Dear all:

Sorry for the mistake - it should have been slow weight gain, not weight
loss.

Also, I just want to point out (since Kathy Dettwyler has not piped up),
that the growth charts are not just formula fed infants - they were
composed of a mix of feeding methods including breastfeeding.  The
differences in comparison to more fully breastfeeding populations is a
normal healthy slowing of weight gain in the 4-6 month period in comparison
to these charts.  Otherwise there is very little variation across
populations despite all sorts of worries about "genetic differences". On a
population basis genetic differences in weight gain are very minimal. On an
individual basis, they may play an important role.

Taking the slower weight gain into account is important.  Nevertheless, if
there is a significant drop in weight gain - it is an indication to rule
out any nutritional, health, or behavioral issues that might be impeding
weight gain.

The new charts for breastfed infants may have two problems - elimination of
the very slow gainers and elimination of high gainers.  The population is
of those who were successful in breastfeeding and those whose infants
gained slower probably were not included (this was a sample of Davis
supermoms) and those who practiced truly ad libitum feeding were not
included.  Many of these women scheduled their babies.  So, it also did not
include those infants who would have been high gainers left to their own
devices.  So, when I get my hands on the new charts - I want to look at the
spread of the centiles.  If the curves are too narrow we could be
inadvertantly classifying our youngest babies as obese or malnourished
before it is wise to do so.

Charts are just charts - it is how they are used that is important, not the
charts themselves.  Just like any tool - SNS's, cups, finger feeding, etc.
You can always point to inappropriate uses and say "well the device
shouldn't be used" and others can point to appropriate uses and say "well
it was useful here".  And as with any tool, you need to look at the whole
picture, not just that one tool.

In the case of a slow gaining infant, I would try to find a registered
dietician who is very knowledgeable about breastfeeding to do a more in-
depth look at the nutritional issues.  Also, after having gone to an
excellent talk on feeding difficulties - even consider an OT knowledgeable
in this area for behavioral issues regarding feeding.  I was fascinated to
learn some of the tricks to helping a child eat appropriately.

Any OTs out there with comments on what to look for in a slow gaining child?

Best regards, Susan Burger, PhD, MHS, IBCLC

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html