Rachel writes:
>
>I used to suspect something amiss in any baby who gained less than
>about 250 g/week but I have seen so many happy, thriving, GROWING
>babies who just aren't that roly poly and heavy that I no longer worry
>about it  unless there are signs that something is wrong.


That's my experience as well - mostly the babies I see and hear about 
are healthy, thriving babies and their weight gain patterns are 
hugely variable. I don't see many sick babies, so this is likely to 
skew my perception, I accept.

I see babies whose weight gain is very fast and babies whose weight 
gain is very slow. They can both have problems and challenges, and 
can both be just fine.

Weight is only one piece of the jigsaw.  Underweight is not a 
pathology in itself - it can only ever be a sign that something else 
is going on, an indication that whoever is supporting the mother with 
her bf should look and listen more closely, more focussedly.  I do 
wish more HCPs did this - being too relaxed about slow weight gain is 
a Big Sin in my book, as it risks missing really serious problems, 
not just to the breastfeeding but to the survival of the baby 
(thinking of the rare cases of undiagnosed serious illness that first 
present as a failure to gain weight).

Weight recording is very useful, but I don't see any clinical benefit 
in having a daily or a weekly standard that babies must match  - 
especially when there is no good evidence that there *is* a daily or 
weekly standard.

>
>It's handy to have a rough guideline, but there will always be a range
>of normal values, for weight gain as well as weight, growth,
>cheerfulness, whatever characteristic we are talking about.


Ha! Good comparison - how about taking it further? We know babies 
start to exchange genuine, broad, social smiles with their loved 
one(s) sometime around six weeks, and we'd expect a healthy newborn 
to be doing this. But we don't ask mothers to *count* the smiles, or 
measure their breadth, in order to check for normal, healthy 
relationships and development, with a required standard of 4 smiles a 
day of at least 45 degrees :) :) .

(Don't stretch the analogy too far - it stops working very quickly!!)

Heather Welford Neil
NCT bfc, tutor, UK

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