Dear all:

Haven't been following any thread, but growth charts are like weighing scales.  Growth charts and 
pre and post feedng weight checks are only useful when you look at the entire picture in context.  
I've decided it is just like the current push in Manhattan to test our children every six weeks --- 
with NO REFERENCE to how the educational system will be improved or respond to this absurdly 
frequent testing system.  You must have an in-depth investigation any time a red flag is raised to 
really determine whether or not an interventions is necessary and if so, what really is the 
appropriate intervention.  Without an appropriate response, measurement is just an exercise in 
futility.

The new growth charts probably have a much more narrow range for reasons that Kathy Dettwyler 
had previously posted long ago.  Those babies who were growing exceptionally slowly were 
excluded and (if I remember correctly) she mentioned that the babies were mostly from Davis - a 
US population that is close to the Norway Lactopia as possible but also probably heavily sleep 
trained.  This may not be your nurse whenever crowd.  So the higher gains that one might see in a 
nurse whenever population may not have been included in these charts.

This means that the extremes have been eliminated and so there may be overdiagnosis of "failure 
to thrive" as well as "obesity" if one merely looks at percentiles in the infancy period.

As with using a weighing scale properly for evaluating intake from a baby ---- that is looking at 
how quickly the baby feed, evaluating how the particular feeding fits within the usual feedings for 
the baby --- evaluating health factors that may influence maternal supply - and I'm sure I could 
add about 20 additional items to investigate at least ---- one cannot look simply at the 
percentile.  In fact, this is what Marie Ruel isolated as the major flaw in health care systems in 
developing countries that stagnated at growth monitoring without the crucial piece --- growth 
promotion!  The whole goal of having a monitoring system is to link it to further investigation and 
appropriate action.  WIthout that, it becomes a useless exercise in measurement alone.

One must evaluate the whole picture when a baby is not gaining along a particular trajectory.  
Birth weight is pretty useless because many babies go through "catch up" or "slow down" growth 
and I think Magda Sachs said this more eloquenty a week or so ago.  What you are looking for is 
plateaus and dips.  These should be investigated.  If a baby is healthy, thriving, and active with no 
particular factors that would suggest a problem then you merely watch to make sure the baby is 
developing properly.  If the baby is lethargic, not meeting developmental milestones or showing a 
myriad of other signs of not doing well -- that is when interventions may be necessary.  

Weights can be a great tool, but NEVER in isolation from the entire picture.  

My son gained very slowly --- despite being born at 8 lb 9 oz.  He has small parents --- I'm five 
feet and my husband is five feet four inches.  He was always exceedingly active.  Nevertheless, I 
am sure part of his slow gain was due to reflux that caused him to limit his feedings.  When I had 
to go back to work and pumped he really would never take more than 2 oz at a time.  Later in life 
he developed sleep apnea from enlarged tonsils.  This was really a period of very slow growth.  
Once his tonsils were removed at age four (which I was very reluctant to do until he really showed 
he did not breath well) he gained 10 pounds in 3 months because he simply found it easier to eat 
without his enormous tonsils blocking his food. So, his later slow weight gain was a clue to a 
problem that took a while to discover.  During the entire time he never showed apathy or lethargy 
but he certainly felt better and ate better once the problem was solved.  I'm sure some day 
someone will figure out why certain children have such an overgrowth of tissue that the tonsils 
become obstructive, making such highly invasive surgical interventions unnecessary.

I would always investigate iron and zinc intake amont infants that are beyond 6 months of age and 
plateauing or dropping in weight gain.  Kay Dewey did a great presentation on iron and zinc needs 
beyond six months - and the need for these nutrents is substantial.  Some infants are quite fine 
and others are not.  Zinc is important for immunity and appetite.  Iron is important for cognitive 
development and about 25% of infants who are not eating an additional food source of iron 
between 6-9 months will develop anemia.  Cognitive development is depressed even before 
anemia occurs. The tests for anemia are highly unreliable and, at least in Manhattan, done 
improperly.  Nurses I have observed routinely squeeze the finger which causes excess interstitual 
fluid to enter the samplke throwing off the assessment of anemia.  Other tests are highly invasive 
requiring venous samples.  Not exactly something I would suggest on a routine basis for infants.

Although the new weight charts show a different trajectory, the utility of the new charts will still 
only be as good as the diagnostic skills of the  user!

Best regards,

Susan E. Burger, MHS, PhD, IBCLC

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