>I have heard this concern before.  I think
it is a cop out for three reasons.  First, I think it is when babies' growth 
begins to plateau after the third month that mothers are often pressured to 
supp or to introduce solids because the babe's growth is 'faltering'.< 

Nina, this is the assumption that WHO makes in its published papers, that 
this is when and how growth charts impact on infant feeding decisions.  
Although there may be lots of evidence in clinical practice, there is almost 
none in published sources, so this is something of an assumption (since an 
impression in clinical practice may or may not be confirmed when studied in 
a structured way).  I think that is one time, but there are others and other 
ways it impacts.  I have long thought that once the new chart showing 
'bumper' growth in the first few months, which we know is normal for bf 
infants who actually have support with bf practice (that leaves out the 
majority of UK babies), that women may be shocked that their baby who looked 
ok on the UK90 chart (we don't use the CDC chart here) is not sticking to 
the magic 50th centile. 

>Education for HCPs is key here.  Second, because mothers rarely decide to
'top-up' all on their own.  They are usually advised to by a health care
professional. < 

The evidence from my study (of course conducted in the UK context) would 
somewhat contradict this. 

>Mother's concern that a baby's weight is following a centile
that falls below the mean can be reassured by health professionals who are
knowledgeable and well educated.< 

If the HCP does have this knowledge: my study suggests a deficit. Through 6 
years of research I searched and searched for a standard text for health 
visitors which covered such info -- nowhere to be found in the UK, maybe it 
exists for Australian Child Health nurses. A recent survey found that just 
over 60% UK paeds and 50% of GPs felt confident that they could recognise 
patterns of normal growth for breastfed babies.  Eeek! 

>And thirdly because the only answer that seem to be available in
the tool kits of very many health professionals is the 'top up'.< 

On this I heartily agree, backed by evidence from my own research. 

My major reason for wondering if the new growth references will do more harm 
than good (in the UK context, not able to speak about others) is that people 
have been expecting them to be 'the answer'.  That means, in my book, they 
have been asking a very restricted set of questions, and we need to ask 
wider questions.  I have been checking for the training materials from WHO, 
still not online (though I was told November.  When I see what other 
questions these attempt to answer I feel I will have a better ability to 
evaluate the potential utility of any improvement the new growth standards 
will bring in practice to the woman and baby at the braface. 


Magda Sachs, PhD.
Breastfeeding Supporter, The Breastfeeding Network 

PS I am expecting to hear Tim Cole (of the WHO working group) in his 
presentation to the UK BFI conference later this week, so may have further 
information on various points!!  Eagerly awaiting!! 

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