Allison Montag asks why a doctor would not be concerned about a 12 day old
breastfed baby who hasn't stooled since day 8.  I'm confused, because today
is the 29th, and the baby was 8 days old on Aug 17, yet is described as
being 12 days old now.  By my calendar the baby is now 20 days old, almost
three weeks.  If baby has still not stooled since day 8 I would be feeling
very nervous if I didn't have a more recent naked weight.  Do you know
the weight now, or more to the point, does the baby's doctor?

A doctor who is not concerned that the baby is 3 oz (90 g) under birth
weight on day 10 is hardly going to worry about stools.  Either doctor is
very very relaxed and is reassured by seeing how the baby seems to be
behaving, the mother is not telling Allison what the doctor is actually
saying, or the doctor is unaware that both the delay in regaining weight
loss after birth and the lack of stools as well as the continued dark color
last time baby stooled, are cardinal signs that the baby is not taking
enough milk.  The baby's apparent satisfaction does not reassure me in light
of the other information; some underfed babies get that way because they
lose the wherewithal to signal hunger after losing an initial amount that
was more than they could handle.  In this case I don't know what percentage
of birth weight the baby has lost, only that it is 3 ounces below birth
weight on day 10.  If baby was less than 6 lb, this is a lot.  If baby was
born weighing 10 lb, not such a big deal.   Can you let us know the birth
weight and what the lowest weight was?

If I know a baby's weight I'm not as concerned about getting info about
stools.  When I ask parents about stools it is usually to ascertain
whether someone needs to see the baby the same day and get a naked weight.
A baby whose weight I know to be lower than expected for age can stool as
much as it likes, I am not satisfied until I know the baby is thriving,
which means growing.  Being considerably under birth weight on day 10 would
concern me, because I expect healthy babies to be well above birth weight by
then.  The mother will have difficulty understanding our fixation on what is
coming out if she doesn't understand it depends on enough going in.  There
are other signs that intake is inadequate here and I would try to help the
mother understand that, and what to do about it - and let her know that one
sign that things are improving is that the baby will start stooling
copiously and frequently, assuming there is nothing exotic wrong with the
baby affecting gut function AND weight gain.

Good luck, and do let us know how it goes.
Rachel Myr
Kristiansand, Norway

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