Pat says,
bowel movements
For starters: 1. I'm of the opinion that 10 days or 2 weeks is too long
for
a baby to regain to birth weight. I wasn't in a position to study this
when
I got my MSN in 1994, but while working on my MSN I did home vss for a
hospital that did 24 hour discharges with a home vss on day 2 and 4.
Invariably I saw babies who were nursing OK on day 2 to be back to birth
weight by day 4. If they weren't back to birth weight by day 4, I
considered baby at risk and could get another vss. If they weren't back
to
birth weight by day 4, it was usually a problem in baby or mom.
2. A baby at 10 days, below birth weight, not having adequate stool, would
have all my red flags waving. Something is wrong with production (mom) or
transfer (baby). Pat in SNJ>>
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Pat, I think the concept is lovely but in the US of A, unrealistic.
(Probably in Canada too). For starters, one study pointed out that in normal
breastfed babies the amount of weight loss averages 5.5-6.6% of birth weight
which occurs between days 2-3, and normal babies will regain by 8.3 days of
age. However, according to the most excellent program done at the ILCA
conference in 2011, 44% of women in the US experience delayed lactohgenesis --
meaning the milk doesn't even "come in" until after 72 hours. Back to
reading Joy Noel-Weiss excellent study in the IBJ, we see that babies whose
mothers have received a lot of fluids during labor AND we use *birth weight*
as a reference point, we will see many many babies who lose >10% of birth
weight. It is virtually impossible for a baby who is born in the hospital
to regain birth weight by day 4. If we use a 24 hour weight as the
reference point, we'll have more babies regaining by 10 days, which is ideal.
Let's say baby weighs 8# at birth and by day 3 has lost 5% of his birth
weight. That's 6.4 ounces. Mom's milk comes in on day 3. Baby weighs 7-10
on day three. Do you really expect baby to be 8# in 24 hours? That's a
gain of 6 ounces in one day. I don't think that is going to happen. But it
certainly is reasonable to expect him to start gaining about an ounce a day
once mom's milk is in, so I would expect this baby to be 8 pounds by day
9.
Now, if the baby isn't stooling adequately (3 scoopable poops), then he
probably isn't gaining an ounce a day or thereabouts, and there is cause for
concern. But if stooling well, gaining at the rate of an ounce a day, are
we terribly concerned about what day he regains weight?
I think we are placing too much emphasis on the day baby regains weight and
not enough emphasis on the overall picture. Amount of fluid mom got in
labor, amount of times baby peed first 24 hours, time of reference weight
(birth? 24 hours?), if mom's milk was delayed coming in, and then rate at
which baby is gaining per 24 hours.
Jan Barger, RN, MA, IBCLC, FILCA
Lactation Education Consultants
_www.lactationeducation.com_ (http://www.lactationeducation.com/)
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