Dear all:

I highly urge those of you who work in pounds and ounces to use the very useful tip of 
sticking the pounds and ounces on the WHO growth charts whenever mothers of three to 
six month olds are being told to supplement.

I just had a case of a six month old in my group yesterday.  She was bright, inquisitive 
and very active physically.  The "very active physically" is a good clue that caloric intake 
is fine.  Every study that I ever read that looked at intake, energy expenditure and 
growth shows that the first thing to go when caloric intake is limited is energy 
expenditure.

The pediatrician was very concerned about this baby thanks to the old growth charts 
which showed the baby slipping down to the 1st centile.

I diligently plotted every weight check against the actual numbers for the 3rd, 5th and 
15th centiles in the WHO tables.  

The pattern showed that there was a dip from 15th at birth to 5th centile in the second 
month of life.  

This may have been due to inadequate intake or merely regression to the mean.  
Regression to the mean is the phenomenon whereby measurement error will always 
produce estimates that are higher and/or lower than the actual values.  Therefore, at the 
fringes of the measurements you will always have some falsely high or low values.  On 
the next measurements, these will tend to go back to the middle.  

The other reason why you will see babies moving is that birth weight is not predictive of 
future growth.  Some babies will normally grow at a slower rate and drop out of their 
birth percentile and this is normal.

Now, moving forward, this baby bounced around between the 3rd and 5th centiles from 2-
4 months of age actually crossed above the 5th centile at the last weight check. 
Regardless of what happened in the 2nd month, this baby is actually slightly increasing 
her rate of growth compared to the reference.  Clearly a different picture than what the 
pediatrician interpreted from the NCHS standards.

So, this confirmatory information will reassure the mother even though the baby's 
development and behavior had already demonstrated to me all I needed to know. 

Best, Susan Burger

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