Jacqui's baby reminds me of the importance of looking at the basic 
breastfeeding "milestones" or management techniques first. For example, 
we assess by looking at diaper counts (bowel movements more important 
than urine in assessing intake or lack of in a newborn). We assess by 
looking at weight loss or weight gain. Too high of a weight loss, say 
over 7% should concern the LC, unless one is a medical professional able 
to diagnose and treat patients who can take medical responsibility, 
which could make a baby lethargic and weak and unable to transfer milk 
properly. We look at latch on, positioning, and rapid or "active" 
sucking. We look at how often and how long (although these are often 
specific to the individual baby). We look at how old the baby is vs. 
weight loss and weight gain (back to birth weight by day 10, 14 at the 
latest and gaining 6 ounces per week).

Satiation or satisfaction are important but they are tricky because a 
baby can be satisfied without eating enough if baby is "content to 
starve." Or baby can eat too much too fast and be fussy and not 
satisfied with an overly abundant milk supply or too fast let down or MER.

I believe that it is very important for an IBCLC to go over all these 
milestones with the mother so that she learns and so that the IBCLC can 
know what direction to go with her helping or intervention in.

And if and when baby can not or is not removing milk properly at the 
breast and thus failing to thrive or losing too much weight, then we 
have to encourage a feeding method that works. This is what Rachel and 
Linda were speaking about. The longer we wait in these babies who have 
dropped too much and aren't gaining, the worse things get.

Kathy Eng, BSW, IBCLC

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