Dear Friends,

I think this ILCA document is wonderful, I use it as a bsis for my courses on management in the first 2 weeks. But about weightgain it is a bit behid in the newest research from WHO. When one watches the WHO data collected within the Multicentre Growth Reference Study (http://www.who.int/childgrowth/en/) closely (not the ready to use charts, but the tables with the numbers, found at the bottom of each of the pages with charting materials <http://www.who.int/childgrowth/standards/en/>), one will see that weight loss is not supposed to last longer then 1 or 2 days and that birthweight can/should be regained within 3-5 days. Taking up to 10 days is when seen within these standards way sub-standard and waiting up to 3 weeks out of the question.
In my, probably not so humble, opinion, there should be far more close monitoring in the first few days with far less laisse-fair and earlier evaluation and refining of management and techniques. Basis of this management should be fairly constant mother-baby togetherness and a minimum of 12/24 breastfeeds

Warmly,

Gonneke, IBCLC, MOM in southern Netherlands

--- On Fri, 6/5/09, Susan Burger <[log in to unmask]> wrote:
Dear all:

First, I'm surprised no one mentioned going to ILCA publications for guidance on weight 
gain. There is a very inexpensive little manual called "Clinical Guidelines for the 
Establishment of Exclusive Breastfeeding" that provides evidence-based values for weight 
gain and MANY OTHER indicators of intake.  This document suggests looking more closely 
when the gain after day 5 is less than 2/3 ounce per day -- suggest that regaining birth 
weight by 10 days is normal and regaining after day 14 is something to be watched. 

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