First, in defense of those who have posted about using the scale. Almost every single post has mentioned that scales should never be used in isolation. Like any tool, it must be used in connection with all the other data and never as an excuse to skip the history. That is where you end up in the situation of many nutrition projects in developing countries where they focus on growth monitoring without promotion instead of the Tanzania experience which used it for empowerment of mothers and health care practitioners. Second, I have seen many babies who look OK and are failing to thrive. Lots who have come into the drop in support group who are still below birth weight at 3, 4, 5, 6 weeks of age and no one noticed without the scale. Pediatricians saw one or maybe two weight checks and thought everything was fine and then something went awry and they never checked or asked questions again and the problem went undetected until far too late. So, I think it is entirely feasible that a baby at 20 days could be missed without a weight check. Most of the time the family and unfortunately health care practitioners as well think the baby is fine because the baby sleeps. And yes, I always ask lots of questions to determine whether or not this is simply the slow gaining baby who is really doing fine. What I find more frequent is that mom is concerned and many practitioners discount her worries and ignore them and it turns out she had reason to be concerned. The worst case was the 4 month old premie who came into support group and was gaining within normal limits at the bottom rung of the weight gain spectrum (4 oz/week). The baby wasn't meeting developmental milestones and slept a lot. This was attributed to prematurity. The baby simply needed to gain more. The mother was furious when she realized that she should have been told to pump and her baby was eeking along. The baby started to gain beautifully when she started pumping and supplementing and immediately woke up and started developing normally. All of this could have been prevented entirely by watching the situation more closely from the beginning with a few judicious weight and intake checks. I do NOT think that there is a question of categories of LCs who use the scale, use it sometimes, or never use it that should be compared. This woudl be a totally silly experiment. It is more a question of learning how to use the scale appropriately, which means in context with all the other data that you collect and in such a way that mom is encouraged and learns to trust her own observations of her baby. As I have pointed out, using a scale inappropriately is a waste of time and money in large scale public health nutrition projects and sometimes even harmful if it detracts from intelligent decision making. Used appropriately it can be empowering. Again, I am going to point out that the context of scale use is extremely important. Just as I mentioned before about never getting a case of mastitis from working mothers off of an oversupply from pumping while others have actually experienced women getting mastitis after overpumping - it can always be due to differences in the populations that we see. For instance, I want to read Magda Sachs work because (and she can correct me if my understanding from Lactnet posts is off) I think her work demonstrates a problem with inappropriate use of the scale. It is not being used in context where women are given sufficiently empowering advice for them to take back the breastfeeding in a way that enables their babies to gain appropriately. I work in Manhattan - a high intervention environment with an overworking, overly controlling, sleep deprived prior to pregnancy, highly competitive environment. Breastfeeding is like everything else here, you must "SUCCEED" in the RIGHT WAY and still be able to do everything else PERFECTLY. That is not the population one works with in Australia where everyone is more relaxed or in Norway where women are not worried about going back to work at 2 weeks, 6 weeks, or 3 months as women worry here. So, here, the incidence of iatrogenically induced problems where mom and baby are out of sync and so intake becomes an issue is probably much higher than in Australia or Norway. So, on a public health scale if one were to think about interventions - it might be like the generalized recommendations that one has for mammograms. For mammograms they have a general recommendation that you get it at a particular age because that is when more women are likely to have problems. One might have recommendations about particular target populations where routine screening of "intakes" should be done. But this would NOT work if those doing the screening simply looked at the numbers. Now, on an individual level we really do need to think differently. Women are coming to those of us in private practice because they have problems. These women exist in all populations. In populations where the culture is more conducive to on cue feeding you are probably going to see more babies failing to thrive from real medical conditions as opposed to iatrogenically induced problems. If you can only spend 30 minutes or less per client for a consultation in a hospital or clinic setting, I think it is challenging to manage to ask all the questions to get the entire context to determine whether a baby's intake indicates an overall problem or just a feeding that is not as good as most feeding. When you can spend 90 minutes to 3 hours with a client, then you have time to do that in depth exploration. Training of mothers and health care practitioners in the Tanzania experience was key to how well growth monitoring and promotion worked. It is expensive and time consuming. The money spent in other projects that focused on MONITORING was wasted money. More of the focus of training has to be on how to link the PROMOTION part to the data from growth monitoring as well as in- depth exploration of feeding patterns, food availability, cultural and familial beliefs than on the monitoring. So, this is key for using a weighing scale. I think if you look at the failures in its use, you will find that training in the use of the scale focused on the mechanics of the scale and the numbers and not the more important aspect of how to collect all the other information needed. On the other hand, my colleagues all come from nonmedical backgrounds and just because they question everything and analyze everything they seem to have just figured this out without training. Best, Susan *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html