>Dear Friends, > >I think this ILCA document is wonderful, I use it as a bsis for my >courses on management in the first 2 weeks. But about weightgain it >is a bit behid in the newest research from WHO. When one watches the >WHO data collected within the Multicentre Growth Reference Study >(http://www.who.int/childgrowth/en/) closely (not the ready to use >charts, but the tables with the numbers, found at the bottom of each >of the pages with charting materials ><http://www.who.int/childgrowth/standards/en/>), one will see that >weight loss is not supposed to last longer then 1 or 2 days and that >birthweight can/should be regained within 3-5 days. Taking up to 10 >days is when seen within these standards way sub-standard and >waiting up to 3 weeks out of the question. >In my, probably not so humble, opinion, there should be far more >close monitoring in the first few days with far less laisse-fair and >earlier evaluation and refining of management and techniques. Basis >of this management should be fairly constant mother-baby >togetherness and a minimum of 12/24 breastfeeds As Magda has postd a few weeks ago, the UK has now got its own presentation of the WHO data, plus guidance on use. UK HCPs are guided to weigh the baby in the first week (after the birthweight, obv) and to watch for the regain of weight within 2 weeks. Now, maybe I am not looking in the right place, but my understanding is that the WHO data only shows what happens. It does not show, or express an 'opinion', on what *should* happen or *must* happen. The *clinical significance* of weight velocity that falls outside the standardised figures is a matter of judgement. Plenty of healthy babies regain birthweight after 3-5 days, and a few healthy babies take longer than 2 weeks to regain birthweight. However, babies who appear slow - compared to the WHO data - should be monitored and their feeding should be observed and all other signs carefully evaluated, with weight being set in context. Obviously, mothers need to be supported to maximise breastfeeding effectiveness. I'd add that mothers should be supported not to be anxious about all of this - and a lot of intervention and monitoring in babies who appear healthy and whose feeding appears normal and who are just not doing what they 'should' be doing with weight, causes extreme anxiety and stress. It is also very undermining to breastfeeding. So I think for all of us this is actually quite a delicate and sensitive area of practice - no one wants to be 'relaxed' about weight gain and thereby miss the baby who is genuinely struggling with effective feeding , and no one wants to intervene with observations and frequent weighings and questioning when a baby is perfectly fine, and just slow to gain. Even the kindest, gentlest and pleasantest observations, questionings and weighings may be perceived by mothers to be stressful, and to be a judgement on her, too :( Heather Welford Neil NCT bfc, tutor, UK *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome