>Dear Friends,
>
>I think this ILCA document is wonderful, I use it as a bsis for my
>courses on management in the first 2 weeks. But about weightgain it
>is a bit behid in the newest research from WHO. When one watches the
>WHO data collected within the Multicentre Growth Reference Study
>(http://www.who.int/childgrowth/en/) closely (not the ready to use
>charts, but the tables with the numbers, found at the bottom of each
>of the pages with charting materials
><http://www.who.int/childgrowth/standards/en/>), one will see that
>weight loss is not supposed to last longer then 1 or 2 days and that
>birthweight can/should be regained within 3-5 days. Taking up to 10
>days is when seen within these standards way sub-standard and
>waiting up to 3 weeks out of the question.
>In my, probably not so humble, opinion, there should be far more
>close monitoring in the first few days with far less laisse-fair and
>earlier evaluation and refining of management and techniques. Basis
>of this management should be fairly constant mother-baby
>togetherness and a minimum of 12/24 breastfeeds


As Magda has postd a few weeks ago, the UK has now got its own
presentation of the WHO data, plus guidance on use.

UK HCPs are guided to weigh the baby in the first week (after the
birthweight, obv) and to watch for the regain of weight within 2
weeks.

Now, maybe I am not looking in the right place, but my understanding
is that the WHO data only shows what happens.

It does not show, or express an 'opinion', on  what *should* happen
or *must* happen.

The *clinical significance* of weight velocity that falls outside the
standardised figures is a matter of judgement.

Plenty of healthy babies regain birthweight after 3-5 days, and a few
healthy babies take longer than 2 weeks to regain birthweight.

However, babies who appear slow - compared to the WHO data - should
be monitored and their feeding should be observed and all other signs
carefully evaluated, with weight being set in context. Obviously,
mothers need to be supported to maximise breastfeeding effectiveness.

I'd add that mothers should be supported not to be anxious about all
of this - and a lot of intervention and monitoring in babies who
appear healthy and whose feeding appears normal and who are just not
doing what they 'should' be doing with weight, causes extreme anxiety
and stress. It is also very undermining to breastfeeding.

So I think for all of us this is actually quite a delicate and
sensitive area of practice - no one wants to be 'relaxed' about
weight gain and thereby miss the baby who is genuinely struggling
with effective feeding , and no one wants to intervene with
observations and frequent weighings and questioning when a baby is
perfectly fine, and just slow to gain.

Even the kindest, gentlest and pleasantest observations, questionings
and weighings may be perceived by mothers to be stressful, and to be
a judgement on her, too :(

Heather Welford Neil
NCT bfc, tutor, UK

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