>Dear all:
>Sorry, I owe Heather an apology. I was operating on some old
>information and the qualitative research done by Magda Sachs a while
>back where some of the clinics were pushing the 50th percentile of
>weight for age as normative when it is not. Glad to know I was
>wrong.
That's ok, Susan, but without wanting to push it too much, you were
'wronger' than you think!
Your statement was that our *policy makers* thought that babies in
the UK grew differently from babies elsewhere....in fact, as Magda
indeed showed in her research, the error was *not* with policy or
policy makers, but frustratingly for many of us, with the practice of
bf support and infant assessment 'on the ground', where some HCPs
were indeed pushing the 50th centile as some sort of ideal (the
closer and more consistently closer to the 50th centile, the
better....which is of course wholly incorrect with knobs, bells and
whistles attached).
This was one of the reasons why people involved in the implementation
of the UK/WHO charts (which included Magda, to her great credit)
jumped up and down very energetically to make sure the 50th centile
was printed as 'just another centile' and not bolded or starred or
striped or anything like that.
>
>I would go further than Heather in saying you can't diagnose
>lactational insufficiency from weight gain at all.
Well, er....that is indeed what I meant! Lactational insufficiency is
*one* of the reasons why a baby might be slow to gain. It's
impossible to diagnose lactational insufficiency from a slow weight
gain at all.
I am always very worried when a slow gaining baby is assumed to have
a mother who 'can't make enough milk', because this glib assessment
is actually dangerous. I think we all of us come across occasional
babies who are at great risk because of an underlying serious
congenital condition (for example, a heart defect) and who fail to
gain adequately by any measure....and it is assumed that all the baby
needs is formula, or worse, that all the mother needs do is
'persevere'.
Heather Welford Neil
NCT bfc, tutor, UK
--
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