Over the past few months I've seen a number of babies less than a month old
who were not gaining: not transfering milk properly for various reasons, or
there not being enough milk there to grow on, or both.  In every single case
the babies were well hydrated, as evidenced by alertness, moistness of
mucous membranes, voiding of urine and ease of blood sampling.  In every
single case the babies had not stooled for at least 24 hours, usually more.
I always ask about stools, as in 'what do the baby's poopy diapers look
like?'.  Parents then usually describe mustard-yellow, curdy stools, or some
kind of transitional stools between meconium and yellow.  In every case
where parents described scanty or no stools, or meconium after the 5th day
of life, the babies were not gaining and in some cases had even lost more
weight after discharge.
In other words, all the babies in trouble were not stooling daily, and all
the babies who were not stooling daily, were more or less in trouble.
I know we have had this discussion before.  I just want to emphasize the
usefulness of this indicator in determining adequacy of intake.  Obviously
when I see them in clinic I have a good scale available, but for phone
triage, I have come to regard absence of stools for more than 24 hours in
the first 6 weeks of life as a bright red flag, accompanied by alarm bells,
and I want them seen within 24 hours at the very most, preferably
immediately.
Absolutely all the babies were wetting diapers several times a day, even the
ones not gaining.

I don't really want to revive the discussion about stool frequency after the
first 6-8 weeks unless there is something new that hasn't been mentioned
when we have discussed it before.  I do think there is some other process
going on in cases of infrequent stooling later on, and I don't pretend to
know whether it is a harmful one.  Those babies are usually gaining weight
so the need for intervention may be less urgent.  In the newborn, it should
be given high priority.
Rachel Myr
Kristiansand,Norway

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