Dear all:

At the San Diego ILCA conference, Laurie Nommson-Rivers did an excellent presentation 
of the predictive value of pees and poos.  She used receiver operating characteristic 
curves (which are a great way to assess cutoff values).  Her work really shows that the 
predictive value of what goes into the diaper is poor and they should only be used as a 
rough guide ALONG WITH OTHER INDICATORS. 

I have seen many a baby who is in serious trouble with perfectly fine diaper counts and 
many a baby who has diaper counts that would suggest trouble who are actually doing 
well in the intake department.  

NO ONE INDICATOR alone is really sufficient to judge what is happening with an infant's 
intake and the reason is that under normal circumstances, physiologic functions adjust --- 
a baby that doesn't eat quite enough at one feed may wake up earlier and feed more 
frequently, a baby who is very energetically crying may burn off more energy but get the 
mother's attention for feeding faster than the sleepy baby, a baby who is not taking 
enough may try to conserve energy and sleep longer ---- it is when the minor 
adjustments to a achieve a homeostatic healthy state start to break down that you need 
to pay attention and the clues that the "system" is breaking down may occur with any one 
of a number of indicators.  


Best, Susan Burger

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