I totally agree susan. I had a mom at a a walk-in session yesterday. Her baby seemed to be guzzling only to find no weight change on the scale after feeding and this was a baby who has been supplementing, feeding every 2-3 hours but not reached his birth wieght after 20 days of life.
The parents came in only to get the "latch checked" because everything else was fine.
Tamara Hawkins RN, IBCLC
NYC
Susan Burger <[log in to unmask]> wrote:
Dear all:
First, I feel that I come from a very different background from most US-based LCs. I have the
utmost respect for those of you who deal with babies in the hospital. I could never do it. We each
have our niche and I prefer working with the long-term breastfeeding relationship that occurs
when a woman is at home (after a delivery there) or after she returns home from the hospital.
So, I consider myself nonmedical. As a nutritionist, however, my observations of the use of
anthropometric measurements (weights, heights, lengths, head circumference, etc) I have seen in
my own and other pediatrician's offices in Manhattan would never past muster in terms of how I
learned these techniques for my work in developing countries. I actually think the average health
care worker AND mother in Tanzania could do a better job with a hanging scale and their TRIPLE A
cycle of Assessment, analysis, action (Don't know what they call it in KiSwahili). So, I do not
consider the general medical estabishment here in Manhattan to be the best users of weighing
scales.
Also, I worked from 1999 to 2004 without a scale watching many babies suck swallow patterns.
So, I consider myself quite experienced in watching the natural rhythms of swallow.
Nevertheless, I still urge some of you to reconsider the scale on the basis of what I call the stealth
feeders and the fakers. I defy anyone to spot these babies in action by watching and listening
alone.
The faker is the baby that sounds as if s/he were gulping away, big deep jaw drops, vigorous
movements. This is the baby often sticks the tongue up to the roof of the mouth and is probably
gulping down saliva. I've seen babies that I would have sworn were taking in a good 3 oz only to
discover they took minimal amounts or nothing. I usually weigh these babies 2 or 3 times to
convince myself that my measurements are accurate. I am sure that some of you will sometimes
be able to spot that tongue up, but I don't think anyone is good enough to detect this all the time.
The stealth feeder. This one is really ingrained in my head because I saw one of these just before I
got my scale. I swear he looked like he was taking nothing. No sounds, slight quick jaw quivers,
barely moving and totally lethargic. I was so nervous that I ran downstairs in a duplex apartment
to drag up the syringe and tube to try to feed him more. When I got back upstairs he was conked
out unwakable. So, I bit my nails for 2-3 days before the mom took him into support group. He
was fine. How many of these babies are given unnecessary supplement?
The scale enables you to more appropriately assess these types of babies so you are intervening
earlier for the faker before this baby fails to thrive and may be subjected to formula that would
otherwise have been unnecessary or unecessarily supplementing a stealth feeder.
In Manhattan we have the luxury of having a dearth of LCs for the population and a high income
population so we can readily cover the cost of our scales. In other areas for the mom that insists
on the scale for those of you who don't like to carry one, one could always charge an additional
fee for test weighing. I know that pediatricians charge $50 for a test weigh on the Upper East Side
of Manhattan.
Think about this. Do we consider pediatrician too medicalized for using a stethoscope? Do we
expect them to diagnose purely on the basis of what they hear through the stethoscope? The
scale is a tool, useful when used appropriately, not useful and sometimes harmful when not used
appropriately.
Makes me think we should have a session at ILCA on appropriate use of the scale so it won't be
such a hot topic anymore.
Best regards, Susan Burger
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