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Rapid Responses: Rapid Responses published:
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Baby growth charts and skilled breastfeeding support
- Magda Sachs (17 June 2005)
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Growing up in different countries
- Vaishali Mona Verma (18 June 2005)
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Misplaced emphasis?
- Elaine O'Prey (21 June 2005)
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A baby's weight
- Tom H Hughes-Davies (22 June 2005)
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Anticipating welcome change
- Kiran C Patel, Rubin Minhas, Lord Naren Patel (30 June 2005)
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Re: Misplaced emphasis?
- Alison M Lees (4 November 2005)
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Have the charts resulted in 'bigger babies'?
- Katherine S Pathak (29 June 2007)
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Magda Sachs, PhD student Department of Midwifery Sudies, University of Central Lancashire, Preston, PR1 2HE
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It is welcome to see the start of a discussion of the forthcoming World Health Organisation growth charts and their possible adoption in the UK. However, we need to focus carefully on the issues. Wright (1) asks; “Are the growth charts that we currently use inaccurate?”, in particular in their application to breastfed babies. While this is an interesting and important question, a more illuminating one might be “Are we using growth charts appropriately?” If all who plot infant growth were aware that the shape of breastfed baby growth centiles differs from those of artificially fed infants’, and if routine weight monitoring were matched with routine skilled breastfeeding assessment, current charts would probably be perfectly adequate. As Wright notes, the babies whose data is included in the new chart received on-going support for breastfeeding and thus show the pattern infants can attain when their mothers are appropriately supported. UK mothers appear to pick up the idea that their baby’s growth should follow a particular chart centile, and even minor fluctuations are of concern. At the same time, if growth falters slightly for a breastfed baby, the first thought is to reach for a bottle. Neither of these common perceptions is seriously challenged by the information given to each mother in the parent-held child health record, or by consistent messages from health visitors. The major value of the WHO growth chart may be in sparking a re- evaluation of the mediocre weight monitoring practice often found in the UK, which frequently undermines breastfeeding. This is a long-standing issue (2) and deserves serious attention (3). Otherwise, UK infants are likely to remain at risk of inappropriate supplementation of breastfeeding due to poor weight monitoring and poor standards of professional breastfeeding support (4). Magda Sachs References 1. Wright C. (2005) Grwoth charts for Babies. BMJ 330: 1399-1400. 2. Davies D.P. & Williams T (1983) Is weighing babies in clinics worthwhile?. BMJ 286: 860-7. 3. Sachs M, Dykes F. & Carter B (2005) Weight monitoring of breastfed babies in the UK – centile charts scales and weighing frequency. Maternal and Child Nutrition 1: 63-76. 4. Renfrew M., Woolridge, M.M. & McGill H.R. (2000) Enabling Women to Breastfeed. London: The Stationary Office. Competing interests: I have been a volunteer breastfeeding supporter in the UK since 1988. |
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Vaishali Mona Verma, General Practitioner D3 25 Defence Colony , India
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My experience of working in UK, India, Oman, Australia, and New Zealand, there is a variation in growth potential which is genetically determined, so I am not so sure what the WHO is trying to get at by making a universal growh chart.My experience in UK, Asian babies showed poor growth profiles. Similarly Asian babies in Australis show low centiles.IN my opinion each ethnic groups needs there own growth charts.I would like the WHO to explain what on earth they are trying to do? regards Mona Competing interests: None declared |
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Elaine O'Prey, Medical writer CM23 4HH
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I read this article with interest, but I felt I had to respond to the following comment from Magda Sachs: "UK mothers appear to pick up the idea that their baby’s growth should follow a particular chart centile, and even minor fluctuations are of concern". In my experience as a mother of two who has breastfed both children, the impression I have been given is that my baby's growth SHOULD follow its curve and that any variation from this IS a cause for concern! (This is something I now know to be incorrect, but at the time it did cause me much worry, many sleepless nights and almost made me give up on the idea of breastfeeding) With my first child I regularly attended the baby clinic, as caring for my baby was a totally new experience for me (I was a post-doctoral biochemist and medical writer with an extremely limited experience of children and babies). Every 14 days I took her along to be weighted and her weight was plotted on a growth chart. When she was several weeks old she appeared to drop slightly below her line. At the time I did question whether the growth curves were applicable to breastfed babies but this idea was quickly dismissed. My daughter's weight in relation to the growth curve did appear to be a 'cause for concern' and I was advised to eat more, rest more, have her weighted each week and perhaps 'try and feed her a little more often'. (Slightly difficult as she breastfed for about 30 minutes every 2 and a half to 3 hours throughout the day). Each time I took her to be weighed I worried about whether she would still be below her line ... was she getting enough food from me? Was breastfeeding working? Was I starving my baby? Should I try some formula instead?? At each session she was still below her line and I was asked about her feeding, and it was even hinted that it might be worth trying a bottle if things did not improve. After several weeks of this (and lots of worry on my part) I eventually saw one health visitor who looked at my baby, asked a few questions about how she fed, and then told me that my daughter appeared happy, alert, active and if she continued to dirty her nappies regularly then she was obviously getting enough food and perhaps this was just the way she was! This provided enough reassurance for me to continue breastfeeding my daughter - something I could have easily given up on, but which I managed to continue for a total of 8 months. With my second child I have not had the chance to get him weighed as often or even had the opportunity to worry as much about his weight gain. From the few readings that have been taken he also appears to have dropped below his line and at a similar timepoint to his sister. Perhaps this is also because he is breastfed or perhaps this is something that just happens to my children! Several of my friends have recently had children (and before anyone askes we all live in different geographical areas) and those that breastfeed seem to have had / are having similar experiences to mine. I don't think that we are an isolated few - the impression WE have been given as mothers is that growth curves ARE important and your baby MUST maintain its line. If these charts are not interpreted correctly then a difficult job is made even harder by adding unecessary worry over the baby's weight. As a mother I would have welcomed more support with breastfeeding and less apparently misplaced emphasis on these growth curves Competing interests: Mother who has breastfed 2 children (both of which dropped below their line) |
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Tom H Hughes-Davies, Retired paediatrician Breamore Marsh SP6 2J
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Healthy babies can manage on breast milk alone, and when given water gain less weight. WHO therefore recommend exclusive breast feeding in the first months, and use such babies for their new charts. It could be argued that such babies gain more because they take more milk than they need in order to satisfy their thirst. Getting rid of unneeded food not only means more work for lungs, kidneys and circulation but chokes metabolic pathways. It can also accumulate as growth or fat. Obesity is not the cause of the metabolic syndrome but like it a consequence of man's metabolic dilemma which arose when heating and machines took over much of his food's work. Bigger babies may be an early sign of this. WHO should follow the ultimate health of babies allowed to take water unlaced with milk and to distinguish hunger from thirst. Competing interests: None declared |
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Kiran C Patel, Specialist Registrar University Hospital Birmingham, Rubin Minhas, Lord Naren Patel
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Wright1 questions a move to growth charts from the World Health Organisation (WHO) based upon recently collected cohort data in several countries around the world. We welcome this consideration since current charts are not only outdated and of limited value in breast fed infants, but may also not be applicable to ethnic populations. Charts reflecting trends to obesity and malnutrition would be ethically insensitive and the scientific community should refrain from ‘normalising’ these ‘disease’ states. Hence although the WHO datasets may only comprise 20% of the population in certain areas, the stringent WHO criteria should be accepted as a ‘gold standard’ for infants. One should also consider that different ethnic groups may require individual growth charts, which is not surprising in groups such as South Asians where definitions of obesity, overweight and metabolic syndrome are already acceptably different from the white European population. However, such growth charts will only be derived from long-term cohort studies in ethnic groups, which are long overdue in the developed world. Kiran CR Patel, Specialist Registrar in Cardiology University Hospital Birmingham Rubin Minhas, General Practitioner Kent and Medway PCT Lord Naren Patel F.R.C.O.G. Conflict of interest: The authors are all members of the South Asian Health Foundation 1. Wright CM. Growth charts for babies. BMJ 2005;330:1399-400 Competing interests: The authors are all national board members of the South Asian Health Foundation |
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Alison M Lees, maternity leave (freelance proofreader) Lees OL4 3AA
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I just wanted to say this is exactly my experience; my son dropped on the charts, now my daughter is doing the same thing. I took my son frequently to the baby clinic worried at first, but then read somewhere that the charts were 'for formula-fed babies' and haven't bothered about it since. Competing interests: None declared |
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Katherine S Pathak, Stay at home mum 14, The Poplars, Great Dunmow, Essex, CM6 2JA
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I have read these articles with great interest as I seem to have fallen foul of the baby growth charts for two reasons. Firstly, my daughter (now 26 months) was breast-fed until she was 11 months and went straight onto cow's milk, therefore never being fed formula milk. In addition to this, my husband's father is Asian and as a result of these factors my daughter's weight began to fall below the expected 'line'at about 4 months old. I agree with the responder who suggested that this pattern of growth is most definitely viewed as a problem. It too caused me much concern in my daughters first year, particularly as I was encouraged to feed her more often and to supplement with high calorie solids. This I knew to be wrong for my child who was active, healthy and developing well, but it is difficult to ignore the advice of the 'professionals'. what I ended up doing, which many other mothers do, is to weigh my daughter at home and not visit the health clinics at all. I was interested to discover recently, the weight chart for my own first year and I was amazed to discover that my weight at one year was almost identical to my daughters. It is no suprise that our infant weight is similar, but the difference is that, in 1975, I was not considered of low infant weight, but perfectly average. What I am intrigued to know is how much infant weights have changed in the last 30 years and whether the expectation created by the growth charts and the encouragement to overfed that I experienced, has actually led to 'bigger babies'. Anecdotally I can say that it has, but I would like to compare the figures for the last 30 years to find out (I have not been able to locate any statistics) because if this is the case then it suggests that it is important to adopt revised charts for infant growth. Katherine Pathak
Competing interests: None declared |
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