Sent this to Mary earlier:
As far as the test weights, he does not have to get undressed. (He does for
the real weight). If he's in a sleeper and diaper, just weigh him in that, I
prefer grams becoz it's very precise. Then let him bf, and weigh again.
Don't change the diaper even if he poops. The difference is the milk intake
in ml. Some mothers rent or borrow the scale and do a pre/post weight with
every feeding for 24 hrs. The reason that info is valuable is that if the
baby is indeed taking in an adequate intake, but still not gaining, then one
must look elsewhere for the problem. The problems that it could be (if
adequate intake is documented) are heart, sepsis, metabolic, genetic, etc. I
would say that 99% of the time, it's inadequate volume. For a 9 lb b.wt
baby, multiply 75 ml which gives you 675 mls or 22.5 oz per day, give or
take a couple ounces, for wt gain to occur. If baby eats 10-12x per day,
that would require a 2.25 oz x10 feeds, or a 1.875 oz x 12 feeds. As you can
see, and I have seen this many, many times in practice, If baby is taking
1.7 oz x9 feeds, he is not getting enough. So the amount he's missing can
seen insignificant, but it's not. If your test wts showed 1/2 to 2 oz, that
sounds good, but if most of them are closer to 1/2 to 1.5 oz, and there are
less than 10 or 12 feeds in that 24 hr period, the baby can be coming up
pretty short. Then mom's supply goes down and things get worse.
I find if I explain to parents that way, they understand, that just a little
underfeeding is a problem. I usually give the example that someone on an
1800 calorie diet that goes to 1700 cals (with same exercise or activity)
will lose weight. And likewise, it's good to show that just a little bit
extra is all it takes to tip the scales in the positive direction, but it
must be consistent with every feed and there must be frequent feeds in a 24
hr day.
Hope this was not too much "advice" - I'm hoping it will help you and the
mom/baby. Keep up the good work helping her.
Laurie Wheeler RN MN IBCLC



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