>Dear Friends:
>
>I saw a woman I know last night, who had her second baby with her, a 
>beautiful baby girl, 4 months old that was bright and sparkling and 
>making  contact
>with everyone. This baby is growing and is plump and poops a lot.
>
>But the pediatrician wants the baby to have a barium swallow because the 
>baby is "falling off the curve" according to industry growth charts. 
>Never mind 
>that the baby is healthy and is growing! And the mother is now worried that 
>something is wrong with her baby, despite her intuition that all is well.
>
>warmly,
>
>Nikki Lee RN,  MS, IBCLC, CCE, CIMI


Nikki, this situation is so common in the UK, and it has only just 
struck me I have only rarely seen it highlighted on Lactnet.  I have 
not come across anyone suggesting a barium swallow for a baby falling 
off the curve (oh  my goodness.......what an idea!!!) but probably as 
many as a quarter of the mothers we speak to have some issue with the 
baby's perceived growth on the charts.

In the UK, the charts used at present are called 'UK 90' and they are 
based on several data sets of babies whose feeding is not 
differentiated, but few of whom are likely to have been exclusively 
breastfed. They differ only a little from the WHO charts at first, 
and actually, the beef we breastfeeding supporters have is not with 
the charts but in *the way they are used*.

Magda Sachs (on this list) has studied this phenomenon in action, and 
written a lot of good sense about the way healthcare professionals 
(in the UK, it is mainly the health visitors who use charts) are not 
trained in the use or interpretation of the charts and how to 
communicate this to mothers.

Mothers are *often* advised to supplement or to stop breastfeeding 
altogether, and the only (literally, the only) reason for this is 
that the baby's weight is not following the 'right' centile.  'Catch 
down' growth, when a large or largish baby grows slowly 
(comparitively) and becomes less (comparatively) heavy is really very 
common as an observation, but it is poorly studied beyond the true 
outlying babies born at > 4.5 kg or the babies born to mothers with 
diabetes.

Heather Welford Neil
NCT bfc, tutor, UK

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