I really appreciated Jack's musings about being careful about rules about
weight loss, and in considering that errors can be made in weights.  I see
that occasionally, too, and it certainly speaks to our responsibility to
keep our scales calibrated and to pay attention to what we are doing.

I believe I posted about my theory on all these rules before, but the
discomfort our profession (and probably other professions as well) feels
about rules and when to break them is explained by adult learning theory.
Novices (and this is not a put-down word -- everyone starts out as a novice)
are rule driven.  They must learn their craft and do so by following the
guidelines established by those who have gone before them.  They must
constantly reference what they see with their theoretical knowledge, because
everything is new.  For the first 5 years I was in priv. practice I lived in
terror.  I knew I didn't know enough to be turned loose, and I read
compulsively trying to make sure I wouldn't hurt anyone through my ignorance.

Now that I have been in priv. pract. ten years, seeing an average of 400
babies with problems each year,  I have seen most things at least twice, and
many problems so many times that I now have some predictive abilities.  Many
of the decisions I now make are almost "intuitive."  That is how learning
theory describes expertise.  At more advanced levels of practice, people
often break the very rules which guided them and protected their clients in
the beginning. And my motto always has been:  if you keep on practicing
anything long enough, you just might get good at it. So perhaps we need to
acknowledge that there are people practicing our profession at all different
levels.  Some of them temporarily need the structure of the rules and
supervision. Some appear to get stuck in a rut where they don't want to
learn more or new information once they process the "rules."  But all are
called to grow, because our purpose is to assist mothers breastfeed infants,
and this takes art and science.

  Certainly, the normal picture for normal infants is to begin to nurse
robustly shortly after birth, and not to lose a great deal of weight.  How
we manage the infants who don't conform to THAT rule, is best decided on a
case by case basis.  Jack's final point, which is that these babies need
very close, early follow-up, is right on target.  These babies are often
given formula the same way pre-schoolers are often given a spanking when
they misbehave.  Its a short cut for taking the time to really get in there
and manage a situation.

Lactnet is such a great teaching forum.  I invite the experts on the list to
try to describe the decision-making processes they use in evaluation and to
describe their rationales for managing various problems.  I used to corner
people who knew more than I and MAKE them tell me WHY they did things the
way they did.  Its a great way to increase expertise and share it.

Barbara



Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html