottles and storage containers Feeding expressed milk to infant (cup, spoon, paladai, bottle considerations)
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Hand-Expression Steps and Common Mistakes
Choosing and Using Breast Pumps (Manual vs. Electric)
Safe Breast Milk Handling
Cleaning and Hygiene for Bottles and Storage Containers
Feeding Expressed Milk to Infants
Common Problems & Practical Solutions (25 minutes)
Causes of sore nipples and immediate relief techniques Managing engorgement and preventing blocked ducts Recognising mastitis vs. normal engorgement and when antibiotics may be needed Low weight gain: assessment steps and feeding plan adjustments Non-judgmental approach to supplementation and safe short-term options
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Causes of Sore Nipples and Immediate Relief
Managing Engorgement and Preventing Blocked Ducts
Recognising Mastitis vs. Normal Engorgement
Low Weight Gain — Assessment and Feeding Plan Adjustments
Non-Judgmental Approach to Supplementation
Returning to Work or School; Feeding Outside the Home (15 minutes)
Creating an express-and-feed routine (timing, containers, transport) Practical storage and transport tips for different commute types Rights and workplace basics (general guidance; encourage local legal verification) Communicating with caregivers and preparing safe feeder notes Emotional coping and practical fallback plans
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Creating an Express-and-Feed Routine
Practical Storage & Transport Tips for Expressed Breast Milk by Commute Type
Rights and Workplace Basics for Breastfeeding Mothers
Communicating with Caregivers and Preparing Safe Feeder Notes
Emotional Coping and Practical Fallback Plans
Special Situations (20 minutes)
Feeding preterm or low-birthweight infants: kangaroo care, cup or tube feeding basics Managing twins/multiples: tandem feeding tips and time-saving routines Mothers on medication or with infectious illness: how to check drug safety and local guidelines (HIV, TB, etc.) Using donor milk or milk banks (where available) — safety basics
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Feeding Preterm or Low-Birthweight Infants
Managing Twins/Multiples — Tandem Feeding Tips and Time-Saving Routines
Mothers on Medication or with Infectious Illness — Drug Safety & Guidelines
Using Donor Milk or Milk Banks — Safety Basics
When to Seek Help & Building a Support Network (15 minutes)
Red flags for baby and mother (e.g., poor weight gain, fever, severe pain) Where to seek help: clinic, CHW, lactation consultant, emergency care Building a support network: partners, family, peer counsellors, community groups Using telephone/text supports, community groups, and referral pathways
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Red Flags for Baby and Mother
Where to Seek Help for Breastfeeding Challenges
Building a Support Network for Breastfeeding Mothers
Using Telephone/Text Supports, Community Groups, and Referral Pathways
Wrap-up, Resources & Final Assessment (15 minutes)
Key takeaways and common pitfalls to avoid Next steps: seeking local support, advanced training options How to use course materials beyond the course (groups, sharing, peer support) Final 20-question multiple-choice quiz (80% pass mark)
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Key Takeaways and Common Pitfalls to Avoid
Next Steps — Seeking Local Support & Advanced Training Options
How to Use Course Materials Beyond the Course
Final 20-question multiple-choice quiz (80% pass mark)
How to Breastfeed — Self-Paced, Evidence-Based Course for African Moms

1. Introduction

Breastfed babies grow at different rates, but consistently low weight gain may signal ineffective feeding, health issues, or maternal milk supply concerns. Early recognition and structured management help babies thrive while supporting continued breastfeeding.

2. Defining Low Weight Gain

  • Normal patterns:

    • Expected weight loss in first few days: up to 7–10% of birthweight.

    • Regain by 10–14 days.

    • Double birthweight by 4–6 months.

  • Red flag: Baby not regaining by 2 weeks, or poor gain thereafter (<20–30 g/day in first 3 months).

3. Assessment Steps

Step 1: History Taking

  • Feeding history: Frequency (8–12 feeds/day?), duration, latch quality.

  • Maternal health: Supply issues, medications, stress, diet.

  • Infant health: Prematurity, illness, reflux, infections.

  • Environment: Access to support, cultural practices, use of formula/water/herbs.

Step 2: Observation

  • Observe a full feed → latch, position, swallowing.

  • Check nipple shape post-feed (pinching suggests poor latch).

Step 3: Physical Examination

  • Plot weight on WHO growth charts.

  • Assess hydration (urine/stool output, skin turgor, fontanelle).

  • Look for congenital anomalies (tongue-tie, cleft, cardiac/respiratory issues).

Step 4: Milk Transfer Assessment

  • Test-weighing (before/after feed weight).

  • Diaper counts (≥6 wet diapers/day by day 5).

4. Feeding Plan Adjustments

  • Improve latch and positioning

    • Correct attachment is the single most effective intervention.

  • Increase feeding frequency

    • Offer breast every 2–3 hours, including waking baby if necessary.

  • Switch nursing

    • Offer both breasts per feed, switching sides when swallowing slows.

  • Breast compression

    • Gently squeeze breast during suckling to help milk flow.

  • Night feeds encouraged

    • Especially important in first 6–8 weeks.

  • Monitor maternal supply

    • Encourage skin-to-skin, frequent stimulation, hand expression after feeds.

    • Consider galactagogues only under medical supervision.

  • Expressed milk supplementation

    • If poor gain persists → hand-express/pump milk after feeds and give by cup/spoon.

    • Avoid bottle introduction early unless necessary.

  • Medical causes ruled out

    • Persistent poor gain → refer for evaluation of illness, malabsorption, metabolic disease.

5. When to Escalate

  • No weight gain despite optimized breastfeeding.

  • Signs of dehydration or lethargy.

  • Underlying medical conditions suspected.

End of Lecture Quiz

Q1. By what age should most infants regain their birthweight?
A. 5 days
B. 10–14 days
C. 1 month
D. 2 months

Answer: B. 10–14 days
Rationale: Persistent weight below birthweight after 2 weeks requires further evaluation.

Q2. True or False: Watching a full breastfeed is part of the assessment of poor weight gain.
Answer: True
Rationale: Direct observation of latch, position, and swallowing reveals the most common causes.

Q3. Which of the following is the first step if weight gain is low?
A. Start formula immediately
B. Correct latch and increase feeding frequency
C. Stop breastfeeding
D. Order blood tests for the infant

Answer: B. Correct latch and increase feeding frequency
Rationale: Most cases resolve with improved breastfeeding technique and frequent feeding.

Curated Online Resources

Key Takeaways

  • Most low weight gain cases stem from feeding technique or frequency, not low milk supply.

  • Stepwise assessment (history, observation, growth charting) is crucial before interventions.

  • Feeding plans should focus on latch correction, frequent feeds, and expressed milk if needed.

  • Medical evaluation is needed if no improvement or if infant shows dehydration/illness signs.

Call to Action

  • Mothers: Track baby’s weight and diaper output — seek help early if gain is slow.

  • Health workers: Always observe a feed before recommending supplementation.

  • Communities: Support breastfeeding mothers with time, privacy, and reassurance.

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