Heather
Thanks for the reality check! Excellent points. Not least that I'm
becoming - rather desperately - aware that there is some slight
tension between cultural and biological infant feeding norms in this
part of the world.
Whether a slow gaining baby might just be physiologically small -
yes, that's possible if either of the parents or grandparents are
small too, but it's the exception, and I'd want to be quite sure that
the baby was really "getting enough" first before putting it down to
inherited genes. Your question about what the new growth charts say,
and how the weights shown would translate to gain per day sent me
scrabbling for my calculator and the WHO documents to find out.
Here is what the WHO documents released in 2006 had to say:
On individual variations:
"What about families or communities that are obviously smaller?
Doesn't that disprove the standards?
Individuals, families and even some communities may show variations
in size, but over larger populations and where children are given the
optimum environment for development, the differences average out to
fall within a remarkably similar range. So in the study, when you
graph the averages of growth in children from Brazil, Ghana, India,
Norway, Oman, and the United States, the result shows lines from each
that fall almost exactly on top of each other."
On how children should grow:
"The new WHO Child Growth Standards differ from any existing growth
charts in a number of
innovative ways:
For the first time they describe "how children should grow," which is
a prescriptive approach, not just
descriptive. These charts show that all children across all regions
can attain a similar standard of
height and weight and development with correct feeding practices,
good healthcare and a healthy
environment. It is, then, a more proactive way of measuring and
evaluating child growth, setting out
normative conditions and evaluating children and populations against
that standard."
On the daily rate of gain, I calculated from the actual weight charts
which can be accessed from
<http://www.who.int/childgrowth/standards/chart_catalogue/en/index.html>http://www.who.int/childgrowth/standards/chart_catalogue/en/index.html
For girls from 0-3 months, the average rate of gain for the average
baby (on the green middle line) is just a tad under 28g per day.
For boys from 0-3 months, the average daily gain is just a whisker
over 28g per day.
For the metrically challenged, this would be roughly 1 oz per day.
Yes, of course there is so much more to breastfeeding than just
ounces (grams!) - breastfeeding is lovely for all sorts of reasons,
but its primary function is to ensure that there is milk transfer
from the mother to the baby, sufficient that the baby survives and
thrives after birth. Mothers whose babies are happy and seem to be
growing would not normally seek the advice of BF counsellors, or
LCs. But we are the ones mothers turn to when babies are unhappy, to
find out why. Part of the history I take is a full list of all the
weights ever recorded since birth. Then I piece together what
happened and when and how it impacted on the baby's well-being
(weight). It's very consistent and very revealing. Mothers want
their babies to be happy, and will go to great lengths to make sure
that they will be, although my impression is that the cultural
pressures here not to breastfeed according to real need are
enormous. I think it's sad when babies are even a little underweight
and irritable because they may be just plain hungry, and I don't
think we do mothers any favours by telling them that it's normal for
their babies to need less milk than they do.
Pamela Morrison, IBCLC
Rustington, England
------------------
I certainly agree that spotting under-nutrition is important, and
that fixing it can mean breastfeeding lasts longer. But I am still
looking for anything that shows us that 'if a baby fails to gain
roughly 30g per day from about Day 3 and for the first 3 months of
life then it is a sign that something is not quite right with the
breastfeeding, that intake is inadequate for some reason'.
This seems to me to be very specific, Pamela - even allowing for your
'roughly' - and while a baby gaining this amount is almost certainly
perfectly adequately nourished, is it not possible that a baby may
gain less than this and still be ok - and just physiologically small?
How do we know that this very specific figure is correct for babies
in general? How do the WHO charts for normally-feeding babies
translate into weight gain per day/week/month? Has anyone done the
maths on this?
I am not being provocative, truly - I just don't know how we know
enough about normal, healthy weight gain in excl bf babies *across
the spectrum* to be able to have something as definite as this, so
definite that you say a baby failing to fit this pattern is, per se,
not adequately nourished.
It's also not what mothers are routinely told in the UK - not that I
am saying what mothers are routinely told has got to be correct! But
if you do practise here, you may find yourself in conflict with
mothers' other sources of info on this specific point. I don't think
what mothers are sometimes told here - that a weight gain needs to be
something averaging out at between 4-8 ounces a week, sometimes
(inaccurately) translated as 100g -250 g - is soundly
evidence-based....but they are definitely not looking for 30g a day.
And as ever - successful breastfeeding is not just about the ounces, is it? :)
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