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From:
"Johnson, Martha (Lactation-SHMC)" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 9 Aug 2002 09:29:42 -0700
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Hi Gayle and Lactnet--
Take a look at the baby, not just the numbers.  Also bear in mind that
babies of moms with OAMER will gain wt more rapidly  in the first weeks.
Now that the problems with OAMER are resolved, thanks to your support and
mom's diligence, baby's rate of gain may now have leveled out to what would
have been "normal" for her in the absence of OAMER.
 Whenever there is a concern about growth rates not lining up with charts, I
like to take a look at the big picture.  Breastfed babies are expected to
double birthweight by 4-6 months, and triple by 1 year.  Is your baby likely
to meet this criterion?  IF so, point it out to ped and mom that things are
probably OK.  Has baby's overall gain been close to one oz a day?  Also be
sure and take into account initial wt loss.  If baby lost a lot of wt
initially, start calculating the 1 oz a day from the lowest wt, not the
birth weight.
good luck!
Martha Johnson RN IBCLC
Eugene OR
-----Original Message-----
From: Gayle Prehn [mailto:[log in to unmask]]
Sent: Friday, August 09, 2002 4:58 AM
Subject: WHO growth chart


Hi, I am a new member of the list since April.  I took
my test last month and hope to be joining the honored
ranks of the certified.  I am requesting your help in
interpreting the WHO growth charts as found in the
appendix of Lawrence, 1999.  I am working with a mom
who is very upset because her pediatrician says that
her 4 mo girl is not gaining well because she has
fallen from the 90th to 75th percentile since the 2 mo
visit.  Initially we had serious problems with
oversupply and OAMER for this little one.  Mom had
previously nursed twins.  Got that one solved and
things were going great, and now mom very upset.  I
have tried to plot the baby on the WHO charts but not
sure if that is how they should be interpreted.  On
those charts, her weight to length has her dropping two
standard deviations since 2 months.  No matter which
chart I use, weight by age, length by age, she is
dropping, though some it is only one SD.  I looked at
the chart on month to month intervals, but difficult to
gage as I have weights for birth, 9 days, 2mo and 4mo.
Do you expect a baby to stay within one standard
deviation if all is going well?  I was hoping to use
information from charts based on breastfed children to
get the doctor of mom's back, but if anything this
looks worse as I am interpreting it.  Doc says to
increase feedings and add cereal.  Mom is reluctant to
add cereal because has had major food allergy problems
with the twins since they weaned, and I agree with
her.  She has tried to add a feeding and baby refuses
to nurse.  Baby was sleeping 10 hours at night.  Mom
woke her for feeding which baby did but then would
sleep more and nurse less during the day.  I have mom
doing breast compression throughout feeding to increase
fat content.  So my requests from you wise ones, 1)
advise on how to use and interpret the WHO growth
charts and 2)any advise for this mom.  Thanks in
advance.

Gayle Prehn, RN   Romeoville, IL

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