Hi all, Im sorry to add  postscript to my already long note, but just a comment
a further note re my comment about how we used to look at weights, we bing
pediatricians, seeing bottle fed and breastfed babies at two weeks or so of age
for their first PE:
In my post today to lactnet I said that one of my problems with Dr. Neifert's
study was:
<<--it's reliance on a single a parameter (wt) and it's unchallenged and
unsupported assumptions  (are their references in the Birth article?) about what
that parameter should be: What is a sufficient weight gain in the first three
weeks of life (didn't we used to say "back to birth wt by the 2 wks check (which
for some wasn't til three weeks), THEN 1/2 to 1 oz a day"? and wasn't that based
on bottle fed babies who were being fed from day 1? and what was the basis for
the claim that that had to happen anyway, does anyone know of any studies, or it
is just one of those old doctor's tales?>>
Just to expand on that thought a bit, remember that bottlefed babies, who are
getting perhaps 2 to 3 oz every 3 hours from age 4 to 6 hrs are also losing
weight in those first few days, all that weight loss is not just waiting for
mom's milk to come in, it's also expected fluid loss as babies adjust to
extrauterine life.  And with bottlefed babies, we're supposed to be happy if
they've regained birthwt by the 2 wk checkup (Is this expectation based on
studies, or just pediatric "experience"?). Then we want them to gain a half to a
full ounce a day, on average. But we usually only checked once amonth, unless
there was a problem in which case they might come back weekly.  There was never
an expectation that a baby would gain an ounce a day every single day (altho
many do), just that the average would be a half to a full oz a day, some say 2/3
oz. So the smaller the number of days you look at (5 vs. 7, vs. 10 or 14 or 30
days) the more apt you are to have that average thrown off but a short course of
slow st gain.
But also, let's get back to that bottle fed baby, because all these pediatric
expectations of weight loss and gain was based primarily on the experieince of
our bottlefed babies--
So you've got this healthy bottled baby (is that an oxymoron?) anyway, birthwt
7# 8oz-- right in the middle of what was considered normal when I was in
training. Say this baby loses the 7% that Dr. Neifert says is ok (we thought it
was ok for bottled babies, fed from day one, to lose 10%, but I digress, and I
have no idea what data that was based on anyway), 7% of 7-8 is about 9 oz, so
this kid is down to 6-15 by day ?5?, probably earlier, who has the data on
bottlefed babes? but then, if he's good,  we want this baby to be 7-8 again by
day 14-- that's fine-- 9 oz in 9 days. exactly what the doctor ordered.  That's
fine, an ounce a day turns out to be the average, for this 7#8oz formula fed
baby.  Now what about a 5#8oz baby--still in the normal range for term, what if
this baby loses 7%-- that's only about 6 oz. If this bottlefed baby regains
birthwt by two weeks, I'm happy, but it's insufficient wt gain, by the stronger
of Dr. Neifert's definitions-- 6 oz in 9 days. And since some of these 2 wk wt
PKU exams are really on day 16 or 20, this kid might only have gained 6 oz in 12
or 13 days, but his pediatrician is happy-- he's back to birthwt.  (Now I'm not
saying the pediatrician in right to be content with this, I'm just saying that
the "oz a day" expectation seems to me to be based on nothing more scientific
than the "back to birthwt by the 2 wk visit" expectation) And all this is in a
bottle fed baby, not waiting for mom's milk to come in, fed from day one. Can't
we expect breastfed babies to lose just a little more??? and take a little
longer to get up to that 24 oz a day intake that the bottled babies are doing?
If you look at growth charts, bigger babies have steeper curves than smaller
babies, we expect big babies to grow faster than small babies. So shouldn't we
control for size of baby when we decide how much a baby should gain?
Now if someone can show me where the "oz a day", or "20 gms a day" came from,
then maybe I'll retire away quietly into the shadows with Gilda Radner's "Never
mind..."  But to me, it just seems to me to come from the growth curves
themselves, and the knowledge of how babies grow, not so much from day 5 to day
10, but rather from the 2 wk check to the subsequent 6wk or 2 mo check-- because
that's what we were looking at, and that's when we said let's be sure they're
gaining a half to a full oz a day.  And, they were bottle fed.
Now you know why I "lurked" and stayed out of the discussion for so long. I
don't seem to be able to ssay something in three lines....
Tina Smillie