Didn't mean this to get so long, but darned if it didn't end up that way.

Pam posts about a baby who looks long and lean, and who seems to be in the
ninety-third percentile for weight and ninety-fifth for length.  I am
writing the numbers out in words because they get garbled otherwise and I
suspect that one of them was garbled in Pam's post.

I'm confused about the percentiles because I didn't think they were broken
down that finely on the new charts.  Also, a baby who is in practically the
same percentiles for both length and weight, should be around the middle of
the chart in weight for length.  Babies who are hanging off the bottom are
not in the ninety-third percentile for weight unless they are way off the
charts the other way, in length.

I'm on holiday now and today we had visitors, a mother and two young
children.  Mother is a friend of my daughter, but I helped her when she had
a couple of nasty bouts of mastitis early on.  She was scolded then for not
breastfeeding correctly at the baby's six week check last summer because he
had already doubled his birthweight.  Now he is a lean, active, healthy,
happy one year old and she is being scolded for continuing to breastfeed him
when he is obviously not getting enough food since he is light for length,
especially iron.  No one has done a blood test on him yet and he eats a
varied diet in addition to getting his mother's milk.  She is being strongly
encouraged, harassed almost, to wean him to full fat cow's milk, pronto.
The scolding is coming from the same source all the way, her well child
clinic PHN.

She never dared tell the PHN she was also tandem nursing his sister, who was
only 16 months old when she got a baby brother.  The sister was weaned to a
bottle after a few months but the contents of the bottles have been
expressed milk until a month ago when she couldn't be bothered pumping any
more.    Until then she had been expressing 750 ml daily, which is about
twenty-five ounces.  And they won't get off her case about how her vibrant,
lovely children are the wrong size and in danger of becoming anemic. When
she continued to exclusively BF past four months she got dire predictions of
how the child would never ever accept solids unless they were introduced
NOW.

She still breastfeeds the baby, and is dreading her next appointment at the
well child clinic. 
Sigh.

No one here has started to use the new charts and the largest well child
clinic in all of Norway, purportedly located in my town, hadn't even heard
they were out yet, as of two weeks ago.

Growth charts are to enable us to spot a problem early on.  They were never
meant to be visual rules for what size a baby ought to be at a certain age.
Babies who deviate a lot from the mean in either weight or length will
always need more careful individual evaluation because the charts only tell
you that the baby isn't average.  They don't tell you what the problem is,
or even whether there is a problem.  Fattening up a baby to make him follow
a certain curve on the chart is missing the point so completely that it is
difficult to know where to start the re-education process for that care
provider.

My daughter almost didn't grow in weight or length from eighteen to
twenty-four months and her growth had been slow from just under a year until
eighteen months.  She seemed to be following my growth pattern, according to
the records I had.  She started in day care because I was working four days
a week, but she ate there and she nursed about as often as before I started
work.  Of interest was that she developed juvenile rheumatoid arthritis at
nineteen months, and started anti-inflammatory drug treatment at twenty-four
months when the diagnosis was made.  The first month on aspirin she gained
two pounds.  Until then, the inflammatory process that was only manifest in
one joint in her body, had been consuming all the energy that should have
been going into growth.  It didn't occur to anyone to start doing
rheumatologic blood work on a slow-growing one year old but it's possible we
would have found some evidence of pathology before the clinical illness
began.  We'll never know.  I do think that her faltering growth was part of
the picture with her arthritis and a child whose growth changes drastically
should be watched.  Not fattened, but watched.  It all boils down to LOOK AT
THE BABY.

Rachel Myr
Kristiansand, Norway

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