Just to mention one of IBLCE's competencies is to "calculate an infant's
kilojoule and volume requirement." I did not see ac/pc weights as one of the
competencies but it does state the use of "infant scales" as one of the
competencies.

I believe it is inappropriate to use ac/pc weights in the healthy thriving
infant that Nina talks about. Except in the rarest of circumstances like a
mother who just does not believe the baby is taking in enough.

I think the archives bear out that virtually all of the posters on lactnet
who do use scales are using them with vulnerable, non-thriving,
or discontented infants. The LC can function without a scale and can
recommend changes in the feeding plan and see the baby again in 24 hours,
for example. The LC might have to do this for several days in a row in order
to figure out that increased number of feedings, for example, didn't lead to
a weight gain. IIf a baby takes in an average of, say, 10 mls x 14 feedings,
the approximately 140 mls would likely be severe undernourishment. In a
vulnerable population of infants, for example, premature infants, losing
even a day or two of good nutrition, could be very dangerous indeed. Do we
know how dangerous is it for an 8 lb baby to lose 1 pound compared to a 4 lb
infant to lose 1 lb?

Ac/pc weights are also used effectively in premature infants in hospital to
determine the amount of ebm that needs to be fed (supplemented), by oral
gastric tube or bottle or other method, to a baby who has just begun to
breastfeed at breast.

Healthy adults don't calculate their food intake by weighing the food, or
calculating the calorie value of each food item. My weight has varied about
+/- about 10 lbs most of my adult life (except pregnancies). However,
nutritionists do calculate calories for folks that need to gain or lose
weight and doctors and nurses do calculate IV fluids all the time, as a
place to start, knowing there is some variation for metabolism, catabolic
states, insensible water loss, etc. Still there has to be some guidelines.

One final comment - number of wet and dirty diapers HAS NOT been a reliable
indicator in many cases I have seen. The heavyness of the wet diaper and the
color of the urine can be helpful but often parents assess that the output
is adequate. I have seen many babies who are not gaining but are stooling in
the "normal" range. I see babies mostly during the first week of life, so I
think that as the baby got older he would not be stooling much if he was
taking in too little, however I'll say again, there is no time to waste with
vulnerable infants, in my opinion.

Respectfully,
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA

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