> Subject: Re: LCs and test weights
> 
> Karen G. posted some refs on TW with pre-term infants.
> 
> 
> None of these papers finds any clinical benefit of test weighing, 
> which is what we are really looking for.
> 


I'd caution relying on abstracts vs. careful reading of an entire research report.

This recent "provocative" discussion has seemed like a comparison of apples and oranges to me since its start. Different posters seem to be referring to different types of scales, situations scales are used in, etc. Personally, I find test-weighing on a precision, digital scale can -- in addition to rest of clinical assessment -- help guide the transition of a supplemented (whether EBM or AIM) higher risk young infant to full direct breastfeeding. It can help to know if the "picture" of breastfeeding on the outside is "matching" the one on the inside re: milk transfer ability, since sometimes breastfeeding can look approporiate from the outside only to find (via test-weighing on an appropriate scale) that a baby has transferred barely enough for a few gm difference. (And, no, I don't "trust" one feeding observation to be entirely accurate of ability or production, which is why some moms are asked to consider rental -- with appropriate instruction re: use -- of such a scale so that several feeds throughout a day can be included in an assessment before developing a plan of care with a mom.) 

When dealing with a transition to full breastfeeding for higher-risk infants, a situation some test-weight "scoffers" admit they rarely -- if ever -- deal with, maternal confidence is often a key component. These mom often have become "fixated" on ounce/ml marker intakes by the time their babies and related objective info indicate readiness to move on to full breastfeeding. Part of the LC job may be helping this mother realize her baby is not in that same vulnerable place he/she was at birth or even a week ago. Sometimes the scale helps a mom "see" this.

Whether cultural differences or otherwise, in addition to the "apples vs. oranges" elements, I feel that at times there has seemed to be a tone to the discussion that has come across as disrespectful or dismissive or untrusting of respected colleagues clinical judgements. That has bothered me...

Karen

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