>Heather,
>
>When visiting a mom whose baby is borderline, but I'm following closely, I
>have been known to take a dry diaper and put 3 tablespoons of water in it,
>then close it tightly - and ask the mom to keep it in the baby's changing
>area so she can compare it to the diaper she is removing (for a day- after
>that it has evaporated).  This gives them a measure for what a wet diaper
>should feel like.  Usually the first time she feels it, she agrees her baby
>has NOT been wetting diapers that well - but by the time we get things going
>- she feels confident that she can recognize a wet diaper.


That's a good idea - if we can't really expect mothers to do this for 
themselves, then seeing it done by the HCP is good.

>
>I agree that stools are important (I tell moms 2 x the palm of their
>hands)...
>
>But NEITHER is as important as breastfeeding OBSERVATIONS followed by
>appropriate interventions (including education about breast compressions,
>pumping after feeds and/or supplementation) and REPEATED weight checks until
>it is clear they are in synch.


I agree - our factsheet emphasises the stool-and-urine observations 
as something very easy the mother can do for herself as a sort of 
frontline check. We want all infants weighed accurately and at the 
appropriate times - NICE guidance has first week weighings for every 
infant done at birth, day 3 and day 5 (NICE is the UK's body that 
advises on evidence-based best practice).  This is not done reliably 
in the UK. If the weights are done, they may be done very haphazardly 
- infant may be clothed or not, according to the HCP's whim of the 
moment, on spring balance scales which are just not accurate. And of 
course, as an absolute basic, there should be observation of feeding.

Heather Welford Neil
NCT bfc, tutor

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