Hi Marko,
Colin's paper is interesting but there are many assumptions that are made in
this paper. We really don't know why mothers start to use formula (so many
researchers target their questions at breastfeeding and ignore the fact that
when a mother stops breastfeeding she doesn't just do nothing she starts
formula feeding). How often do mothers diagnose "insufficient milk" based on
weight gain?? My experience would be that it's more likely to be infant
behaviour that results in mothers starting to use formula- weight gain might
play a role but surely if a child is exclusively breastfed and not growing
consistently well that this is worth investigating and not ignoring.
Oh and whilst the paper states no conflict of interest I would suggest that
there is one- Colin has accepted funding from Nestle carried out research on
the use of toddler formulas. He does not support the WHO recommendation to
continue breastfeeding beyond a year and interestingly it's the older
infants whose growth appears to be inadequate using the NCHS data.
Karleen Gribble
Australia

----- Original Message -----
From: "Marko Kerac" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, July 14, 2009 11:05 PM
Subject: WHO growth standards - adopt but beware doing more harm than good


> Dear Colleagues,
>
> Interesting discussions are arising about the new WHO growth standards.
> These should of course be strongly supported, but it's important to be
> aware
> of how they diagnose growth in relation to the previously used references.
> Differences are not always obvious. Being based on breastfed infants, it
> was
> for instance widely expected that the new standards would "diagnose less
> breastfed babies as growing poorly" (ref Protien Energy Malnutiriton,
> J.C.Waterlow, 2006 reprint, pxx) The acutual situation may be more
> complex,
> especially since longitudinal and cross sectional measures of growth
> capture
> different aspects of a complex physiological process:
>
> One thought-provoking reference for LACTNETers to be aware of will enable
> appropriate growth counselling to avoid the pitfall of inadvertently
> undermining rather than supporting exclusive breastfeeding:
>
>
> "Will the new WHO growth references do more harm than good?"
> Binns & Lee,
> Lancet www.thelancet.com Vol 368 November 25, 2006, p 1868
> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69772-9/fu
> lltext
>
>
> Exclusive breastfeeding for 6 months is
> the normal way to feed all infants. The
> new WHO growth reference released
> in April, 2006, is based on breastfed
> infants under optimum conditions.1
> The sample is highly selected for the
> factors likely to promote growth in
> breastfed infants, and less than 10% of
> those initially surveyed were included
> in the fi nal study.
> Most mothers and health professionals
> are concerned about their
> infants' growth, particularly for the
> fi rst 6 months. If they believe their
> infants are not growing adequately,
> they are more likely to introduce
> supplementary foods, including "topups"
> with infant formula or even
> switching to formula completely.
> "Insuffi cient milk" is the most
> common reason for the early cessation
> of breastfeeding and mothers often
> self-diagnose this on the basis of
> perceived slower growth.
> The new WHO growth references
> show the maximum growth rates that
> can be achieved with breastfeeding
> under optimum conditions. But, for
> the fi rst 6 months of life, the new
> WHO growth references, for boys and
> girls, are heavier than those produced
> by the US National Center for Health
> Statistics (which formed the basis of
> the old WHO references) for every Z
> score from -3 to +3 (see fi gure).2 The
> diff erence is greater for weights below the mean, and it is in this
> region
> of the chart that mothers are more likely to be anxious about the growth
> of
> their infant.
> The new WHO growth reference
> is a triumph of modern statistical
> techniques. But has the real purpose
> been lost in the technology? What is
> really needed is a growth reference
> that presents growth rates that can be
> realistically achieved during the fi rst
> 6 months of life and maximises the
> duration of exclusive breastfeeding.
> We declare that we have no confl ict of interest.
> *Colin Binns, MiKyung Lee
> [log in to unmask]
> School of Public Health, Curtin University, GPO Box U1987, Perth, Western
> Australia 6845, Australia.
> 1 de Onis M, Garza C, Onyango AW, Martorell R.
> The WHO Multicentre Growth Reference Study:
> planning, study design, and methodology.
> Acta Paediatr 2006 450 (suppl ): S5-96.
> 2 WHO. WHO child growth standards:
> methods and development. Geneva: World
> Health Organization, 2006: http://www.
> who.int/childgrowth/publications/technical_
> report_pub/en/index.html (accessed Nov 7, 2006).
>
>
> Also try:
> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61657-2/fu
> lltext
>
>
> With best wishes,
>
>
> Marko.
>
>
>
> Dr Marko Kerac,
> Research Fellow & PhD Student,
> UCL Centre for International Health & Development, 30 Guilford Street,
> London WC1N 1EH, UK
>
> email: [log in to unmask]
>
> http://www.ucl.ac.uk/cihd/research/nutrition/mami
>
>
>
>
> -----Original Message-----
> From: Lactation Information and Discussion
> [mailto:[log in to unmask]] On Behalf Of LACTNET automatic digest
> system
> Sent: 14 July 2009 05:00
> To: [log in to unmask]
> Subject: LACTNET Digest - 13 Jul 2009 (#2009-698)
>
> There are 2 messages totalling 63 lines in this issue.
>
> Topics of the day:
>
>  1. disappearing jaundice
>  2. WHO Growth Charts
>
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> ----------------------------------------------------------------------
>
> Date:    Mon, 13 Jul 2009 22:01:13 -0500
> From:    laurie wheeler <[log in to unmask]>
> Subject: disappearing jaundice
>
> I would say the baby was dehydrated (10 percent wt loss), the color can be
> mottled and lousy until the baby hydrates, and I would say that is what
> improved the color. If I remember correctly, visible jaundice usually
> appears at levels of 5-6, and I don't think baby dropped from 9 to 6 in
> one
> feeding. Just my humble opinion. But good news for your mom/baby anyway!
> Laurie Wheeler RN MN IBCLC -- just returned from beautiful Florida Gulf
> Coast Mississippi USA
>
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> ------------------------------
>
> Date:    Mon, 13 Jul 2009 22:35:30 -0400
> From:    Pat Bucknell <[log in to unmask]>
> Subject: WHO Growth Charts
>
> Kathleen,
> I put the conversions on a computer generated mail label stuck to the
> bottom
> of the charts, so when moms use them at my BF support group they know how
> to
> to do it.  I also happen to carry a pocket sized calculator with me.  :)
>
> Warmly,
> Pat Bucknell IBCLC
> Mother's Helper/private practice
> Avon Lake OH
> ____________________________________________________________
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>
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> End of LACTNET Digest - 13 Jul 2009 (#2009-698)
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