Myself and other LCs I know in the USA use test weights ONLY IN PROBLEM
SITUATIONS. This is not a routine practice and should not ever be used, in
my opinion, for the "normal" or "usual" breastfeeding dyad.
Once a problem presents itself, like large weight loss, poor weight gain,
for example, a test weight might be used to determine intake at a feed. The
LCs I know realize that said feed is only a "snapshot" and may or may not
represent a typical feed, and that feeds vary so there is really no
absolutely "typical" feed.
An example cited recently on lactnet was a probable oversupply case, where
it was mentioned the LC has seen a baby consume 4 or 5 oz in 5 min. Another
example, would be a premature infant getting close to discharge home to see
if he is really transferring much milk, or to determine how much, if any,
complement needs to be given after a breastfeed.
I have used a test weight once to show a nurse that a baby was not
transferring milk. This was a preterm infant about to go home, I was
recommending pumping and alternate feeding in addition to the at breast
feeding, and the nurse felt I was undermining the mom's confidence. The baby
had lost more weight than I thought appropriate, was jaundiced, and I saw no
to very little swallows. The milk transfer was 2cc.
I have also used the test weight to show a mother with breast reduction
surgery that the baby needed additional milk. This baby had gone home, was
losing weight (about a 4lb baby to start with) and mother beleived he was
doing well. Pediatrician was not going to see the baby again til 2 mos old.
I had advised breastfeeding plus alternate feeding but mom really wanted to
give baby the breast only. I was following them carefully and of course
encouraging the breastfeeding but with alternate feeding and additional
milk. Of course we were working on maximizing her milk production as well. I
was really scared for this baby. The test weight demonstrated to the mother
that the swallows were not amounting to much milk at all. This is not a fun
consult and I do not like these situations, but I believed the baby would be
in danger otherwise.
Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA
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