Hi Marco and others
Although the authors of this letter declare that they have no conflict of
interest, at least one of them has done research funded by Nestle (the
CUPDAY study), has presented this research at Nestle promotional events and
has allowed his work and image to be used in Nestle's promotional materials.
There was also an issue of Breastfeeding Review devoted to this issue
(perhaps last year) which is worth a read.
Susan's criticism is bang on the money. There is a problem here in
Australia (and in some other places, I believe) with health care providers
using growth references improperly - and as a result many infants
inappropriately fed infant formula. The issue is not with the WHO growth
reference but with the way health professionals use it. A tool like this
should not be implemented without accompanying education and training.
Nina Berry
AUSTRALIA
-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Marko Kerac
Sent: Tuesday, July 14, 2009 11:06 PM
To: [log in to unmask]
Subject: WHO growth standards - adopt but beware doing more harm than good
Dear Colleagues,
Interesting discussions are arising about the new WHO growth standards.
These should of course be strongly supported, but it's important to be aware
of how they diagnose growth in relation to the previously used references.
Differences are not always obvious. Being based on breastfed infants, it was
for instance widely expected that the new standards would "diagnose less
breastfed babies as growing poorly" (ref Protien Energy Malnutiriton,
J.C.Waterlow, 2006 reprint, pxx) The acutual situation may be more complex,
especially since longitudinal and cross sectional measures of growth capture
different aspects of a complex physiological process:
One thought-provoking reference for LACTNETers to be aware of will enable
appropriate growth counselling to avoid the pitfall of inadvertently
undermining rather than supporting exclusive breastfeeding:
"Will the new WHO growth references do more harm than good?"
Binns & Lee,
Lancet www.thelancet.com Vol 368 November 25, 2006, p 1868
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69772-9/fu
lltext
Exclusive breastfeeding for 6 months is
the normal way to feed all infants. The
new WHO growth reference released
in April, 2006, is based on breastfed
infants under optimum conditions.1
The sample is highly selected for the
factors likely to promote growth in
breastfed infants, and less than 10% of
those initially surveyed were included
in the fi nal study.
Most mothers and health professionals
are concerned about their
infants' growth, particularly for the
fi rst 6 months. If they believe their
infants are not growing adequately,
they are more likely to introduce
supplementary foods, including "topups"
with infant formula or even
switching to formula completely.
"Insuffi cient milk" is the most
common reason for the early cessation
of breastfeeding and mothers often
self-diagnose this on the basis of
perceived slower growth.
The new WHO growth references
show the maximum growth rates that
can be achieved with breastfeeding
under optimum conditions. But, for
the fi rst 6 months of life, the new
WHO growth references, for boys and
girls, are heavier than those produced
by the US National Center for Health
Statistics (which formed the basis of
the old WHO references) for every Z
score from -3 to +3 (see fi gure).2 The
diff erence is greater for weights below the mean, and it is in this region
of the chart that mothers are more likely to be anxious about the growth of
their infant.
The new WHO growth reference
is a triumph of modern statistical
techniques. But has the real purpose
been lost in the technology? What is
really needed is a growth reference
that presents growth rates that can be
realistically achieved during the fi rst
6 months of life and maximises the
duration of exclusive breastfeeding.
We declare that we have no confl ict of interest.
*Colin Binns, MiKyung Lee
[log in to unmask]
School of Public Health, Curtin University, GPO Box U1987, Perth, Western
Australia 6845, Australia.
1 de Onis M, Garza C, Onyango AW, Martorell R.
The WHO Multicentre Growth Reference Study:
planning, study design, and methodology.
Acta Paediatr 2006 450 (suppl ): S5-96.
2 WHO. WHO child growth standards:
methods and development. Geneva: World
Health Organization, 2006: http://www.
who.int/childgrowth/publications/technical_
report_pub/en/index.html (accessed Nov 7, 2006).
Also try:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61657-2/fu
lltext
With best wishes,
Marko.
Dr Marko Kerac,
Research Fellow & PhD Student,
UCL Centre for International Health & Development, 30 Guilford Street,
London WC1N 1EH, UK
email: [log in to unmask]
http://www.ucl.ac.uk/cihd/research/nutrition/mami
-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of LACTNET automatic digest
system
Sent: 14 July 2009 05:00
To: [log in to unmask]
Subject: LACTNET Digest - 13 Jul 2009 (#2009-698)
There are 2 messages totalling 63 lines in this issue.
Topics of the day:
1. disappearing jaundice
2. WHO Growth Charts
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Date: Mon, 13 Jul 2009 22:01:13 -0500
From: laurie wheeler <[log in to unmask]>
Subject: disappearing jaundice
I would say the baby was dehydrated (10 percent wt loss), the color can be
mottled and lousy until the baby hydrates, and I would say that is what
improved the color. If I remember correctly, visible jaundice usually
appears at levels of 5-6, and I don't think baby dropped from 9 to 6 in one
feeding. Just my humble opinion. But good news for your mom/baby anyway!
Laurie Wheeler RN MN IBCLC -- just returned from beautiful Florida Gulf
Coast Mississippi USA
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Date: Mon, 13 Jul 2009 22:35:30 -0400
From: Pat Bucknell <[log in to unmask]>
Subject: WHO Growth Charts
Kathleen,
I put the conversions on a computer generated mail label stuck to the bottom
of the charts, so when moms use them at my BF support group they know how to
to do it. I also happen to carry a pocket sized calculator with me. :)
Warmly,
Pat Bucknell IBCLC
Mother's Helper/private practice
Avon Lake OH
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End of LACTNET Digest - 13 Jul 2009 (#2009-698)
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