I accept  the valid points that Heather and Karen are making about scales
and the issues about whether they are accurate, calibrated, used correctly,
not sat on by toddlers or used by unskilled people, or the baby is weighed
with a diff. scale next day, etc.  But you can't claim that a protocol is
not useful when it isn't used properly.  I hate to come across as the person
who is always defending technology or tools when my own practice has gotten
simpler and simpler in terms of what I use to teach and to assess.  I do
home visits carrying one small bag with no equipment other than non-latex,
non-powdered gloves, some peridontal syringes, a few nipples shields and my
very expensive, very well calibrated baby scale. I do everything else I  do
with just my eyes, my hands, and my brain.

There is no particular point to weighing a baby who is obviously thriving.
I do not see those babies.  I see very marginal infants, some really
struggling.  I submit that these babies are quite commonly weaned very
quickly to the bottle because they so clearly are doing poorly at breast.
Many very skilled private practice LCs  intervene in these situations and
salvage them, but these cases are not managed the way one can manage less
critical cases.

 If the baby had on a bib with spit up on it at the first weight, that must
stay on for the postfeed weight. If a bootie drops off, or the diaper gets
changed, or whatever, you will get a different reading.  And in the
confusion of a consultation, such things are possible even with experienced
practitioners.  I always insist and follow up personally to see to it that a
second weight is performed within a few days on the same scale (either mine
or the same scale at the doctors that the baby was weighed on prior to
referral to me) in order to get an interval weight.  I have more confidance
in the "snap shot" weight I've taken if I can also have the interval weights
to provide info on whether the intervention to salvage bfg is working for
the baby, as reflected in improved growth.  Just because this takes time and
effort to coordinate doesn't make it impossible, and it ought to be the
standard of care.  Weights are not the only information one needs, but with
poorly feeding infants, they give a piece of the puzzle that can be useful
for planning and monitoring.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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