1) Immediate indicator while on the breast):  Duration & rhythmicity of swallowing using 
visual, auditory, sensory (what mom feels while baby is on breast) cues

2) Immediate response to intake:  Behavior:  Lethargic, sleepy, quiet alert, fussy 
including duration and frequency of feeds
 
3) Medium term response to intake:  Output (stools and pees), skin turgor & color

4) Longer term response to intake:  Weight loss, weight gain and rate of weight velocity 
(rate of loss or gain over time)

I'm sure you can add to the list.  What becomes evident if you look the least bit beyond 
the superficial is that you have checks and balances that come into play with all of these 
indicators.  One responds to another to compensate and keep the baby in healthy 
homeostasis --- and they can go either direction.  It is when the homeostasis is pushed 
beyond a limit that things break down and the baby is no longer in a healthy state and 
cannot be determined by one indicator alone.

Most important of all --- listening to everything the mother is telling you carefully --- 
neither providing unwarrented reassurance nor reacting with unwarrented alarm as you 
process her concerns.

I have seen complete and total train wrecks when health care practitioners looked at only 
one the above indicators without looking at the total picture.  I still think about the 
mother whose baby was drinking huge amounts from the breast and no one believed her.  
On the basis of the weight alone, her pediatrician told her she didn't have enough milk 
(even though she could later pump 2x per day and get over 32 ounces total).  She made 
her pump and bottle feed even though the baby could not feed well from a bottle and took 
less than half as much from the bottle as from the breast.  A resident at the hospital 
made her feed formula which this baby promptly vomited right back up.  The baby had a 
rare metabolic disorder.  No one listened to the mom except the endocrinologist she 
finally insisted on seeing.

Best, Susan Burger

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome