Using my last post today to apologize for the one below - meant mostly
tongue in cheek, but of course that doesn't come across in the email.
I would suggest, Susan, that the test weigh you referred to was useful only
to convince the paediatrician, who like many doesn't separate out what the
different indicators measure:
Number of wet and soiled diapers (indicator of milk production and intake)
Not gaining weight (indicator of nutrient absorption)
If a baby is having lots of output but not growing, to me that's a sign that
the problem isn't milk production or milk transfer, but that the baby's
health needs further investigation.
Not a lot of output plus slow/no weight gain - could be milk production,
could be milk transfer, but in North America, it's likely breastfeeding
management - not nursing often enough, for long enough.
Not a lot of output plus perfectly fine weight gain, developmental
milestones, etc. - if it ain't broke, don't fix it. (Unless there are
indications that oversupply is an issue - another branch on the path.)
I know there are a lot of LCs out there really helping, but in my area,
health care professionals/LCs often seem to do more harm than good. If you
all won't listen to my venting, who will?
Ingrid
-----Original Message-----
From: Ingrid Tilstra [mailto:[log in to unmask]]
Sent: Friday, September 24, 2010 10:07 AM
To: 'Lactation Information and Discussion'
Subject: RE: Or where is the evidence that test weighing IS harmful?
If someone is going to do something, isn't the burden of proving that it's
NOT harmful on them, rather than the other way around?
And saying it's not the tool but the user is like saying it's not the gun
but the shooter - who cares, if you're just as dead?
Ingrid
Subject: Re: Or where is the evidence that test weighing IS harmful?
I have seen much reporting of anecdotal observations about test-weighing
where people assume it is harmful to breastfeeding. Yet, I have not seen any
peer-reviewed research to support that contention.
I did a thorough review on the topic several years back when I presented at
ILCA on the topic. The following list includes two meta-analyses -- one on
growth monitoring and another on test weighing.
Magda Sachs work illustrates the misuse of the growth charts.The
metaanalysis conducted by Marie Ruel looks at many studies on growth
monitoring. It is quite useful to understand how an inadequate
understanding of how to use a tool can lead to its misuse and how an
adequate understanding of its use can lead to very helpful interventions.
The most interesting of these was the use of growth monitoring as an
empowerment tool for mothers in Tanzania. Rather than pointing to a poorly
implemented program to blame the tool, she took a much broader view with far
more examples and pointed to examples of when it is helpful and when it is
not helpful to use growth monitoring. Unfortunately, sometimes those who
work in developing areas of the world actually understand how to use such
tools to better advantage than in developed areas of the world. I find that
in Manhattan, growth monitoring is relatively poorly understood.
Similar to the Tanzania situation, Paula Meier's work shows that used
properly, test weighing, can end up being empowering for mothers. I realize
that many on Lactnet have seen the worst abuses of the scale. Nevertheless,
that does not negate the fact that the peer-reviewed evidence does show that
the issue has to do with HOW the tool is used, not the TOOL itself.
I will again repeat that I constantly teach mothers how to use the
information in ways that helps them MINIMIZE the use of formula. And I have
been able to use it to prevent the totally ridiculous method of having a
mother pump and bottle feed to determine what a baby is drinking. That to
me has to be the least accurate method of assessing milk intake that one can
use.
Bibliography
Anscombe, Francis J. (1973) Graphs in statistical analysis. American
Statistician, (1973) 27, 17-21.
Dowling DA, et. al. Cup-Feeding for Preterm Infants: Mechanics and Safety.
Journal of Human Lactation, 2002;18(1):13-20.
Habicht, J-P, Yarbrough, C. & Martorell R. Anthropometric field methods:
criteria for selection. In: Human Nutrition: A Comprehensive Treatise.
Plenum Press, NY, NY. 1979;2:.
Hurst, JM, et al. Mothers performing in-home measurement of milk intake
during breastfeeding of their preterm infants: maternal reactions and
feeding outcomes. J.Hum. Lact. 2004;20(2):178-187.
Riordan J et al. Indicators of effective breastfeeding and estimates of
breast milk intake. J.Hum. Lact. 2005;21(4):406-412.
Ruel MT. Chapter 5. Growth monitoring as an education tool, an integrating
strategy, and a source of information: A review of experience. Child Growth
and Nutrition in Developing Countries. Priorities for Action.
Pinstrup-Andersen P., Pelletier D, and Alderman H. (eds) Cornell University
Press. 1995:78-96.
Sachs M, Dykes F, Carter B. Feeding by the numbers: an ethnographic study
of how breastfeeding women understand their babies' weight charts.
International Breastfeeding Journal. 2006;1-29.
Scanlon K.S. et al. Assessment of Infant Feeding: The validity of
measuring milk intake. Nutrition Reviews. 2002;60:235-251.
Savenije OEM & Brand PLP. Accuracy and precision of test weighing to assess
milk intake in newborn infants. Arch. Dis. Child. Fetal Neonatal Ed.
2006;91:330-332.
http://en.wikipedia.org/wiki/Accuracy May 30, 2007.
Sincerely,
Susan E Burger, MHS, PhD, IBCLC
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