Dear all:

Second, I must point out that we need to be careful about blanket statements about the accuracy, reliability, dependability, or precision of instruments.  You MUST understand WHY an instrument is being used in order to fully understand what level of accuracy, reliability, dependability, or precision you need.  It would be completely silly to weigh an elephant with a scale that is accurate to 2 g.  It would still be silly to weigh an adult with a scale that is accurate to 2 g.  It would be overkill to weigh a toddler with a scale that is accurate to 2 g.  If you were merely measuring weight gain (not intake) it would be unnecessary to invest in a scale accurate to 2 g even for newborns.  

I also am confused as to why there is a tendency to question some indicators more vociferously than others.  I have yet to see a post to Lactnet (other than myself) pointing out that there is hardly any accuracy, reliability, dependability or precision to using diapers as an indicator of intake.  In fact, Laurie Nomsson-Rivers research shows that the predictive values of the cutoffs (of which there is a huge diversity of cutoffs among the diaper diaries used by hospitals in Manhattan) are not very good.  Yet, do we have discussions about how the diaper diary led to bad advice?  Rarely. I do believe that diapers are useful as a VERY CRUDE indicator and agree with Laurie Nommson-Rivers' conclusion that "Available evidence suggests this relationship [weight loss and diapers] is not strong enough to allow soiled or wet diaper counts alone to be used as a screening tool".

I chalk the tendency to jump on some indicators and not others to the "confirmation bias" that is common and normal for all humans to engage in.  We tend to accept the evidence that confirms our beliefs and reject evidence that refutes our beliefs.  Thus, it takes us a long time to change if we have believed something for a long time.  Because we work in a field that would almost have been unnecessary but for the marketing that made the normal act of feeding an infant an artificial event, it is entirely predictable that we would be suspicious of "medicalized" tools.  I myself have never considered the scale a medical tool since I come to this through nutritional sciences.  I have always seen it more like the equipment one uses in the kitchen.  A measuring spoon helps someone learning how to cook, but cannot turn that new cook into a great chef.  A great chef may rarely use that measuring spoon, but they do know when to use it for those special dishes that require accuracy. 

Best, Susan Burger

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome