Sorry for my sloppy keyboard habits.  A kind soul asked about my mispelled
word.  It is not growth tradgetory or tragetory as I so rapidly banged out
on my keyboard - it is growth trajectory.  As in the angle of the curve.

As for how I convince pediatricians about how to interpret growth curves, I
guess I am now picking my battles with pediatricians since we have our
trendy hip Tribeca group taking a dim view of our practices here in
Manhattan.  I'm used to doing anthropometry surveys in developing countries
where even the primary health care workers (lower on the totem pole than
nursers or MDs) usually do a better job than I've seen in most
pediatrician's offices in this country. When I see how anthopometry is
typically measured, I can understand why Jack Newman thinks its all
useless.  Nevertheless, in certain circumstances and in the international
nutrition literature - there have been some notable successes in the use of
growth charts.  So, I often take the pediatrician's reports on weights with
a grain of salt, especially when they have balance scales.

Michel Cohen may take a "dim view of our theories and equipment" but any
equipment can be used well or not, whether it is tongue exercises, feeding
devices, positioning, or weights.  Weights are just one of many tools we
can use appropriately, but should never be used in isolation.  I think in
the area of weights I would suggest doing it yourself.  The scales we use
are accurate to 0.1 oz which is far more accurate than most pediatrician
scales and possibibly even the hospital scales.  The scale is but a
snapshot of what goes on.  BUT if you do follow ups and/or run support
groups you can get a better picture of how things are progressing.  Make
sure to calibrate the scales periodically, that the baby is undressed to
the diaper and that you zero the scale with the diaper on the scale so you
don't have to do the math. Whenever I get a client who prefers grams I go
for it. Pounds and ounces are so difficult in the math department.

I have two stories about looking at the whole picture.

One was a baby whose pediatrician had measured her intake a few hours
before my former supervisor saw the baby.  This baby would fall under the
clinical definition of marasmus, which I saw frequently in developing
countries.  The baby took about 0.2 oz by trying every feeding method
available and promptly threw up.  The weight loss was close to 20%.  We
called the pediatrican who said that she had measured that the baby had
taken 1 oz during her office visit and that the baby did not need to be
hospitalized.  The baby had two convulsions in the middle of the night and
the parents did not take the baby to the hospital until the morning.  The
baby had suffered from a series of strokes.  This is a case where the
pediatrician did not look at the baby, but looked at the scale.

The other was more recent with a baby who had a greater than 10% weight
loss by day 3.  I went into the consult on day 4 expecting a train wreck
because the pediatrician had said that the baby was doing fine and didn't
need supplementation.  Sure enough, the baby had gained weight and took 2.5
oz at the feeding from one breast and passed out completely satisfied.
This was a case of the pediatrician actually looking at the baby and what
the baby was doing.

Of course, I also have lots of stories where the scale was very helpful to
me, but its just one piece of the puzzle.

Best, Susan

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