Our own Magda Sachs has co-written a cogent article on the issue of weight
loss in poorly feeding breastfeed babies and the insights she shares on test
weights (drawn from thoughtful analysis of the existing research) are worth
a read. Sachs M and Oddie S:  MIDIRS Midwifery Digest 2002, 12(3):296-300.
Magda's use of the Cochrane Data Base to select references to support her
conclusions makes the article particularly strong in terms of reliability
(in my opinion.)

She includes an excellent list of the risk factors for ineffective bfg that
put infants at risk for poor intake.  She describes the lack of any research
(only anecdotal reports) to substantiate that weighing is stressful to
parents.  What seems stressful is the arbitrary weighing on clearly
inaccurate scales for no useful purpose.  I agree with this conclusion.

However, when a baby has lost a significant amount of weight (at this point
in history rather arbitrarily set at 10%) then weighing becomes part of a
COMPREHENSIVE evaluation of feeding.  The scale must be accurate, the timing
of weights appropriate, and the usefulness of the information derived from
the weights must be communicated to the parents.  In other words, that
information becomes a gauge of what action the parent must take to insure
the intake of the baby.

There is an amazing quote from a new study by Anne-Marie Widstrom et al in
the most recent JHL.  They state with regard to the effect of
supplementation on maternal confidance and ultimate duration of bfg:  "The
supplementation of a baby for medical reasons did not impair the duration of
of breastfeeding, but supplementation without medical reasons did."  (JHL
2003; 19(2):176.)  I believe the same can be said for *test weighing* for
medical reasons.  As Maria Ramsey states , mothers generally know within 3
days that their baby has a feeding (hence intake) problem. Ramsey,M and
Gisel,E:  Neonatal Sucking and Maternal Feeding Practices, Dev Med and Child
Neurol 1996, 38:34-47.

Ramsey says that  these mothers swiftly begin compensating.  Their
compensations may take the form of very assertive waking, freq. feeds etc
and soemtimes early supplementation.  I see these mothers not as waffling on
their intention to bfeed, but as sensitive and acutely aware of their infant
being in trouble.  These mothers, in my experience, welcome real information
about intakes (achieved by weights on an accurate scale) and as the weights
improve (as the direct result of improvments in the status of the infant in
response to effective bfg management interventions) the weights become the
mechanism for reassuring the parents that the crisis is over and the baby is
competant to feed normally.  At this point interventions can be withdrawn.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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