I found I needed to convert this baby's weights into metrics to be able to 
reason further about it.  The baby started at 3780 g and is now at 4140, 
approximately.  We don't know the baby's length, so we don't know if it looked 
like a little butterball or a skinned rabbit at birth - and that makes a 
difference.  A baby born with generous reserves can tolerate a larger loss at 
the start than a baby who is born very lean.  Also, some babies lengthen more 
than they fatten, and if you measure the baby's length you understand where 
all the energy is going, plus you understand why the baby is acting like it has 
a hollow leg. (It's because it has not one, but two hollow legs.) 
We didn't learn when the lowest weight was recorded, but it was 3400 g, or 
just ten percent below birthweight.  If that weight occurred any time after 
about day four, I would take it as a yellow flag.  Not a red one, but not a 
green one either.  A baby who is still dropping in weight after the fourth day 
of life is not typical nor do I believe it is physiological, and I would want to 
know at that point that baby was in fact feeding effectively and on cue.  If 
this weight was on or before day four I would be less concerned, because 
when they start gaining that early, they rarely get into serious trouble in the 
next few weeks.  
I would let the parents know that they could expect the baby to be an eager 
feeder until birthweight was regained and baby was back on its 
preprogrammed track.  A gain over birthweight of less than 400 g in the first 
five weeks doesn't convince me that the baby is thriving, by any means.  I 
would need to see the actual baby, see how long, active and socially engaged 
it is, and how happy, or worried, it looks. 
Even if we measure the weight gain from lowest weight, it is only 740 g, or 
about 25 ounces in all.  Not alarmingly low by any means, just lower limit of 
normal. Certainly not an amount where you would be justified in expecting the 
baby to settle down and stop wanting to feed so frequently.
If the feed of 2 ounces or approx 60 g mentioned in the Lactnet post was 
representative, the baby would likely need to repeat this performance about 
10 times in 24 hours to get enough food to support growth, according to the 
fifteen percent of body weight per day estimate.  That would give roughly 600 
ml or about 20 ounces of milk per 24 hours.  If the feed was not 
representative, then expectations must be adjusted accordingly, depending on 
whether it was better or less effective than average for the baby.  A single 
pre- and post-feed weighing will not do this.  This could be an example of how 
knowing the amount taken by the baby actually confuses the issue.  The baby 
is not satiated for as long as we expect a five week old baby to be.  Telling 
the baby, or the mother, how much milk the baby got will not affect the 
baby's satiety.  The baby will be satiated when s/he is taking in more energy 
than is being used up.

Despite my reservations about pre and post weighing, I'm with Gonneke and 
others who have suggested measures to encourage improved intake by the 
baby.  It could be breast compression, wearing baby in a sling, or observing a 
feed and watching for how much time is spent swallowing and how much just 
hanging out.  It doesn't seem at all odd to me that the baby wants to be on 
the breast all the time.  Even if this is the baby's ideal growth pattern, such a 
growth pattern in my experience is associated with precisely this behavior.  I 
would not hazard a guess as to whether the feeding behavior causes the 
growth pattern or the other way around.  I'd just want to make sure that the 
mother's expectations of the baby are realistic and in keeping with the baby's 
needs.

My hunch? That supply is just hanging in there, and baby is compensating for 
this by feeding often enough.  This is based on what I often find to be the 
case in similar situations.  I could well be completely off the mark!

Rachel Myr
Kristiansand, Norway

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