>Dear all:
>
>I have to respectfully disagree that weighing is NOT a clinical 
>intervention -- and I would argue that it is not an intervention at 
>all.  Furthermore, weighin g -- for the purposes of evaluating 
>growth -- is is NOT a good screening tool either.  The reason why is 
>it not a good screening tool is that by the time the baby is not 
>gaining well, the damage has already been done.  Other screening 
>tools such as the infants behavior and intake are much more PROXIMAL 
>indicators of the baby's feeding than weighing.  Having looked at 
>the evidence -- or lack thereof --- on growth monitoring, I was 
>unable to find any evidence that it makes a good screening tool.


Agree with all of that - but to me, it is still an intervention, and 
it needs to be carried out intelligently, purposively and accurately. 
I don't much mind if you remove the 'clinical' epithet from it or 
leave it there :)

Current guidelines from the UK Royal College of Child Health who 
along with other stakeholders developed the training in the use of 
the 'new charts' in the UK specifically state that weighing healthy 
babies more often than once a month in the first 6 mths (after 
birthweight has been regained) is not only unnecessary but poor 
practice.

This is context specific, I now see - fortunately, paediatricians in 
the UK have very little to do with healthy babies and so happily 
don't have a chance to recommend crazy practices like feeding 4 x a 
day or sleep training, so we don't have to weigh babies in order to 
educate their mothers against poor advice and info.

>
>I was, however, able to find evidence that it makes a good 
>EDUCATIONAL tool, when used appropriately, and can be a draw for 
>mothers to seek other health services.  In this regard, the 
>importance is to collect lots of information about the feeding 
>patterns, illnesses, sleep patterns, etc was well as a good physical 
>assessment of the mother and the baby while feeding in order to 
>figure out a) if a slowing or stagnation in growth is having an 
>impact on health and b) what are the root causes of that slowing of 
>growth.  Usually an in-depth dialogue with the mother will reveal 
>the root causes and enable the mom to develop a plan to improve the 
>feeding.  Linking changes in behavior with the growth patterns can 
>be helpful when a mother realizes --- Oh, when I started sleep 
>training here, my baby slowed down in growth --- Oh, when my 
>pediatrician said my baby should only feed four times a day (a 
>recent case of mine) my baby really lost weight --- and then modify 
>those behaviors accordingly.  When weighing is used inappropriately 
>as so aptly described by Magda Sach's work, it can have negative 
>effects.
>
>The reason why it is not a CLINICAL tool is because everyone 
>rightfully has the ability to buy their own (however inaccurate) and 
>weigh themselves, their baby, their food or whatever as they choose. 
>You don't need to (nor would I ever want this to happen) have a 
>license to buy a scale or be a health care practitioner to buy a 
>scale.  Parents buy them all the time.


Not here they don't - I have never known any mother buy or hire her 
own scale in 30 years of practice. I have known one mother only in 
all that time to do the step-on-the-scales-and-subtract-her-weight 
thing  because her clinic were so useless (I expect there were others 
who did it for fun every so often).

Context clearly makes a difference on this issue.

Heather Welford Neil
NCT bfc, tutor, UK


-- 
http://www.heatherwelford.co.uk

http://heatherwelford.posterous.com

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