Andrew says,

<<  The proof is in the pudding!  I think LC's
 loose credibility when the doc wants to know the baby's birth weight,
 discharge weight & current weight and the LC simply replies that the baby
 "looks fine to me."  Babies can "look just fine" one minute and then crash &
 burn the next minute. To simply blow off the baby's weight (gain or loss) as
 unimportant seems awful cavelier and potentially dangerous to the baby.  >>

Well, I WISH I could blow off weight.  Dieting is much more difficult.  I'd
like to blow off about 12 pounds or so....

OK, that said, Andrew -- I don't think ANYONE is suggesting that we not pay
attention to weight, nor weigh the baby.  Yes, I have scales in my office, but
hopefully, none on my eyes.  We (I) ARE saying that you need to pay attention
to the BABY and NOT just the numbers -- or percentages, in this case.
Babies who are dehydrated or not eating enough (calories) do NOT just "look
fine one minute and then crash & burn the next."  There are plenty of signs
that all is not well other than just a certain percentage of weight loss or
lack of gain.  If a mom calls me and tells me her 10 day old baby hasn't
stooled in 3 days, I want punkin in for a weight check and a bf evaluation.
If I see that a baby has lost 12% of stated birth weight, but is peeing,
pooping, has moist membranes, looks healthy, bright and alert, and is bf well
with good suck & swallow, then why should this baby be supplemented?  Yet,
this is what I see some HCPs do immediately -- one had the mother pump and
give the baby the breastmilk in a bottle to make sure the baby was taking the
required (according to her calculations) amount.  Yet the baby was FINE --
just had lost 9% of birth weight.  It's like the HCPs that decide to
supplement a baby because the glucose level is getting a bit low.  You know,
40 is the cutoff, and the glucose is only 47, so we better give some formula
to make sure it doesn't get any lower.

And yes, those are true stories.  It's difficult to look at the baby and make
an evaluation based on the baby -- it's much easier to follow some arbitrary
"rules" and treat according to numbers -- lab values and percentages.

Sigh.

Jan Barger, RN, MA, IBCLC
in Wheaton where it is REALLY cold!!