This baby illustrates exactly the problem of judging the breastfeeding.
Of course, if he really did lose that much in only 4 days, there might
be something wrong with him.  He could have some sort of metabolic
illness.  But he may not have gotten any milk during four days.  I don't
think this is completely impossible, though it is a lot.  I see babies
like this frequently, though I do not usually admit them to the
hospital, because, I know that all they need to do is eat, and I get
them eating (see JHL June 1996).

Nevertheless, I would like to emphasize again the pause which occurs in
the baby's chin as he nurses and is a guarantee of intake--a mouthful of
milk.  *Open--pause--close* type of suck.  I do not feel I have ever
been let down by this physical sign, which can be seen at the very first
feeding.  It is far more reliable than "hearing" swallowing and all the
other things I've heard of as a sign of milk transfer.

In this way, if the baby is doing this type of nursing for much of a
feeding and yet loses weight, something is wrong with the baby.  If the
baby only nibbles, then the problem is that he is not getting milk.  The
problem is that the physical sign is very difficult to describe in word.

I have taught this sign for years, now, and some of you have been to
conferences where I have taught this.  Am I wrong on this?  Does the
pause mean something or not?

Jack Newman, MD, FRCPC