First, in defense of those who have posted about using the scale.  Almost every single post has 
mentioned that scales should never be used in isolation.  Like any tool, it must be used in 
connection with all the other data and never as an excuse to skip the history.  That is where you 
end up in the situation of many nutrition projects in developing countries where they focus on 
growth monitoring without promotion instead of the Tanzania experience which used it for 
empowerment of mothers and health care practitioners.

Second, I have seen many babies who look OK and are failing to thrive.  Lots who have come into 
the drop in support group who are still below birth weight at 3, 4, 5, 6 weeks of age and no one 
noticed without the scale.  Pediatricians saw one or maybe two weight checks and thought 
everything was fine and then something went awry and they never checked or asked questions 
again and the problem went undetected until far too late.  So, I think it is entirely feasible that a 
baby at 20 days could be missed without a weight check.  Most of the time the family and 
unfortunately health care practitioners as well think the baby is fine because the baby sleeps.  And 
yes, I always ask lots of questions to determine whether or not this is simply the slow gaining 
baby who is really doing fine.  What I find more frequent is that mom is concerned and many 
practitioners discount her worries and ignore them and it turns out she had reason to be 
concerned.

The worst case was the 4 month old premie who came into support group and was gaining within 
normal limits at the bottom rung of the weight gain spectrum (4 oz/week).  The baby wasn't 
meeting developmental milestones and slept a lot.  This was attributed to prematurity.  The baby 
simply needed to gain more.  The mother was furious when she realized that she should have 
been told to pump and her baby was eeking along.  The baby started to gain beautifully when she 
started pumping and supplementing and immediately woke up and started developing normally. 
All of this could have been prevented entirely by watching the situation more closely from the 
beginning with a few judicious weight and intake checks.

I do NOT think that there is a question of categories of LCs who use the scale, use it sometimes, 
or never use it that should be compared.  This woudl be a totally silly experiment.  It is more a 
question of learning how to use the scale appropriately, which means in context with all the other 
data that you collect and in such a way that mom is encouraged and learns to trust her own 
observations of her baby.  

As I have pointed out, using a scale inappropriately is a waste of time and money in large scale 
public health nutrition projects and sometimes even harmful if it detracts from intelligent decision 
making.  Used appropriately it can be empowering. 

Again, I am going to point out that the context of scale use is extremely important.  Just as I 
mentioned before about never getting a case of mastitis from working mothers off of an 
oversupply from pumping while others have actually experienced women getting mastitis after 
overpumping - it can always be due to differences in the populations that we see.

For instance, I want to read Magda Sachs work because (and she can correct me if my 
understanding from Lactnet posts is off) I think her work demonstrates a problem with 
inappropriate use of the scale.  It is not being used in context where women are given sufficiently 
empowering advice for them to take back the breastfeeding in a way that enables their babies to 
gain appropriately.  

I work in Manhattan - a high intervention environment with an overworking, overly controlling, 
sleep deprived prior to pregnancy, highly competitive environment.  Breastfeeding is like 
everything else here, you must "SUCCEED" in the RIGHT WAY and still be able to do everything else 
PERFECTLY.  That is not the population one works with in Australia where everyone is more 
relaxed or in Norway where women are not worried about going back to work at 2 weeks, 6 weeks, 
or 3 months as women worry here.  So, here, the incidence of iatrogenically induced problems 
where mom and baby are out of sync and so intake becomes an issue is probably much higher 
than in Australia or Norway.

So, on a public health scale if one were to think about interventions - it might be like the 
generalized recommendations that one has for mammograms.  For mammograms they have a 
general recommendation that you get it at a particular age because that is when more women are 
likely to have problems.  One might have recommendations about particular target populations 
where routine screening of "intakes" should be done.  But this would NOT work if those doing the 
screening simply looked at the numbers.

Now, on an individual level we really do need to think differently.  Women are coming to those of 
us in private practice because they have problems.  These women exist in all populations.  In 
populations where the culture is more conducive to on cue feeding you are probably going to see 
more babies failing to thrive from real medical conditions as opposed to iatrogenically induced 
problems. If you can only spend 30 minutes or less per client for a consultation in a hospital or 
clinic setting, I think it is challenging to manage to ask all the questions to get the entire context 
to determine whether a baby's intake indicates an overall problem or just a feeding that is not as 
good as most feeding.  When you can spend 90 minutes to 3 hours with a client, then you have 
time to do that in depth exploration.

Training of mothers and health care practitioners in the Tanzania experience was key to how well 
growth monitoring and promotion worked.  It is expensive and time consuming.  The money spent  
in other projects that focused on MONITORING was wasted money.  More of the focus of training 
has to be on how to link the PROMOTION part to the data from growth monitoring as well as in-
depth exploration of feeding patterns, food availability, cultural and familial beliefs than on the 
monitoring.

So, this is key for using a weighing scale.  I think if you look at the failures in its use, you will find 
that training in the use of the scale focused on the mechanics of the scale and the numbers and 
not the more important aspect of how to collect all the other information needed.

On the other hand, my colleagues all come from nonmedical backgrounds and just because they 
question everything and analyze everything they seem to have just figured this out without 
training.

Best, Susan

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