Marsha writes;
>>I have had a few mothers call recently with babies who were not gaining up
to par (not meeting minimum acceptable weight gain)
My question is, is it possible to not be getting enough milk and still have
the wet and dirty diapers that indicate sufficiency?  My feeling is no, their
body isn't going to get rid of waste if it is not getting enough nutrition to
meet needs. <<

First of all, "numbers" of diapers as an assessment tool for parents is very
subjective.
I recently saw a very undernourished baby, at 1 month of age, who was still
peeing and pooping at just the right numbers, obviously not the right amounts
in each diaper BUT if a parent  has never seen the right amount, its hard to
judge what the right amount is!
Judging by this baby and many others I've seen, he would have had to have
been malnourished and dehydrated to such a dangerous extreme as to require
hospitalization,before his mother would have tagged his output as a sign of
such. In fact, one might expect that the difference in output between a baby
who is gaining marginally and one who is gaining well to differ only
slightly. And we want a parent to be able to assess this via tracking
diapers?!
she also writes;

>> ;-(  Both of these babies are giving all the cues we tell moms to watch
for regarding sufficiency.<<

No they are not, they aren't gaining well enough! They are obviously getting
a lot or they wouldn't be gaining at all but the difference between getting
enough to gain well or enough to gain slowly can be relatively small.
Certainly small enough to make them appear as if all is well!
The measures that you used to increase the volume taken seem right on-how
about massage,or improving Mom's ability to assess/effect fdng effectiveness
and check out flow in f-ball hold-I often find it to be more robust! You?
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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