On September 6, 2000, Barbara Wilson-Clay wrote:
'Dysfuctional feeding is promptly recognized as a crisis in the elderly, or
even in animals, but it is frequently ignored in infants.'
Well, I just had to add my 50 ml worth to this discussion.
Dysfunctional feeding may be unrecognized because we lack good standards on
which to judge.  We have accepted the so-called physiologic weight loss for
so long, and we have only really studied infant growth systematically AFTER
the effects of artificial feeding had become so pervasive that physiologic
norms were impossible to find.  WHO's study on growth of BF infants seeks to
rectify this, and the results will be available in the not-too-distant
future.  (I'm told the Oslo arm is going very well!)
Also, without intelligent reasoning applied to the individual case, meaning
an assessment of each baby's weight loss, taking all factors into account
(meconium passage before first weighing, medications, maturity, availability
of mother all spring to mind, and there are more), we will do no better at
protecting vulnerable babies.  For many babies, being fed formula to correct
a 'number' problem quickly will carry more risk than watching and waiting.
For others, supplementing may be vital.
Growth hormone in infancy, according to David Barker (British hormonal
imprinting proponent/devotée), is inversely proportional to incidence of
depression in adulthood.  We don't know why some people have more growth
hormone than others, or why some peoples' growth hormone is better able to
express itself.  It could be that slowly growing babies are alerting us to
other risk factors.  We simply don't know.  I agree we should be very
attentive to the baby who just doesn't take hold and thrive, and we should
seek to understand the mechanisms at play while doing everything possible to
make more breast milk available to them.
Is it not a paradox that babies who are feeding beautifully can also be seen
as vulnerable due to imagined risk factors, or procedure-defined risk
factors, and subject to treatment which also can jeopardize breastfeeding?
As long as a baby is eating and excreting well (and I define that after a
clinical assessment, in person) I am reassured that nothing is gravely
wrong, even if the bilirubin is a little high or the membranes were ruptured
a couple of days before birth, but this often puts me at odds with
pediatricians.  It seems it is hard to trust watching and waiting, and given
the lack of standards I can understand why.

An aside, for the benefit of Dr Jack: if we don't weigh the babies between
birth and 3 days, we don't have to know how many of them have lost nearly
10% of birthweight by then.  If babies are closely watched in that time and
appropriately cared for, knowing their exact weight is unnecessary
information, akin to electronic fetal heart monitoring in normal second
stages.  By the third day, you will have separated most of the problems from
the normals and can direct efforts toward those who need help, rather than
ritual measurements of uninteresting parameters on all babies.  Of course,
if you have been following the babies and mothers closely the first three
days, you will already know where the problems are!  In the interest of
speedy record-keeping, weights are very convenient, but we should beware of
overreliance on numbers.

cheers
Rachel Myr
in mild but wet Kristiansand, where I learned yesterday that the epidural
rate at my tertiary care hospital, which is the only maternity unit in the
area, is about 12%.  Yep, only about one in eight!  YES!

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