Hi Karleen,
I am shocked, but on the other hand not surprised.  Recommended weights have 
been gradually creeping up. That figure would ensure that even more babies 
are put onto artificial baby milks very early in life. I wonder how this is 
being justified pyshiologically, because I think the onus of proof lies with 
people who set figures.
Two of my own four babies wouldn't have made this level of gain. The first 
one, when I had iatrogenic lactation failure, gained on human milk (donor 
milk from another mother offered by staff, and a small amount of my own 
milk), but her gains dropped off and flattened out when she was given two 
different brands of cow's milk-based mixtures, eventually receiving the full 
amount calculated of ABM. I relactated, thanks to LLL, and she resumed 
gaining on my milk alone. All of my babies, except the first (who was being 
topped up with artificial milk by the midwives), regained and exceeded their 
birthweights by 7 days.  She took longer.
I don't have the records for the first 2-4 weeks for him, but the next baby 
gained an average 120g per week (60 one week, 180g the next, on a regular 
basis), and was ahead on other milestones.  The nurse who weighed him wasn't 
impressed! With the third baby, probably the biggest gains were while I was 
tandem breastfeeding and I noticed he gained more in the weeks his brother 
was more demanding,  In weeks 2-4, his weight gain per week was 5.5 ounces 
(165 g), and for the next two months it averaged at least 240g  p/w. My 
fourth baby fitted the figures Karleen cited, except for the gain for the 
week to age 3 weeks (a respectable 180g). She was my best gainer, till she 
fell off the graph around the time she started solids and gained very little 
for several months. Reason unknown, but all her other milestones were met 
and the child health nurse was happy with her progress, as was I. What 
surprised me, when I dug out the baby books for my youngest two children 
(the only complete baby records I still have), was how much they gained in 
their early months.
Why am I citing this personal history? Because it shows a different story, 
with babies who had other patterns. People working with babies tend to like 
numbers and this number will be remembered, cited without question, and 
applied - and babies who are doing nicely, being breastfed frequently enough 
and transferring milk effectively, will be unnecessarily topped up. They 
will be exposed to artificial food very early in life and the mother's 
confidence in her body may be undermined.
I should now go and look at the paper cited.  Karleen, do you have the 
citation to share, please?
Virginia

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
Brisbane, Queensland, Australia

On Tuesday Karleen Gribble wrote:
I have just been rereading Marianne Neifert's paper on lactational 
insufficiency. I find it interesting that they determined that a woman was 
not providing her baby with enough milk if they gained less than 200g a week 
between weeks 2 and 4 of life. That seems to be too high as a cut off to me. 
I would be interested in the opinion of Lactnetters.
Karleen Gribble
Australia

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