I'm not sure if the bell curve inset on this will cut and pasts (I'm 
pretty sure it won't) but that's the little section - Bell Curves - that 
we'll be using for our purposes (Nursing Matters advocacy statement) 
this week. They are nice images - maybe Diane can post this on a webpage 
and then give us the url?

Diane wrote this this morning, in response to my request, so is 
interested in thoughts, as am I , as we have time at this end to wait 
for a little polishing. I think this is an excellent start on a 'crib 
sheet' to give to anyone who is not sure of what a weight chart is. I do 
wonder if it's benefit from slightly more narrative, and slightly less 
'stand alone' comments, in the opening - mostly as it starts with a 
'don't know' and I wonder if 'definites' are best up front. So I think, 
as a one sheet hand out "Bell Curve" is the opening info. As that's the 
one that applies to _everyone_, regardless if an 'issue' has arisen.

I've already had requests to distribute this sheet, hence my feeling 
it's appropriate to post it here and ask for opinions. The _need_ is 
immense. :-)

Morgan Gallagher

- - - - -
*/Interpreting Your Child’s Weight/*

*A weight chart looks simple enough. But your child’s place on it isn’t *

*all that simple to interpret. Here are some points to consider.*

*Low birthweight.* If your child was born very small, new research 
indicates that it may not be in his best longterm interests to “catch 
up” quickly. If his pre-birth growth was slowed, his development and 
metabolism may not be geared to an onslaught of endless food, which may 
make him prone to obesity and all its problems in later life. Since 
we’re not sure yet what the right course is, it may be best not to push 
for a higher place on the curve, but simply to follow his inclinations. 
We just don’t know.

*High birthweight.* There is a tendency to believe that the heavier baby 
will have more problems with hypoglycemia. To guard against this, keep 
your newborn skin to skin with you full-time until it’s no longer a 
concern, and insist that testing be done only if your baby is symptomatic.

*Early weight loss.* This baby’s weight will follow a “smile curve” of 
loss and then gain. If he is weighed before his weight reaches its 
lowest point, and is weighed again just after he has started to gain, it 
may look as if he is continuing to lose when he’s actually gaining. It 
takes at least one more weight check after he is feeding well to know 
for sure how he’s doing.

*Catching up.* When an adult is ill and loses 30 pounds, all she has to 
do once she’s well is regain those 30 pounds and she’s back where she 
started. It’s different with babies. If a baby loses a pound at the 
start, by the time she regains that pound her peers may have added 
another pound. She’s still a pound behind. Even if she begins adding the 
ounce a day that is typical for babies, she still won’t catch up; 
they’re all gaining an ounce a day too! The baby who hasn’t been growing 
well needs, at some point, to do some “supergrowing” – a 
steeper-than-normal curve – in order to catch up.

*Bell** curves.* Growth charts are based on the idea that size, like 
many other differences among people, takes the shape of a “bell curve” – 
a few people on each end and lots of people in the middle. Some people 
have tiny noses, some have huge noses, most noses are somewhere in 
between. A few babies are really big – bigger than 90 percent of their 
peers – which puts them in the 90^th “percentile” for size. A few are 
bigger than only 5 percent of their peers. They’re in the 5^th 
percentile. There is /always/ going to be someone out there who’s the 
smallest of all. That doesn’t means she isn’t healthy! She may simply be 
petite. But what if she started at the 90^th and dropped to the 5^th ? 
That may mean there’s a problem, but not necessarily. Was she big 
because her petite mother had gestational diabetes? Did she change 
percentiles rapidly, which may signal a problem? Or did she change them 
really slowly, which may mean she’s working her way from the football 
league to the ballerina corps? Even a flat line may not be a problem. 
Some babies grow extremely fast at first, then level off for a few 
months. Slow-growing babies are unlikely to level off if they’re 
healthy. But you can see that a growth chart is just one of many health 
variables to consider. The most “weight” needs to be given to whether 
she’s content and interactive, developing skills at a typical rate, has 
full access to food, and has no other signs of illness. In general, the 
more experienced the helper, the more the growth chart is seen as just 
one of many tools. That makes sense, when you realize how complex the 
meaning of the points on the simplest growth chart can be.

             ***********************************************

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