On Friday, November 11, 2011, Heather Welford Neil wrote:

> .the overwhelming evidence is that return to birthweight is not fixed 

> in stone at an early stage. The WHO weight and growth charts (from data 

> taken from excl breastfed babies) do not start until 2 weeks for that
reason.

> 

> I think the evidence is pretty clear: the key to assessing how well a baby


> is doing vis a vis his weight gain is *trajectory*, not a date by which 

> the baby achieves birthweight....birthweight can be i) badly recorded ii) 

> artificially inflated - see the recent paper on maternal intra-partum 

> fluids.

> 

> A newborn should be *gaining* weight, for sure, after about day 4-5 - 

> there are a number of  studies that confirm this -  but I don't know of 

> any studies (and I have done a fairly recent trawl of the literature on 

> this for a piece of work I did for my organisation) that indicate failure 

> to reach birthweight by day 4 to be a sign of being 'at risk'. If there 

> has been more recent work done on this, I'd be interested.

 

I agree!  Regaining birthweight (BW) by a certain day is not as important to
me as the trajectory that Heather spoke of.  If a baby weighed 7 lbs, 15 oz
at birth, I would want to know the lowest weight by day 5 or 6.  If that
baby lost 10% of BW, that would be a loss of about 13 ounces, and I would
expect it to take 2 weeks or more from the lowest weight (on Day 5 or 6) to
regain the 13 ounces; by that time, that baby could be 3 weeks old.  If the
baby lost 7% of BW, that would be about a 9-ounce loss (by Day 5 or 6) and
that could take over a week to regain; that baby could be 2 weeks old at
that point.  Some babies regain faster and some slower.  To paraphrase Dr.
Jack Newman, as long as the baby is GAINING what is minimally acceptable, it
is okay.

In my area, babies have the first pediatric office visit on or about Day 4,
so that may not be the lowest weight.  I encourage the parents, if it
becomes necessary, to remind the pediatrician to take that into account and
request another weight check in 4 days or so.  If the weight gain is good,
the parents are not comfortable with being told to come back in a month.
Some are anxious to know that the baby continues to do well by having the
weight checked weekly until the baby is a month old - that sounds like a
good idea to me.

As for the second topic, I like to give a new mom a visual image of an
adequate BM that she can easily remember and use for assessing adequacy.
Kay Hoover has a sheet, "Diapers of the Breastfed Baby" that shows the BMs
of a breastfed baby.  It is great for the different stages of appearance
from Day 1 to Day 5, specifically for consistency, color, and size.  Her
instructions say:  "Only count poops larger than this" followed by a picture
(the picture shows a quarter next to the poop of that size).  I share the
sheet with new moms.  The other side of the sheet is for recording feedings,
wet diapers, and poopy diapers; the format makes it easy for the parents to
keep an input-output diary by just circling the correct information, and it
includes minimums expected during the first week.

IMO, these two topics are very important for IBCLCs to be well-informed
about and the parents need that type of very specific information/guidance.


Warm regards,

Lee Galasso, MS, LLLL, IBCLC, RLC

Westchester County in NYS, USA

"Children Are Born with the Need to Breastfeed"

 


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