Jan,

Have been thinking about your question re inadequate weight gain in
presence of "adequate stooling."

My first question is, "Do we know what adequate stooling is?"

A couple years ago, I was a member of a research committee whose purpose
was to design a study of normal elimination patterns of breastfeeding
infants in the first week of life.  We were able, in essence, to
complete the study design, but were unable to actually conduct the study
due to time constraints of some of the committee members.

We did however, learn a number of things in setting up the study.

1.  We were unable to locate a single research study on this subject.

2.  The closest thing we found to research was the report by Seacat and
Neifert.  According to the report,  147 women were given a 15-question,
quick-screening report when they were seen at  4-7 days postpartum.  The
authors reported that "only the questions regarding infant elimination
patterns were associated with lactation outcome a t 3 wees.  Failure of
the infant to have 'milk' stools by the first visit was significantly
associated with subsequent lactation insufficiency.  Having fewere than
4 'good-sized' bowel movements each day and voiding fewer than 6-8 times
each day were also associated with subsequent isufficient lactation."

Seacat, J.M., Neifert, M.R., and DeMarzo, "Findings from a
Self-Administered Screening For to Assess the Onset of Breastfeeding,
American Journal of Diseases of Children, April 1989.

One question I have about this "study" regards lumping 4-7 day olds into
a single category.  Is it more significant for a 7 day old than for a 4
day old to have at least 6 wet diapers a day, and does putting all these
babies into the same category skew the statistics?

Some of the questions were struggled with on the research committee are
basic things that we have discussed on Lactnet, but they do have an
impact on results of a study or quasi-study done on this issue.  Some
questions we asked were:
When should the baby have regained birth weight?
How big is a good-sized stool?  What if baby stools more than once
before diaper is changed?
How do you tell the diaper is wet?  Weight?  Wetness indicator?  Kleenex
in diaper?  What if it is dirty too, then how do you tell if it's wet?

More questions I've considered--do size and/or number of voids or stools
vary between 37 week and 42 week babies?  between 5 and 10 pound
babies?  Will the type of diaper (even of different paper diapers)
change the perception of numbers, color, or wetness of diapers?

Lots of questions.  No answers.
--
Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA
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