>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.<

This is just the sort of thing I worry about with the new UK 'breastfed baby
weight chart' which Child Growth Foundation has printed.  I don't know what
data they used (none was supplied with the draft I have been sent), but its
these sorts of questions that will not often be asked.  Partly because
health visitors, who use these charts every day of their working lives,
don't have training in how they are constructed or how to read/interpret
them.  (So I have been told -- if you are a UK health visitor who has had
such training, I would be interested in hearing about it.)

In the UK babies are monitored in the community by health visitors and only
see a paediatrican if referred.  Immunisations and a 6 week check are done
by General Practitioners.  In the UK, every baby is issued with a 'red
book', which is supposed to go with the baby, wherever the baby goes.  In
the red book are charts for weight, height and head circumference.  When
these are measured they are plotted on the chart, as well as written in the
book.  Many many women go to a clinic EVERY WEEK, for the first months,
perhaps even 6 months, and get the baby weighed.  The length and head will
not be measured so often even if a mum is in clinic every week (although
they are often measured more frequently than 'good practice guidelines'
recommend).  The remarks that have been made in others' posts about
professionals using population based charts to follow the growth of an
individual baby, and how this can be misleading, apply doubly and in
different ways when parents have this kind of visual record.  Even if the
health care person is not too clued up about what charted weights indicate,
the hcp will be seeing many charts a day, and know that they come in a
variety of shapes for healthy babies.  What a parent, a first time mother,
for example, sees is ONE.  She sees the smooth curves and does not know that
they may not represent the growth of any single baby in the data set that
the chart is based on.  She hears "oh its usual for babies' lines to wiggle
around", but she also hears "He's following his line, he's doing well".  If
she sits in a baby clinic for several hours -- as I am doing repeatedly in
some research fieldwork -- she will hear similar statements over and over
again.

I also wonder what effect it will have when women and health visitors start
to plot babies on the new chart and see that the baby is not gaining the
initial amounts indicated by charts based on breastfed babies (part of the
different shape of the population curves for bf babies is steeper gains in
the earliest months).  Will the interventions be ones to address (or rule
out) the commonly-seen (here in the UK, at any rate) poor-ish attachment of
the baby to the breast, or
will it be even earlier supplementation?

My observations in a UK child health clinic don't lead me to make optimistic
predictions on this one.

Magda Sachs
Breastfeeding Supporter, BfN and research student, UCLAN, UK

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