You are not going to be able to convince any of these doctors. But part
of the fault is ours as well. We have bought right into the percentage
weight loss stuff, the 20 minutes per side, the every three hour stuff,
and the physicians are trying to protect their legal bottoms. I have
always been 100% against percentages. They are irrelevant! A baby who
breastfeeds well, will come up even he loses 12% of his body weight. A
baby who breastfeeds poorly, will not gain weight even if the scale says
he lost only 4%. And if there is a concern, the first thing we should do
is fix the breastfeeding, not supplement. See breastfeeding decision
tree in June 1996 JHL.
And we are so, so sure of the bloody scales, aren't we? Well, I saw a
baby who was 2.8 kg (6lb 1oz) on Monday, and reweighed on Tuesday, the
next day, (albeit on another scale) and weighed 3.2 kg (just over 7lb).
Was I happy about the weight gain? No. If it had been the other way
around, would I have had a kinipshin? No. I was happy that at least
this mother and the students observing at our clinic would really
understand the value of scales in the short term.
What is relevant is that the baby was drinking milk like a trooper
drinks beer (open‹pause-close type of sucking) for long periods. Thus I
knew the baby was getting lots of milk and I couldn't care less which
weight is the "right" one, because I knew he would gain weight.
Babies can be observed drinking on day one. If they drink, that's good.
If they don't, fix the latch, use compression, if there is a problem
(long feeds, sore nipples), but we still have time. But the ones that
are not need to be observed carefully, and they need to be followed up
closely on the outside. Luckily, most will be fine, but you can't weight
(hee hee) 2 weeks, you gotta see them in the next 24 to 48 hours.
Jack Newman, MD, FRCPC
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