Wednesday, December 8, 2010

Why I stopped worrying about growth charts...

I started this post assuming that a number of my mommy friends who want to exclusively breastfeed their babes are getting inaccurate information from their pediatrician's office. I'm told that they are by reports in the media and in casual conversation. All over the net, there are moms encouraged to head to the 6-month check-up with the WHO breastfed baby growth charts in-hand. However, what I've read on the CDC website and in medical journals doesn't seem to support that assumption. Even the CDC acknowledges that the WHO growth charts should be used for children up to 2 years. This is a more recent development (as in, within the past 4 years), but most doctor's offices should be in the loop on that by now.

"In April 2006, the World Health Organization (WHO) released new international growth charts for children aged 0–59 months. Similar to the 2000 CDC growth charts, these charts describe weight for age, length (or stature) for age, weight for length (or stature), and body mass index for age. Whereas the WHO charts are growth standards, describing the growth of healthy children in optimal conditions, the CDC charts are a growth reference, describing how certain children grew in a particular place and time. However, in practice, clinicians use growth charts as standards rather than references.

"In 2006, CDC, the National Institutes of Health, and the American Academy of Pediatrics convened an expert panel to review scientific evidence and discuss the potential use of the new WHO growth charts in clinical settings in the United States. On the basis of input from this expert panel, CDC recommends that clinicians in the United States use the 2006 WHO international growth charts, rather than the CDC growth charts, for children aged <24 months (available at CDC growth charts should continue to be used for the assessment of growth in persons aged 2–19 years.

"The recommendation to use the 2006 WHO international growth charts for children aged <24 months is based on several considerations, including the recognition that breastfeeding is the recommended standard for infant feeding. In the WHO charts, the healthy breastfed infant is intended to be the standard against which all other infants are compared; 100% of the reference population of infants were breastfed for 12 months and were predominantly breastfed for at least 4 months. When using the WHO growth charts to screen for possible abnormal or unhealthy growth, use of the 2.3rd and 97.7th percentiles (or ±2 standard deviations) are recommended, rather than the 5th and 95th percentiles. Clinicians should be aware that fewer U.S. children will be identified as underweight using the WHO charts, slower growth among breastfed infants during ages 3–18 months is normal, and gaining weight more rapidly than is indicated on the WHO charts might signal early signs of overweight." (Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC), MMWR. Recommendations And Reports: Morbidity And Mortality Weekly Report. Recommendations And Reports / Centers For Disease Control [MMWR Recomm Rep], ISSN: 1545-8601, 2010 Sep 10; Vol. 59 (RR-9), pp 1)

M at birth
 They key here is that pediatricians are trained to look at overall growth trends of the individual infant, not to fixate on a goal number. The environment in which the child is raised, the method of nourishment, other health conditions, and gestational age at birth are all factors that contribute to the growth and development of a baby. As a mother, I know it's easy for me to fret when folks tell me how tiny my girl is, and I confess that yes, she's in the 25th percentile for her age. As if I have been deficient as a mother because my kid is small and not yet crawling at nearly 9 months. But those are my issues and have nothing to do with the CDC or WHO.

This is significant to me because my healthy girl, who was 9 1/2 pounds at birth, quickly fell in the percentages (97th percentile to 25th percentile on the WHO charts in the first 4 months), and I was sent home with samples of formula and instructions to see an LC with the assumption that my supply was not sufficient to nourish her. After feeling like a failure as a woman because I couldn't have my homebirth, I needed to know I could at least succeed as a nursing mom. Don't get me wrong, I was ready to supplement if I truly had a supply issue, but I was going to take the appropriate steps first.
    M at 10 days
  1. Determine if I really had a supply issue by either exclusively pumping for 4 consecutive feedings or weighing M before and after each feeding, as recommended in the La Leche League publication, Making More Milk
  2. If I did have a supply issue, I'd meet with a lactation consultant, nurse frequently, and drink mother's milk tea to help build my supply
  3. If I still had supply issues or needed to supplement in the mean time, I would contact the Mother's Milk Bank or another milk-sharing organization

Thankfully, I did not have a supply issue at all. M was getting plenty of milk. To confirm all was well, our pediatrician had M come in for weight checks every couple of weeks, and she could see that M's weight gain was healthy and within normal paramaters. Breastfed babies put on weight slower than formula fed babies, in general, and our pediatrician took that into account. M was born at 41 weeks, 4 days gestation which really started her out in the 90th percentile for gestational age. Factor in that M dropped to 8 pounds 13 oz before we left the hospital and was down to 8 1/2 pounds before she started gaining within her first week, and that huge percentage change doesn't seem so drastic.

Yes, our ped used the charts as a guideline, but she didn't insist I start supplementing immediately or panic that our child was malnourished. She casually mentioned that our girl was 'a little smaller' than she'd like and wanted to keep tabs on her growth for a while. I was the one who focussed on the charts and the numbers and printed out charts. Turns out, she's doing just fine. So, I put all of that away for now, and we'll just enjoy watching M grow at whatever pace is right for her.  
M at 8 months


Corey said...

just read your mastitis post... ok so this sounds nuts... but it worked and I had mastitis BAD... for more than a week (second round of diff. antibiotics finally worked too. my husband got in the shower with me and in the hot water massaged the infected breast to work out the kinks. it hurts like hell but it worked!!! I feel your pain.

Geigerin said...

Thank you for that tip! I've had mastitis too often this year, and I'll take any advice for relief. Usually, a hot shower with my spouse would be more romantic than that. lol

Thankfully, my daily dose of lecithin seems to be keeping it at bay for the time being. :)