I appreciate the points everyone is making about three scales and 3  
different practitioners, and how the baby is diapered or dressed or  
undressed...
I use a BabyWeigh which I recalibrate every time I move it...the  
scientist in me would like the same scale and the same observer but  
this is real life not a laboratory...

In this case I don't see weighing the baby diapered and dressed as  a  
mistake because only by mimicing the pediatricians method can I get a  
handle on the trajectory of the weight gain/loss...
the actual weight of the baby is not as important as the trajectory  
of the gain or loss when it comes to making decisions about what  
should or shouldn't be done today...

Too me what is most important is what test weighings over the course  
of an entire day reveal about milk intake combined with the  
appearance of the baby...
In my experience it matters not how the baby is dressed or diapered  
for test weighings as long as the baby isn't changed between pre-feed  
and post-feed weights...
One glaring exception to this is if the baby spits up on his clothes...
If you want a mother to be able to manage test weighings over the  
course of a day you need to remove as many barriers as possible and  
dressing and undressing the baby is a barrier...
Also baby's intake can be fine or even great but baby's appearance  
and behavior can indicate malabsorption or undiaignosed  
illness...test weighings help reveal this when everyone suspects  
breastfeeding is to blame for the infant's FTT...

I talked to the midwife yesterday which clarified things...the mom  
did not recall all the weights and when they were done the way the  
midwife recalls...
midwife noted:

birth weight  7 lbs 14 oz (spring scale)
36 hours old 7 lbs 4 oz (spring scale)
day 6   7 lbs 10 oz (spring scale)
day 9 or 10  7 lbs 15 oz (digital scale)

my notes:
day 18  7 lbs 11.2 oz (BabyWeigh)

So I asked mom what has changed since the appointment with the  
pediatrician and it turns out Dad returned to work after 2 weeks off,  
and mom has no family in town and a high need two year old ...
Also midwife indicated mother did not know about the importance of  
B-12 supplementation until Bradley classes and usually consumes in  
the neighborhood of 30-40 grams of protein per day according to her  
diet diary which of course is much more important to know than the  
mother's recall of her highest protein day of 90 grams...

All of this new information helps explain why she looks like she has  
glandular tissue but it's not lactating as opposed to true  
hypoplasia...still the absence of breast changes during pregnancy is  
worrisome...at this point I'm still going to proceed as if she has  
sufficient glandular tissue but she has dramatically down regulated

If phyto-estrogens pose no problems for breastfeeding I would like  
this mom to be able to consume soy...does anyone know if soy  
consumption can antagonize prolactin's effects?

Thanks again,
Jen O'Quinn IBCLC

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