>The difference between the words "solely" and "primarily" are a mute >point

I don't think there a "mute" point at all, or even a MOOT point.  Primarily
means "most of the kids, most of the time."  That is a far cry from claiming
that the current NCHS/CDC/WHO/Ross Labs growth charts are "based on
formula-fed babies" and therefore worthless for using with breastfed babies.

As near as I can tell, most of the problems related to pediatricians using
the growth charts to encourage formula supplementation of the breastfed baby
are based on ignorance of how to read growth charts, and ignorance of how
children grow, not the charts themselves -- not how much it says Johnny
should weigh at 3 months.

You have pediatricians who think all babies should gain steadily.  And those
who think anything below the 50th percentile needs to be watched.  And those
who think anything below the 25th percentile is failure to thrive.  And
those who think babies are supposed to always grow along the same percentile
all the first year, instead of going from 95th to 20th or from 5th to 75th,
or anything in between -- all of which can be perfectly normal for a
particular baby.  And those who think that parental and siblings growth
rates are irrelevant.  And those who don't understand "catch-down" growth
for babies who are really big at birth.  And those who don't understand that
premature babies take about 3 years to 'catch-up' and so correcting for the
length of prematurity should be done for about the first 3 years.  And on
and on and on and on.

NOT TO MENTION that the "new and improved" growth charts floating around
there purporting to be more accurate for breastfed babies -- at least the
ones based on the DARLING studies of Kay Dewey and colleagues -- are based
on babies who were 'mostly' breastfed on a 3-4 hour schedule and who
'mostly' slept alone in a crib in a separate room and were encouraged to
sleep through the night at a very early age.  Both the infrequent
breastfeeding and lack of breastfeeding at night can compromise the quantity
and quality of the mother's milk, and the baby's milk intake, leading to
poorer growth than you would have seen if those babies had been fed on-cue
around the clock.

I urge everyone (as I have repeatedly here on LactNet) to AT LEAST wait
until the new WHO growth charts come out in 2003.  And even then, DO NOT
EXPECT that they will solve the problems that come from pediatricians
misusing the charts.

I fear that while today we may have breastfed children inappropriately
labelled as 'slow gaining' or even 'failure to thrive' from using the
current NCHS/CDC/WHO/Ross Labs charts, what we'll have in the future are
breastfed children inappropriately labelled as 'doing fine' from using
charts derived from babies who were fed on a schedule and not at night.

Katherine A. Dettwyler, Ph.D.
Expert in child nutrition and growth and development

P.S.  Poland had its own charts for many years.  Poland, like England, had a
number of indigenous growth experts who conducted studies and produced
charts for local use.


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