>I would have to read the whole article (which I can't do right now), but
>after reading it, I think it's a perfect example of how the general
>understanding
>of what test weighing does for the clinician is misunderstood (particularly by
>those who don't use it).
>
>To repeat (which has been done ad nauseum):   the scale is a tool.   It's a
>tool.   If I were to think a 2 week old baby took in 90 ml during a pre and
>post-feeding weight but then really "found out" that it was only 75
>ml (using as
>this example the greatest edge of the error range, i.e., 15 ml, to give the
>most dramatic example possible as a result of this study)


Heather - thanks for your post. I appreciate your care in replying.

However,  the maximum error in this study was 30 ml, not 15 ml.
Don't know if that makes a difference to your feelings about it.

>, then I wouldn't
>change a thing that I said to the new mother:   If her baby had been
>acting hungry
>after the feed, then I would have assumed that 90 ml is not enough for him.
>If I then found out that he had really only taken in 75 ml, then in my head I
>would say, "Well, my inituition about his satiety is even more true."   If he
>had taken 90 ml and seemed satisfied, and I found out it was really 105 ml,
>then I wouldn't change a thing I said either. In fact, let's exaggerate this
>completely: let's say I watched a baby guzzle and gulp at the breast, spit and
>sputter, throw up a whole lot after a feeding, hiccup, look around, seem,
>satisfied, poop his diaper, etc.   Let's say the moom had round, full, leaking
>breasts.   And let's say the scale said he took two-tenths of an
>ounce.   Would I
>believe it and look at numbers only in a vaccuum?   No, I wouldn't.   In fact,
>in a case like that, I might even think that there was a chance that I weighed
>him wrong or that we had added socks or a hat unwittingly. I could give
>example after example, but I think you all get it.


I don't know why you would be weighing these satisfied babies, though :)

>
>
>The way most good scale-using practitioners use the scale is to assess the
>*rate* at which the baby is transferring milk and the volume *in relation* to
>that weight.   As I've said before, all 3 oz are not created equal.
>3 oz after
>switch-nursing, breast compressions and sitting around for an hour is not the
>same as 3 oz taken predominantly off one breast in a relatively short 25
>minutes.   We can use the scale to clinically get at:   1) where supply is,
>exactly.


But the study shows this cannot be done *exactly*.

>  2) how does flow "behave."


And if it can't be done exactly, how can you be show how flow
behaves....and what is the norm for flow, too? Do  we have an
evidence-base for a baseline flow?

>  3) When does baby start to have trouble
>accessing the milk and at what point in the feeding.


I don't understand how a test weight would show you at which precise
point the baby had trouble - given that we cannot be precise.

I am genuinely seeking knowledge and information  here!

Heather Welford Neil
NCT bfc, tutor, UK

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