Hi Jen, 

In my experience, the simple presence of urine or stool on day 1 or 2 does not mean the infant is getting colostrum. Let me expound. (BTW I have posted on this several times in the past, I don’t remember under what heading, you might find some posts in the archives). Capital letters are for emphasis. 

Think of infants who are NPO and even for a time without an IV, they will void and stool. The infant is born with perhaps a full bladder and also meconium. It is true we can expect more output if they are eating, but babies void and stool even without food. AND THEN IF THEY ARE NOT GETTING ENOUGH, THE OUTPUT GOES DOWN OR GOES AWAY.  This happens usually once they are at home. Parents will see pink or red or orange in the urine, and the baby will stool only once or none or will keep the dark color for too many days.

So, while the presence of urine and stool can be ONE SIGN of reassurance, I do not take it as the only sign. Listen to the mother. Most mothers know if their infant is satisfied and content or unhappy. Ask her to describe the feeds, or better yet observe a feed(s). Is the baby just flutter sucking? Is the baby coming on and off the breast? Is the baby having longer, stronger feeds at other times? How are the mother’s breasts looking, changing? What is her history? Risk factors for mother/infant? For example, small or early infant? Does the mother feel, or has someone told her, the baby is using her as a pacifier? I believe strongly that babies DO NOT DO THAT and are, instead, trying to get milk, to no avail. So that statement is a big RED FLAG for me. If you are also wondering if the well infant needs supplementation, most don’t at 24 hrs. 

Recently, I had a discussion with a co-worker about cluster feeding. That phrase, from the mother, requires a bit of exploration. A mom had reported cluster feeding all night. I explored that, and sure enough there was a very scant milk production on day of discharge. Cluster feeding was really feeding constantly all night long and still with hunger cues. Breasts were very squishy, and the latch was poor. The pees and poops were within normal parameters AT THAT MOMENT (36 hrs), but without increasing milk production/intake, the output was going to go away. I think the weight loss might have been normal or maybe 7 or 8%. If you have ever done early follow up clinic, you will see that babies often DO NOT LOSE MUCH WEIGHT in the hospital, but they can lose a whole lot in 1 or 2 more days of low intake. So the weight is normal at 36 hours but 14% below birthweight on day 3 or 4. 

Jen, in other words, assessing if the infant is getting milk is more than the stools.

You said << have staff that are making patients panic if the infant feeds for short periods for 2 or more ...always thought infant won't stool if …getting breastmilk and that we can relax if one stool in 24 hours and two on day 2.  … in need of support …or I need to stop telling families that I know their infant is doing well because of the stools.  Please help>>>

 Laurie Wheeler RN MN IBCLC
Beautiful Gulf Coast of Mississippi, USA


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