Barbara Wilson-Clay notes that three weeks is a long time to wait before
diagnosing a BF problem.  I agree.  I personally don't use those three weeks
as a reason not to do anything, but as a reprieve from using extreme
measures.  The problems will usually be evident by the end of the first week
after birth.

We weigh babies at birth, at discharge from care in hospital if it is more
than 48 hours after birth, and then they are weighed some time in the first
few weeks if mother or the health visitor is concerned about feeding.
Babies who go home before 48 hours are weighed when they come back for PKU
testing around day 5.  A baby who has lost more than 10% of birth weight at
discharge or at PKU testing will be weighed again in a day or two, with the
expectation that there will have been some gain by then.  For babies born at
home, I record birth weight and weight when I transfer the case to the
health visitor, and of course I have observed baby's feeding and elimination
patterns all along.  These babies are not where the problems are either!
They are undrugged and never separated from mother, BF sorts itself out
nicely regardless of whether mother has experience from previous children.

I expect babies who are BF well from birth to have passed their birth weight
before they are a week old.  Many are above birth weight on day 5, and by a
week are FAR above birth weight.  Even in our hospital it was the norm for
babies to be gaining by day four, which we saw when they were still in the
hospital long enough to be weighed on day 3 and again at discharge, which
was our routine then.

It is very nice to have three weeks of grace to correct a BF problem without
it being perceived as dangerously pathological, for those who make a slow
start.  For the mother it is reassuring to know that as long as baby is back
on track and making progress, even if that is just holding steady at 7-8%
below birth weight for a few days, they have three weeks to get up to birth
weight before we bring in the big guns.  If we were finding these babies for
the first time at three weeks, it would be awful, because there would be
much more urgency about correcting problems.

Re: weighing in the first year of life-- this is done at every contact with
the system for well-child care as part of the care, and mothers may come as
often as they like for weigh-ins on a drop in basis at the centers.  Mothers
of slow gainers HATE weight checks.  The others like it fine.  Wonder why?!
Last week at a well-baby center I met a colleague whose daughter at 5 months
is following the lowest percentile curves for weight and length.  Baby was
doing SIT-UPS in her pram to see out, lifting her head and shoulders off the
pad without holding on to anything.  Placed on a mat on the floor, she
rolled around, back to front and front to back in a purposeful way, waving
arms and legs and smiling and crowing the entire time.  I held her, she was
solid muscle and ready to spring.  We need curves for activity level.  There
is no way that kid could accumulate any fat anywhere, she is just plain too
BUSY.  But mother is not attending the well-child center nearest her home
because the attitude there is that the growth curves are more important than
the baby.  The neighboring area center has the opposite stance, and she much
prefers to come there.  Sadly, all of them are run by the same bureau in
local government so the differences are due to the people staffing them.  It
would be nice if they all used the sense they were born with to interpret
the clinical findings.  Come to think of it, maybe they do :( .

Sorry this is so long.  I couldn't seem to say it in fewer words.
Rachel Myr
Kristiansand, Norway

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