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Re: Intervene early to improve outcomes in intellectual development.

Poor weight gain over the first 6-8 weeks is known to be a risk factor in its own right for developmental delay, which can be demonstrated not only at school age but, as shown by McDougall et al as early as 4 months.1

McDougall et al suggest that the Child Health Surveillance check at 6 -8 weeks provides the opportunity to identify infants with early weight faltering; and that future research could ascertain whether intervention, presumably to increase weight gain, would improve later outcomes for infants. However the first 6-8 weeks are the vulnerable period, interventions are needed during and not after the completion of this time.

It has already been shown that interventions can be used to encourage weight gain in both breast and formula fed infants during this early “window” of opportunity.2 3

UK Health Visitors (and midwives) carry calibrated electronic weighing scales and see mothers frequently during this important time. If infants are weighed weekly, then there is the opportunity to detect and promptly remedy weight faltering thereby reducing the risk of developmental delay. Also since the effect on later intellectual development has been shown to be approximately linear over the whole range of weight velocities, there is the opportunity to help all babies.4

The proposal to omit the first 2 weeks from the WHO2006 breastfed weight charts (for UK use),5 thereby also removing birth weight from the chart so that birth centile cannot be identified, may unfortunately limit the implementation of a cheap worthwhile public health intervention.

Yours sincerely

Dr C A Walshaw

References

1 McDougall P., Drewett R.F., Hungin P, Wright C.M. The detection of early weight

faltering at the 6-8 week check and its association with family factors, feeding and

behavioural development. Arch. Dis.Child. doi:10.1136/adc.2008.139063

2 Walshaw C.A., Owens J.M., Scally A.J., Walshaw M,J,. Does breastfeeding method

Influence early weight gain? Arch. Dis. Child 2008;93;292-296.

3 Fomon S.J., Filer Jnr L.J., Thomas L.N., Anderson T.A., Nelson S.E. Influence of

formula concentration on calorific intake and growth of normal infants. Act Paed.

Scand. 1975;64: 172-181.

4 Emond A.M., Blair P.S., Emmett P.M., Drewett R.F. Weight faltering in infancy and

IQ levels at 8 years in the Avon Longitudinal Study of parents and children. Pediatrics

2007;120e1051-e1058 DOI:10.1542/peds.2006-2295.

5 Application of WHO Growth Standards in the UK. Report prepared by the Joint