Dear all:

Regardless of how you feel about weighing, as of December the IBLCE made it a requirement to be competent in using the WHO weight charts.  Note, this doesn't say YOU have to weigh -  or - that you HAVE to weigh.  So, I think that mean understanding how to interpret charts.   I actually think it is not a bad thing for people to thoroughly understand the implications of weight and weight charts because weight is the first most sensitive indicator for early growth.  Later, length becomes more important.

Now, this doesn't negate some very valuable comments from others that a weight chart is NOT going to solve breastfeeding problems.  In fact, understanding weight charts without understanding breastfeeding means that you really fully don't understand how to use the weight charts.  One commentator on Lactnet mentioned how other health care practitioners should be well trained in breastfeeding and I thoroughly agree.  In fact, I ALSO  think many really do not understand growth curves and measurement as well as they should either.  

For example, I am still appalled that someone could do all of the training to become a neonatalogist -- which supposedly involves science and measurement and still not understand the principals of precision (which is you must REPEAT the measurement) and publish an absurd paper comparing bottle feeding to breastfeeding.  And many health care practitioners and the journal editors did NOT CATCH THIS MAJOR ERROR.  Furthermore, many people then confused accuracy and precision and claimed scales were not, when these same authors in fact claimed they were.  The worst problem that confuses everyone is dependability which is one component of precision -- the part that deals with observing changes over time.  For some reason most people assume that the scale is less dependable than their eyeballs.  Not so.  Any change that happens over time requires you to make observations over time. If you see a client once, you only have one observation of whatever you use as an indicator, be it making a mother pump her milk into a bottle and feed it to her baby (which I think is the worst possible indicator in the world), using a stethescope to hear the swallows, or observing a satisfied sigh after a single feed.  While I agree that there are reasons for not weighing, claiming that scales are inaccurate is NOT one of them. I am quite tired of claims that this is a reason when the overwhelming evidence is completely to the contrary.  Scales ARE accurate for one thing -- weighing an object. 

On the other hand, claiming that some people put too much value on the numbers is appropriate.  When you really understand the scale and measurement, you understand that one single number by itself is simply not enough.  You can never use a scale in isolation because it is merely a number.  You have to put that number into context.  You cannot put the number in context without doing a very thorough history, careful observations, and lots of dialogue with the mother.  

To illustrate.  My poor son just did his science project and was getting a good grade on it.  I spotted what the science teacher did not.  His methods section sounded fine.  His discussion section sounded fine.  His partner wrote the methods and my son wrote the discussion and edited the methods.  The two sections actually did not mesh if you went through the details.  After lots of discussions of what went on top of what -- the soup can, the tin can, or the pot, I discovered my son didn't really understand the full purpose of all the tools he used.  So we went back to square one and he had to tell me what each piece of equipment meant -- that the pot or large tin can of water was supposed to be steam under the earth's surface, the foil on the pot was the earth's crust, the soup can was the processing plant capturing the steam and the pinwheel was the turbine.  It will make no difference to his grade, but it will make a difference to his understanding. He was just mechanically following through on some procedures his partner found on the internet and jotting down numbers and making a graph that showed the number of spins on a pinwheel increased. He didn't fully think about what that meant in terms of modeling a geothermal plant that would capture energy. That is the problem with science education when it becomes a jotting down numbers exercise.  It drove me nuts when I taught science as a Peace Corps volunteer because the students were excellent at memorizing and terrible at understanding the underlying concepts. 

The defensive posturing that I see most of us must adopt in the US and other similar developed areas is because of iatrogenically induced problems based on a misunderstanding of the measurements take with scale.  Whenever there is any breastfeeding problem whatsoever, it seems like supplementation is the cure.  Since there are still practitioners that only pay lip service to breastfeeding is best, while really thinking formula is just as good (because I and/or my babies MUST be just fine if I or they didn't have an immediate adverse reaction the moment the formula was swallowed) then supplementation is mistakenly seen as formula. Here I quote:  "Breastmilk is truly best" and in the same book "Plenty of Ivy League-bound students and successful venture capitalist were formula-fed as infants and kept up just fine with their counterparts"  Tanya Remer Altmann, MD, FAAP, and Michele Le Shuffett, MD.  "Mommy Calls"  American Academy of Pediatrics.  2008.  pp. 18 and 31.  Nothing in this book talks about mimicking breastfeeding and minimizing risks when using formula, or pumped milk or bottles.  No discussion of how to help mothers with problems make whatever they do as close to breastfeeding as possible.  We need to work on helping those who have problems look at breastfeeding as the norm that is the model for any adjustments they must make.

Without linking the new WHO growth curves to really solid training in breastfeeding problems with more realistic case studies, I seriously doubt that any but the most breastfeeding motivated health care practitioners will really use them in ways that enhance breastfeeding.  So of course their use will continue to have a bad reputation when they could be used in a much more intelligent and judicious manner.  Quite frankly, I have used them now as part of my defensive strategy against inappropriate supplementation and more importantly am collecting data against inappropriate training of babies to sleep 12 hours at 8 weeks of age.

So, I think THE MOST IMPORTANT uses of the weighing scale whether it is for test weighing or for growth monitoring is EDUCATING OTHER HEALTH CARE PRACTITIONERS AND EDUCATING MOTHERS TO STOP LOOKING AT THE CLOCK AND START LOOKING AT THEIR BABIES' CUES.  That would be the primary purpose in my mind.  There are some diagnostic reasons to use them that don't crop up often, but when they do I am glad for the scale.

Best, regards, 

Susan E. Burger, MHS, PhD, IBCLC 

As for the scale, the aches I developed in my shoulders drove me to yoga on the Wii (which I know the true yoga enthuisiasts will claim is NOT yoga), to feeling competent enough to practice push ups while my son was training for his black belt, to Martial Arts -- which has its own series of aches and pains.  But in the end, I have to say I am far more fit than I ever would have been.  The arthritis I felt in my knees in my mid twenties doesn't bother me except when I sit in a cold theater too long, my back is straighter, my sinus allergies are almost gone.  I am now having a reaction about some advertisements that are encouraging New Yorkers to stop walking as much which is about the only thing that slightly lowers our obesity rates and use a particular service that will enable them to sit around at home more.  

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