I really like discussions like this, because they tend to go to the bottom line of things.
I do not have access to this journal, so I can't read the study. But I suppose the study was descriptive in nature, thus weighing and measuring lots of babies and put the data into graphs and tables. That gives a fairly stable notion of a status quo, just as all growing charts used in the western world in the last 100 years or so. WHO data is measured on children who were fed ecologically, or ''as nature intended'' or as far as we know or suppose nature intended it. That could be seen as an intervention study, feeding method being the intervention, all other growth studies being the controls. These data differ immensely from what the ''status quo'' studies show. They show that loosing weight in the ranges we are teached to see as normal of physiological in fact need not be so. These data confirm my lifelong conviction that it is kind of odd to accept weightloss in the ratios we do in any healthy newborn mammal.
That being said, I do acknowledge that lots of babies are born with a not-natural high birthweights due to excessive fluids. To cover that I can accept the weight at 24 hours as reference rather than the actual birthweight.
Bottomline is that it is not the weight itself that is the cullprit but the fact that newborns need food and that insufficient weightgain is or can be a sign of not getting enough food. Lack of food in the early days will lead to low sugars and other unwanted, intervention inducing things. The other thing is that breasts need stimulation in the early pospartum days and insufficient weightgain may be a sign of insufficient breat stimulus.
Weightgain or the lack thereof is a sign of healhty development or the lack thereof, together with other signs like output, skin tonus and colorations, muscle tone and temperature.
If in so may children weight gain is insufficient that is not a sign that slow weight gain is somehow physiologic (it may be ''normal'' in the sense that it is seen a lot), but that something is going really wrong in the care for moms and babies in the early postpartum
Warmly,
Gonneke, IBCLC, MOM in southern Netherlands
--- On Sat, 6/6/09, Joy Noel-Weiss <[log in to unmask]> wrote:
From: Joy Noel-Weiss <[log in to unmask]>
Subject: Re: [LACTNET] Weight gain is never sufficient
To: [log in to unmask]
Date: Saturday, June 6, 2009, 3:16 PM
Dear Gonneke
You might want to check out this paper by Crossland et al. [Crossland, D.
S., Richmond, S., Hudson, M., Smith, K., Abu-Harb, M. (2008). Weight change
in the term baby in the first 2 weeks of life. Acta Pædiatrica 97, 425–429.]
Crossland found that 54% of the breastfed babes and 39% of the formula fed
babes had not regained their birth weight by 8 days of age.
I recently did a systematic review to determine physiological (normal)
weight loss in breastfed neonates. The four clinical practice guidelines I
looked at favoured 7% as a threshold, and I pulled all of their references
along with my search of electronic databases.
I found 6.5 or thereabouts was an average/mean loss - this would mean that
50% of the babies lose more. How can 7% be used as a threshold when it is a
mean loss?
In the research I am doing right now, I have come to realize that we use
birth weight as a baseline and that might be a problem straight off - should
the weight measured within minutes of birth be the baseline or should
babies' fluids settle before the baseline weight is measured?
So I see two issues - 1) what is acceptable loss, and 2) how do we determine
how much a baby has lost?
I appreciate the importance of weight as an assessment tool, and I agree
that we should monitor closely. It is best to catch problems early. Our
comfort with measurements can lead to clinical decisions based the number
and not the whole picture.
Joy
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