In a message dated 12/15/01 12:11:25 PM, [log in to unmask] writes:

>The paper makes no mention of feeding challenges, and it is really a
>'count 'em up' study that nevertheless gives support to anyone trying
>to say that long periods (more than a day)  without stooling is not
>normal, ***in the first weeks***.  I think experience strongly
>suggests that more than a day without stooling should prompt the
>carer to look at the feeding.

I agree with this statement and am especially glad that Heather chose to
highlight "in the first few weeks".
I do, however, have a concern with the "numbers" of stools expectation  given
to parents for the FIRST WEEK. In this area, parents are discharged with the
idea that the stooling expectation should roughly correspond with the number
of days old the baby is, ie. on day 4, baby should have 4 and that this
applies until the milk comes in or  continues at roughly 4/day. As a VNA
nurse I see the majority of my clients at day 3-5 and most often,
particularly for primips that are nursing (of course!), the baby has
diminished his stooling pattern over the 24hrs. or so prior, very often the
babe hasn't stooled at all for 12-24hrs. On further investigation the Moms
milk is either just becoming more abundant or has done so over the last 12-24
hrs. I explain to the parents that for the day or so before the milk comes
in, the babie's body is starting to require more volume then the breast is
offering, the meconium is largely gone and there just isn't enough there to
move through. Although some of these babies may have been feeding much larger
volumes for the previous 12hrs. or so, I explain that in this case, it just
hasn't had the chance to move "all the way through" and to be patient. IME,
they are never prepared for this.
IF these parents were not to see me, they probably would then feel concerned
enough to call the pedi office, where more often than not, they will not be
asked about the "state" of their milk supply or the adequacy of their feeding
but will be instructed to suppmt and or offer some rectal stimulation. This
is a particularly cruel irony as it is  about the worst time to suppmt, when
all is about to come together!
The very reason why I emphasize assessment of intake, ie sucking/swallowing
vs. output .
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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