Dear all:

I know that there are special charts for special conditions such as prematurity and Down's.  I don't know, however, if these charts are based on healthy breastfed babies with these conditions.  I'm sure Nancy Wight has special charts that are used for in-hospital monitoring. 

Since I only see babies outside the hospital, I'm seeing them at an older age when they are much less fragile.  So, basically, for premies I merely see if the baby is growing along A curve. For babies who are 32-36 weeks, you can get them on A curve by using Z-score charts rather than percentile curves. I've done several babies this way.  If you pick the z-scores that surround the babies weight moms can focus on THEIR babies weight rather than a weight that would be impossible given the prematurity.  The other way would be to subtract the number of weeks of prematurity from their current out of the womb age.  

I much prefer the customized charts because mothers can sometimes feel bad when a baby is growing perfectly well along the lowest centile or in the case of some premies -- below the centile curves.  It looks better to moms when they are growing between curves.  The most recent chart I did was a now seven month old baby who was growing beautifully between the - 2 and the -3 z-scores and then had two bouts of illness - diarrhea followed by flu during the same interval that the baby started to sleep 12 hours.  The weight plummeted just below -3 scores.  The pediatrician told the mom to wake the baby up to feed more frequently (I'm so thrilled with the pediatrician) and the baby has started to rebound now.  What is nice to see is that the length gain has been tracking beautifully along the -2 z score.  Between three and six months, length gain is a more stable indicator of growth. Weight tends to wobble around a curve much more.  When slightly older babies are seriously in trouble, you always see it in the length as well.  

On the percentile curves this looks terrible because the baby was born well below the first centile.  Even though the pediatrician had been reassuring her that the drop in growth was due to the long sleep and the illnesses, the mom was much more relieved to see the steady gain of length on the z-score charts and the rebound in weight as well.

Best, Susan Burger

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