Liz writes:
I do not think of test-weighing (as in: Weigh the baby before, and after,
a feed-at-breast, using a scale sensitive to 1/10 ounce, without changing
diapers, clothes, etc.) as an "intervention;" I think of it as
"asssessment."
There are many means of competently assessing milk transfer and intake.
Test weighing is one of them. It tends to be a regular part of assessment
in some countries, and not-so-much in others.
When I wear my private practitioner hat in the USA, I do a test weigh each
and every time I have a consult with a dyad ... because I usually see them
in the two-week time frame after hospital discharge, and after the
expected milk surge of Lactogenesis II has occured. Of course, it is just one
feed I am getting a snapshot of, but the baby's outward behaviors have fooled
me enough times that I like to have the data from the weight as well.
~~~ I chime in here to agree and expand. I've seen many babies who appear
to be swallowing, or are gulping and stressed, but their milk transfer is
not normal, even poor, or almost nil. They may have limited tongue
movement/power due to restriction, recent release and/or tight or asymmetric muscle
function, larnygomalacia, low stamina of early-baby issues. I've also met
some "stealth swallowers" who don't seem to have much rhythm or aren't awake
yet are moving milk well, or at least much better than it appears. I've
seen babies making a wet sort of noise and I pointed out that that was the
sound of the baby trying to get the tongue to do what it needed to do, and
losing suction over and over, mom said everyone had told her that was the
sound of the baby swallowing really well. A test weight showing 0.3 helped
the mom understand ( with my framing) how much her baby was willing to work,
how breastfeeding was important and they have a nice relationship going,
but also why the baby wasn't gaining( at 3 weeks of age already), why
"feedings" took up to 3 hours, and help us come up with a plan for feedings that
helped the baby get a reasonable amount of food in a reasonable amount of
time, etc. This gives the mom and I the information to help her plan, even
though it went against the pediatrician, other HCPs, community support
suggestions, etc to "just take away the supplement and make her breastfeed
more." Test weight, if it can work, can also show a mom how much or little a
baby is losing around feedings, either at mouth corners from poor seal, or
when refluxing afterwards. A mom can see why her little baby "drinks" a 3
1/2 oz bottle, when 1/3 of it actually caught in the cloth over the baby's
chest and that she is not overfeeding ( doctor said mom was overfeeding the
baby...) or that that "huge" reflux episode actually amounted to 0.2 oz, not
the "whole feed." So, as one part of a very thorough assessment and
information-clarifying sharing time, the scale can be very helpful. There are
local IBCLCs who still rarely use a scale, but I like the information it
provides, part of a very big picture, and often showing us things we couldn't
see clearly any other way. I admit this may be a very US-centric viewpoint.
Then again I am a nerd and like both the tight focus and the big picture...
:)
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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