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Allowing moms to self-weigh babies in BF support group

HIFA Quotation: 

Growth monitoring and regular developmental assessments are key components of what all parents need in order to rest assured that their infants and toddlers are on track or, if not, so that they can intervene early on, before any deviations affect the child's future.

If parents own their own children's growth & development charts, they will be able to see if the child is on what David Morley (who, with the nurse-midwife, Margaret Woodland invented the "Under FIves" growth chart) called the "Road to Health". This "road" is marked on the card with a dotted line delineating the 95% weight for age for each month of age 0-60, and the bottom line indicating the 5% limit. When receiving the card, the parents are educated to understand that it's the slope of the child's weight gain (that is, the velocity of growth), not the absolute weight that is indicative of healthy growth. When the slope levels off for more than a week or two in the newborn or for a month or two in the toddler, they are taught to seek help. And where, as in the West, obesity is prevalent, a steep slope provides early warning.

The Under Fives Card is a wonderful teaching aid for the family, all of whom will become interested and involved. Since it's the family's responsibility to feed the child, they are the ones most interested in the child's growth. They therefore should own the growth chart. David Morley even invented a simple, direct-read hanging scale, such that each centimeter of stretch of the spring translates into a Kg. of weight on the UFC. Mothers are in my extensive experience highly unlikely to lose these UFC cards and can easily remember to bring them on each doctor or practitioner visit. Health personnel can & should copy the parents' chart at each visit, and advise as needed. 

The electronic health record cannot function in this manner. It perhaps could if a computer was designed to accept the UFC belonging to the mother and update it at each clinic/office visit with that day's weight, and the doctor or nurse practitioner's notes; in this way the visit could be simultaneously recorded for both the family and the health facility. Relying on the EHR doesn't help the family, and doesn't provide a complete record since many families travel widely, appear at various emergency facilities, and children engage in all sorts of activities (sports etc.) with health consequences which the parents know about and can record on a UFC but which don't appear on the EHR. Furthermore, many doctors are becoming fed up with the EHR and may not study it adequately!

Date of HIFA message: 
Wednesday, February 14, 2018
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Author Name: 
Nicholas Cunningham
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Nicholas Cunningham is Emeritus Professor of Clinical Pediatrics & Clinical Public Health at Columbia University, New York, USA. He is interested in International Primary Maternal and Child Health Care, community owned, professionally overseen, and supported by $/power interests, encorporating integrated cure/prevention, midwifery/child care, child saving/child spacing, nutrition/infection, health/education (especially female), monitored but not evaluated for at least 5-10 years, based on methods pioneered by David Morley at Imesi (Nigeria) and by the Aroles at the Jamkhed villages in Maharashtra State in India. 

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