Barbara W-C writes:
>I appreciate Heather's balanced response to the growth issue. She is
>correct; the WHO data is not all in, but the ref. Dr. Neifert refers to in
>the Clinics in Perinatolog article is:
>Dewey, K, Peerson, J, Brown,K, et al. Growth of breastfed infants deviates
>from current reference data: A pooled analysis of US, Canadian, and
>European Data Sets, Pediatrics 1995, 96:495.
Thanks, Barbara, I will check this out.
>
>Here's my own opinion. Failure to feed robustly (which ought to be reflected
>by growth and health) is rapidly recognized as a symptom in animals or the
>elderly. I maintain that this is the case with newborns.
I agree, and I have some concern that (here, at least) some HPs are *too
casual* about breastfeeding that takes a while to get going - this is
partly due (I think) to the way mothers are cared for here. They see
hospital midwives up to day 2 or 3, community midwives up to day 10 or 11
and then health visitors who tend not to see them anything like as often.
No single professional or profressional group has a continuous view, and
any problems just get passed on. So a baby not feeding well on day 3
quickly becomes the community midwife's issue and if she doesn't know how
to respond within another few days it's the HV's remit.
This has led to (in my experience) a number of situations where ineffective
feeding has been allowed to persist, even when the mother has asked for
help because she knows it shouldn't be like this. She may get no more than
professional reassurances that she should just carry on doing what she's
doing. Then (because babies are weighed infrequently here compared to the
US) there is a mega-panic at 4, 5 or 6 weeks when the baby is finally
weighed....
But if there is concern in the early days, it's not weight that should be
the issue, but the effectiveness of breastfeeding, which can only be fully
assessed on listening, and observing.
>I agree with Heather. Each baby needs an individual approach. I saw a 37
>weeker a few days ago who had been referred to me by an anxious pedi who was
>concerned when baby dropped about 9% of birthweight. Baby was under 6 lbs
>at birth and this loss was a concern. On Day 8, with exclusive bfg. baby
>was back within an ounce of birthweight. She is still small, sleepy, and an
>inefficient nurser who takes a lot of time to complete a feed. Yet beyond
>improving mother's latch a bit, I proposed no intervention beyond a bit of
>postfeed pumping (since she has a pump) to keep her supply well stim.
No argument there at all with this!
Heather Welford Neil
NCT bfc Newcastle upon Tyne UK
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