Dear all:

I think the use of any tool is highly dependent upon the skill of the user and how the tool is being 
used.  One of the most important empowering experiences with the use of scales was in Tanzania 
with a project funded by SIDA, the Swedish International Development Agency.  This experience 
clearly showed that growth monitoring and PROMOTION (the latter bit is key) that was run by the 
mothers themselves empowered these women to problem solve really was terrific.  They did a 
terrific job at solving their infant and young children's problems when their weight faltered 
because they were enabled to do so.  

Now, there are very many nutrition projects that got so involved with the charts without thinking 
of the meaning of the charts where the growth monitoring itself was totally irrelevant and didn't 
solve anything.  You could have achieved the same results without the growth monitoring.  The 
difference was that there was no link between the problem solving aspect and the monitoring.  It 
was just an activity for health workers that had nothing to do with the advice dispensed.  

One of my colleagues from my nutrition days, Marie Ruel,  did a terrific review of the differences 
between appropriate use and inappropriate use of growth monitoring and promotion.  The 
IMPLEMENTATION of the process of growth monitoring and evaluation makes a huge difference in 
the results.

I always use a scale and it is for me one tiny bit of information in the overall picture of all the 
other observations I do.  I'd say most mothers are reassured by the scale and I use the results as a 
tool to teach them how to watch their babies and focus on how their baby is swallowing using 
other observations - sight, sound, feel.  

Also, it is absurd to even consider a study that uses looking at a line on a bottle as an accurate 
measure.  By no means should this ever be used as a gold standard.  Makes me want to line up a 
whole group of IBCLCs at ILCA and make them "read" a bottle and then show the huge coefficient 
of variation from that process.  There is a huge body of literature in anthropometry that has been 
developed over the accuracy of the triple weigh averages which is how the scales accurate to 0.1 
oz function.  This is not just for test weighing babies, but in all areas of science that deal in small 
weights with scales.  

How many tools have we discussed on Lactnet?  All of tools have their flaws and advantages 
depending upon how they are used.  

Best regards, Susan Burger.

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