Dear Karleen:

I beg to differ with your characterization of those of us who have the misfortune to work 
with populations that have had a huge disruption in normal infant feeding practices.  I 
have not seen one single posting that suggests that any of us who do use a scale think 
that scale use makes the difference between a lay counselor and a "professional".  If you 
have seen such a posting, please point me in that direction because I did not read it and 
may have missed it.  I personally, have pointed out how there are similarities between 
any indicator of intake that one would use when one looks at that indicator in isolation. 

Never have I personally suggested that the scale is useful for all situations.  Moreover, I 
think one needs to understand that different tools are often more appropriate for one 
situation or another.  As I posted before, the work in Tanzania by the Tanzanians and the 
Swedes showed how use of a scale for "weighing" not test weighing was an empowering 
experience for ILLITERATE women.  Another study by one of my dear very outspoken and 
sometimes extremely annoying colleague Sabu George showed the total futility of how 
weighing was used for supplementation programs in India.  The difference in these 
findings is the "context of use".  I think the study in Tanzania is instructive not because of 
the use of the scale, but HOW they used the information to empower these women in 
making their own decisions.  They could have used any tool --- the point is HOW they 
helped these women with informed decision-making.  In any clinical setting, we should do 
this.  

On the other hand, I have seen repeated suggestions on Lactnet that the scale is 
HARMFUL.  With no proof whatsoever that this is the case in the United States.  Before 
you judge how some of us use the scale, I invite you to come and observe the challenges 
we face and how we use the scale.  

I have also seen many many posts of situations from many solid lactation consultants 
that show how they have put the scale to good use for encouraging mothers to get away 
from worrying about their baby's intake.  In the United States setting I find that is helpful.

More importantly, I find it exceedingly patronizing to consider a "lay peer counselor" as 
something less in value than a professional.  The roles are "different" and that is where I 
found the term "second level credential" to be absurd.  The roles of a peer counselor 
should be considered every bit as valuable and very different from the role of a lactation 
consultant.  Both should be considered members of the same team and should be valued 
for their different and complementary roles.

Personally, I think lay counselors should understand the use and misuse of scales so that 
they know when it would be and when it would not be appropriate to refer to lactation 
consultants who do and do not use them.  I would definitely want peer counselors to know 
the difference between a lactation consultant that clung to the numbers on the scale 
rather than have the dianostic ability to know how to help mothers with slow gaining or 
failure to thrive babies.  It is the diagnostic ability that is key.  Not the "scale use or not" 
that is important.

Best regards, Susan

PS.  Heather has been so persistant that she is nudging me into looking into all the 
unanswered questions about scale use or not.  There are many unanswered questions.  
So, I'm starting a series of small studies in my support groups.  If I can answer her 
questions and get it published --- guess who will be acknowledged in any papers I write.  
Only my seven year old son is more persistant than Heather when asking questions and 
believe it or not, I consider that a complement even though it sometimes makes me feel 
a bit grumpy.

I think it IS important to really look into the issue in a much more profound way than the 
fatally flawed study published in the Archives of Diseases of Childhood.  

Unfortunately, any study that I do will be relevant only in the context of a society that 
has had a break in normal infant feeding practices and high intervention births.  

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