Clinical Inquiries

How should you manage an overweight breastfed infant?

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EVIDENCE-BASED ANSWER

There are several steps you can take. Monitor the growth of exclusively breastfed babies by plotting routine weights and lengths on the World Health Organization (WHO) growth curve (strength of recommendation [SOR]: A, systematic reviews). Reassure parents that higher-than-normal weight gain in infants who are breastfeeding easily without supplementation has no known adverse effects. Advise parents to change behaviors that result in overfeeding or insufficient physical activity (SOR: C, expert opinion). Refer parents to a lactation consultant to manage large volumes of milk that exceed the infant’s need. In the rare case of an infant who exhibits lack of satiety or dysmorphia, consider an overgrowth syndrome and seek an endocrinology and genetics consult (SOR: C, expert opinion).

Clinical commentary

Avoid comfort feeding, stress activity

Philip Reilly, MD

SeaMar Community Health Center, Seattle, Wash

I often see breastfeeding mothers who are concerned about their chubby babies, who have both a high success rate with breastfeeding and a high rate of type 2 diabetes as adults. When talking to these mothers, I first stress the importance of focusing primarily on nutritional feeding, not “comfort feeding.” I point out that evidence suggests that exclusive breastfeeding helps prevent adult obesity.

It’s also important to recognize that the epidemiologic shift toward increased obesity and diabetes has to do with the activity habits of children and adults, as well as their eating habits. As children grow, our advice should focus on encouraging activity, limiting “screen time,” and eliminating juices and other high-calorie dietary additions once an infant is no longer exclusively breastfed.

Evidence summary

An estimated 9.5% of infants and children younger than 2 years of age are considered overweight—that is, their weight is at or above the 95th percentile of weight-for-recumbent length on the sex-specific growth charts from the Centers for Disease Control and Prevention (CDC).1 The prevalence is unknown for infants who are exclusively breastfed2 or fed only human milk without any supplementation (except recommended vitamins, minerals, and medication) for the first 6 months of life.

Exclusively breastfed babies have a different growth curve

Because comparison growth studies demonstrate that healthy breastfed infants have a different growth curve than formula or mix-fed babies,3 the WHO growth curves (http://www.who.int/childgrowth/standards/en/), rather than the CDC charts, should be used to monitor the growth of exclusively breastfed babies.4 The WHO Working Group on Infant Growth studied infants whose sole nourishment was breast milk until 4 months of age.3 The CDC charts reflect a heavier and shorter sample of infants. Moreover, the WHO charts are based on shorter measurement intervals and may therefore be a better tool for measuring rapidly changing rates of growth.4

Evidence-based answers from the Family Physicians Inquiries Network

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