P. Meier et al, Estimating Milk Intake of Hospitalized Preterm Infants who
Breastfeed, JHL 1996 12(1):21-26 -- documents the fact that observation alone
is often quite a poor way to assess intake.  This is esp. true for the
premature or ill infant.  Test weights may not tell you everything about the
feed, but they are a way to get information you may not get otherwise.  I am
sensitive to the 'performance anxiety' issue.  I weigh each baby at the
beginning of a consult.  Moms are used to babies getting weighed at clinic
visits or check-ups and this does not upset them.  I do not mention that I
may weigh again after the feed. If the 1st weight indicates baby is where
they should be for the age, I probably won't do a second weight.  For the
baby who is having some growth faltering I sit and watch and talk and get the
hx etc.  After the feed is over, I take the baby and say something like "One
test weight doesn't always represent what occurs at each feed, but based on
this experience and how baby fed now, lets see what kind of intake it
produced."

Mothers generally appreciate having some basis for how to best proceed. Today
I saw a 5.2 oz preemie who was IUGR and just released from the NICU this
week.  She's had lots of bottles and feeds very weakly at breast if you can
even get her to latch-on.  I did a post test weight after she'd nursed for
about 12 min on a nipple shield. She'd nursed in a very lazy fashion, tho mom
said it was better than usual because at least she'd kept sucking for the
whole time.  I attribute that to the shield.  Anyway, the intake was about 16
ml.  I was surprised it was that much based on her suck.  But that info gives
mom and me a way to gage how to manage feeding her as she finishes growing
towards her due date.  We can periodically re-assess and taper off
supplements (pumped milk by bottle at this point -- mom won't use tube
device) as baby becomes more robust.  Shield will help keep baby at breast in
the meantime.  Mom was delighted not to have her very real perception of low
intake at breast dismissed.  I got no sense from her that the experience
disempowered her.  Informed consent implies accurate info. How can we reject
a simple tool which, if handled with sensitivity, helps us preserve bfg while
protecting the vulnerable infants growth needs?

Those who have not read Meiers article really need to do so.  I would welcome
a dialog after that.  I think she's right on target.  When I have checked my
own observations against an imperical measure I am humbled by how often and
how far I am off.  Again, this is far more likely to be true of faltering
babies than with competant, robust nurslings.  You can look at them nurse and
tell they are fine.  Sometimes I even weigh them pre-and post just to get
exper. measuring my observational skills against the scale.  It DOES provide
insight.
Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx