Hi!

I'm back from some time away.  My, the mail piles up.

I have been following the "weight loss" issue for some time now.  It
concerns me.

Why do we weigh healthy babies as frequently as we do?  Why do we watch the
clock to assess when a baby last fed?  Neither weighscales nor clocks
existed until recent history.

There is a weight of experience and science that documents that normal
children lose weight (often up to 10%) in the days following birth.  Most
of this is body water.

In my mind we weigh babies too often, and therefore interfere when no
intervention may be required.   The result is anxiety in parents and,
occasionally, breastfeeding failure.  Why do we let machines such as clocks
and scales get the better of us?  The temptation should be resisted.

I believe that, with the exception of birthweight,  we should not  weigh
**healthy** babies in the first 3 days of life unless there is a recognised
feeding problem.  I also believe that a weight loss of greater than 10% in
a **healthy** baby should not immediately be assumed to be a disease
process - we should use our experience and clinical judgement to assess the
infant, the mother and their interaction before assuming there is anything
that requires intervention.

PS  1.  It is probably true that the combination of syntocinon and
intravenous fluids in labor can water load the fetus.  We sometimes see
this as a dilutional effect on the serum cations (particularly sodium).
The newborn is usually clinically unaffected but the subsequent weight loss
can be more than usual.

PS  2.  As a point of interest it seems that weight loss in the first few
days of life in sick babies in intensive care may be a good prognostic
factor, reducing the risk of complications such as patent ductus
arteriosus.  Whether it is the water loss itself or some other mechanism
that results in a negative fluid balance that improves outcome in this
babies I do not know.  Whether in a 500g scrap or a 5000g hulk, I,
personally, am happy when I see a weight loss of 1-3% per day in a sick
infant for the first 2 or 3 days, followed by a gain with the establishment
of appropriate nutrition.

Khalid Aziz
Memorial University of Newfoundland