Dear all:

I know Magda's experience and read a lot of what she wrote and I know Australia and 
some parts of Europe went through an era of weighing every feed on a 24 hour basis for 
all infants.  Of course there will be a backlash against overuse and misuse of the scale in 
that setting.  In Magda's case, the information given to the mothers was not provided in 
such a way that the scale was useful at all --- in fact it was detrimental.

I will repeat again what I have said before.  Any tool can be used or misused.  I have 
seen some monstrously bad outcomes from clipping posterior tongue ties which is very 
much in the discussion right now.  And I have seen excellent outcomes from the same 
procedure done by a different practitioner.  

Here in the United States - or at least here in Manhattan among the moms who come to 
my clinics, there is RARELY what I would call a normal start to infant feeding.  Most have 
given formula or expressed breast milk before I saw them.  Every now and again, I will 
have a home birth baby in my group.  These usually have some fundamental primary 
problem on either the milk supply or the oral anatomy side of the equation.  

It is a completely flawed rationale to conclude that you need a 24 hour period of weighing 
for it to be useful.  I read something like 21 studies on test weighing and you can get a 
reasonable estimate of the 24 hour period as long as you understand the culture specific 
feeding patterns.  In the US, this means that parents are doing everything they can to 
induce their babies not to feed at night, so here, feeding at night will be different.  

Moreover, if you keep weighing babies INFREQUENTLY over time --- say once a week, 
you can track trends and you reduce what we call "undependability".  "Undependability" 
for feedings is far less than "undependability" for foremilk or hindmilk, but still is 
substantial enough that no tool (even your eyeballs and your clinical judgement which are 
also tools) is adequate for judging a single feed.   Mothers always know whether a 
feeding is a good, bad or indifferent feeding and this is very important to discuss with the 
mother.  One feeding is never enough even WITHOUT the scale to really judge how an 
infant feeds.  So if you only have one visit with a mother, you absolutely must engage 
her to describe how the feeding you observe compares with other feedings.

To give an example of the multiple feeding scenario, recently I worked with a delightful 
mother of a home-birthed slow gaining baby who did not attach for 2 days and took 11 
weeks to get to full feeds at the breast.  This is a case where clipping of a posterior 
tongue tie, tons of skin to skin and maintaining the milk supply enabled this baby 
transition from taking nothing from the breast for weeks to fully feeding from the breast.  
Her rate of weight gain clearly was satisfactory for her at 1/2 ounce per day despite the 
ILCA document that puts the bottom range at 2/3 ounce per day.  Along the way there 
were many relapses, for instance when her baby had bad oral thrush.  The weighing was 
not the main focus of our work, but it gave her confidence because her baby did not give 
clear swallowing cues.  She was at times both a faker (seeming to swallow but taking 
nothing) and a stealth feeder (seeming to hand out pacifying when she was really 
swallowing).  I'm thinking that Cathy Genna's use of the stethoscope might have worked 
with her. 

The difference between using the scale as a tool and using the scale as a gadget is to use 
it merely as a point to assist the mother to investigate the underlying feeding patterns 
and to assist her to discover what is going right and what might be improved.  If you use 
it to "diagnose" failure to thrive or to "diagnose" inadequate intake --- its a lost cause.  
You MUST absolutely look at the big picture of all the information you have at hand.  In 
actuality, I probably use it more as a tracking progress and training tool.  With the scale 
you can gradually convince mothers who have overused their left brain to start trusting 
their right brain.  In fact, I think that is really what is most needed for many women in 
the United States.  Right brain enhancement exercises!

Best, Susan

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