Kelly asks about research articles about the harm caused by pre and post feeding weight checks.  After having read at least 40 articles on the topic of test weighing, not one demonstrated harm.  Some of the skeptics of test weighing actually changed their opinions about test weighing after conducting a study trying to demonstrate that it was inaccurate and therefore harmful.

Kelly's situation, however, leads one to employ some common sense about the situation in which test weighing is being employed.  It sounds like this is being done by nurses who are untrained and might provide incorrect advice based on misinterpreting the results of test weighing.  Furthermore, repeatedly again and again on Lactnet most Australians have a deeply negative response to test weighing which seems to be a reaction to a period of time when test weighing was used for every feeding in the first couple of weeks after a baby's birth.  I have enough anecdotal reports from Australians and a few clients who have done 24 hour weighings for weeks to know that that process can be stressful even if not reported in the research.

So, just thinking pragmatically, the harm of test weighing after every feeding might be addressed pragmatically:

1)  Misclassification of the adequacy of feeding: 
Babies who are in the hospital are usually 4 days old are less.  The quantities of milk they drink are very small in comparison to their intake at 1 or 2 weeks of age.  (The increase in intake from day of birth to day 10 is an 11-fold increase). So this can lead to misclassification due to:

a) the ratio of the amount ingested to the accuracy of the ability of a good electronic scale changes from about 3:1 (5-7 ml on day 1 versus 2 ml accuracy of scale) to about 35:1 (60-81 ml by day 10).  When the amount you are measuring is almost as much as the range of error of the measurement it makes no sense to employ that for any sort of diagnosis. And no decent IBCLC would ever use a pre and postfeed weight measurement in isolation even on day 10.  A thorough health history and observation of many other factors about that feed much be incorporate.

b) the trajectory of improvement or stagnation in poor feeding is highly unpredictable in the first three days of life.  So, if the volume of the feeding was measured just before the milk supply jumped up - it would clearly give a different picture than after the milk supply jumped up.   

Equally important would be to figure out if the information being used in isolation to determine the need for supplementation?  This would obviously be a terrible decision because of the range of variation in feeding volumes from feed to feed.  There are more conditions that could lead to unnecessary supplementation in this regard.  There are many more factors that can lead to an underestimate of intake in the early days than an overestimate.  A worse case scenario would be if they started to use the scale to "top up" perceived low volume feeds.  That would be disastrous knowing what we already knew and was further confirmed by Kent's work on the feed to feed variability in volume of intake.  

It is one thing when you have a full track record of mother's observations of feedings that are consistent with a weight check of a typical feed and have an in depth conversation as well as thorough assessment of the suck, than to measure the up and down roller coaster that is often the start of mom and baby getting in sync with each other in the first three days or so.


As a first step, I would find out WHY the nurses think they need this information and then explore whether or not that really fulfills their perceived need.  I think in most cases, one can easily debunk the need to use the scale this early on a routine basis.  There might possibly be some special circumstances where a case might be built for rare, strategic use of the scale (not that I can think of any right now).  

Perhaps an inservice training on when test weighing is useful and when it is not by the IBCLC who has been doing it might be productive. 

Best, Susan Burger, MHS, PhD, IBCLC

 

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