|Home | About | Journals | Submit | Contact Us | Français|
The case reports of Shroff et al1 document a serious clinical problem with potentially devastating consequences. The tragedy of this situation is that the affected infants are all perfectly healthy and, if we only look for it, the condition is preventable. Local experience of precisely such a case led to the introduction of routine postnatal weight monitoring of infants during the first 2 weeks of life. This policy met with a great deal of resistance on the basis of three unsubstantiated arguments: that inadequately feeding infants can be recognised from other clinical cues, that we don't know what degree of weight loss is acceptable, and that demonstrating weight loss will discourage mothers from continuing to breast feed.
Hypernatraemic dehydration associated with breast feeding is a problem in the UK.2,3,4 Our experience5 and that of Shroff et al denies that inadequately feeding infants can be reliably recognised from other clinical cues. Infants who are not adequately breast fed have been reviewed by doctors, health visitors and midwives, without any recognition of the clinical problem. If the problem is not recognised, owing to subjective clinical assessment, then it cannot be remedied. In contrast, monitoring postnatal weight loss provides an objective assesssment of the adequacy of nutritional intake, allowing targeted support to the mothers of those infants who are failing to thrive or are showing excessive weight loss.
Claims that we don't know what degree of weight loss is acceptable have been addressed by our study of postnatal weight change, which set out clear upper centiles for the degree and timing of initial weight loss and time taken to regain birth weight.6 This has allowed us to develop clear guidelines for providing additional support to breastfeeding mothers. We now weigh babies routinely around days 3, 6 and 10 with continued monitoring of those who have not regained their birth weight. Breastfed infants with >10% weight loss are referred to specialist breastfeeding‐support sisters for supervised feeding, advice on positioning and milk expression. In addition, paediatric medical staff see and monitor infants who lose >12.5% of their birth weight.
Anecdotal cases may suggest that demonstrating weight loss or poor gain could discourage mothers from continuing to breast feed; however, other mothers may be reassured and encouraged to continue breast feeding. We have found no evidence that such weight monitoring discourages mothers from continuing to breast feed.7 Our monitored population (in contrast to two local control groups) actually showed an increase in 6‐week breastfeeding rates after introducing a policy of routine weight monitoring.
It would be nice if that which was natural and best could always be easily established, but we must recognise that sometimes it can be hard. We will serve breastfeeding mothers best if we identify those who are having difficulties and provide early help and support. The arguments against routine weight monitoring have been addressed, and it is time to offer this safety net to all infants.
Competing interests: None deilwed.