I believe it was Rachel who asked in what situations test weights could be
helpful.
Since I do use test wt.s in the hospital setting I will share my criteria for
use.  First, in the NICU, as we transition babies from gavage to
breastfeeding we can certainly get the staff off of our backs if we can show
good intake at the breast. I teach mothers how to perform the test weights
and after they have finished breastfeeding they let the nurse know how much
supplement the infant needs by gavage. i.e.  infant needs 40 ml q 3 hr.
..takes 25 from the breast...is given 15 ml EBM by indwelling naso gastric
tube. A hidden benefit is that we give the mother almost total control of the
feeding.  The other benefit is no bottle crosses the infant's  lips. Once
baby has demonstrated good intake at breast, mother no longer needs to
perform the test wt. and breastfeeds on demand. Many a baby has been spared
unnecessary bottles this way.  Also as mothers get ready to take these
smaller, more fragile babies home they have learned from test weighing what
an effective breastfeeding session is.  We never do test wt.s while premies
are first learning to nurse and we always make sure mothers learn the
elements of effective breastfeeding: good position and latch, swallowing,
breast softening, infant satiety, good output. We seldom send these families
home with scales.

There are some other situations where test weights can be helpful...infants
with Phenylketonuria (PKU) who can have some breastmilk...mother needs a way
to measure 24 hour intake.  Cardiac babies are often fluid restricted and
have low energy reserves and high caloric needs. By analyzing how much they
get from breast clinicians can determine how much high calorie supplement the
baby needs and come up with a workable feeding plan.  I also use a spot test
wt. for babies who come in as outpatients with poor wt. gain. Much as I think
I'm good at assessing breastfeeding I have been wrong in both direction...a
baby I thought was gulping at breast actually was getting very little and was
swallowing his own quite copious secretions. Very quiet swallowers have
fooled me also.  The cardiac baby, the PKU baby and certain other babies with
special needs (airway problems, clefts to name a few) certainly can benefit
from measuring intake and often this can preserve some degree of
breastfeeding for these families.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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