>Dear all:
>Sorry, I owe Heather an apology.  I was operating on some old 
>information and the qualitative research done by Magda Sachs a while 
>back where some of the clinics were pushing the 50th percentile of 
>weight for age as normative when it is not.  Glad to know I was 
>wrong.


That's ok, Susan, but without wanting to push it too much, you were 
'wronger' than you think!

Your statement was that our *policy makers* thought that babies in 
the UK grew differently from babies elsewhere....in fact, as Magda 
indeed showed in her research, the error was *not* with policy or 
policy makers, but frustratingly for many of us, with the practice of 
bf support and infant assessment 'on the ground', where  some HCPs 
were indeed pushing the 50th centile as some sort of ideal (the 
closer and more consistently closer to the 50th centile, the 
better....which is of course wholly incorrect with  knobs, bells and 
whistles attached).

This was one of the reasons why people involved in the implementation 
of the UK/WHO charts (which included Magda, to her great credit) 
jumped up and down very energetically to make sure the 50th centile 
was printed as 'just another centile' and not bolded or starred or 
striped or anything like that.

>
>I would go further than Heather in saying you can't diagnose 
>lactational insufficiency from weight gain at all.


Well, er....that is indeed what I meant! Lactational insufficiency is 
*one* of the reasons why a baby might be slow to gain.  It's 
impossible to diagnose lactational insufficiency from a slow weight 
gain at all.

I am always very worried when a slow gaining baby is assumed to have 
a mother who 'can't make enough milk', because this glib assessment 
is actually dangerous. I think we all of us come across occasional 
babies who are at great risk because of  an underlying serious 
congenital condition (for example, a heart defect) and who fail to 
gain adequately by any measure....and it is assumed that all the baby 
needs is formula, or worse, that all the mother needs do is 
'persevere'.

Heather Welford Neil
NCT bfc, tutor, UK
-- 

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