From Linda Shields, Faculty of Health and Social Care, University of Hull
Weighing babies has long been used as an indicator of healthy development (28 April, p 6). The almost mandatory visit by mothers and infants to the infant welfare nurse or health visitor is part of the culture of having children. It is good to see solid evidence that the growth charts are flawed in favour of babies fed on formula milk, and that a revision is under way based on the weights of breastfed babies. This can only be of benefit to infants and mothers alike.
The baby health clinic visit has always provided useful opportunities for mothers to learn the difficult task of caring for a new baby. However, a decade ago in a research project in Brisbane, Australia, we found that weighing was beset by error – so much so that any changes in the recorded weight of an infant under 9 months of age at weekly clinic visits were most likely due to error (Journal of Advanced Nursing, vol 25, p 587).
A longer period between weighings was necessary to detect real weight change. For older infants, the visits had to be at least a month apart.
One must be careful, however, of throwing the baby out with the bath water. We recommended that visits to the baby health clinics be used as education and learning sessions for parents, without the emphasis on weight gain so encouraged by some infant welfare specialists.
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From Nikki Stokes
Growth charts based on formula-fed babies may do more than just put breastfeeding mothers under pressure: they may discourage new mothers from seeking advice from their local maternal and child health (MCH) nurse at all. I stopped visiting my local nurse after she used the formula-based growth chart to exaggerate my 8-month-old son’s “growth slow-down” and suggested I was being a negligent mother by continuing to primarily breastfeed. I also know other mothers who stopped attending check-ups with their MCH nurse after similar experiences.
Being a new mother is challenging enough without being undermined by well-meaning MCH nurses using these inappropriate measures of normality, which only serve to damage the nurses’ credibility and put new mothers at risk of missing out on the valuable support that MCH nurses provide.
Boronia, Victoria, Australia
From Kerre Willsher
For about 20 years as a maternal and child health nurse I used these charts knowing they were flawed, out of date and indicative of artificially fed white, middle-class, American infants. Unfortunately, there were no other guidelines available. In an extreme case I was using them on Korean children living in Australia. I always told their parents that the charts were dated and that as long as the infant looked well there was no cause for concern.
I am distressed that as a conscientious health worker I may have inadvertently put children on the road to obesity. I will be relieved to see charts that are more accurate and in context, but will always correlate them with my own observations.
Whyalla, South Australia
Hull, East Yorkshire, UK
