Over and over again,  I emphasize to all that weights have to be taken in context!  Birth weight and weight loss

and weight gain, hydration status, infant health, maternal health, milk transfer, day of life or age of infant, height growth, 

infant demeanor, infant output, accuracy of the weight/scale, length of time from the last feeding, the gain from birth and the gain from the last weight.  All of these factors and maybe even a few

more must be taken into account when making feeding recommendations.  




Birth weights can be incorrect or inflated!  Numbers can be transposed or misread.  The numbers must also add

up.  Numbers of feedings day and night, number of bottles, number of expressed ounces, number of oz offered vs those taken.





I can't tell you how many times I ask mothers who express concern over their young infant's "weight loss" whether or not 

their pediatrician weighed the infant naked and the answer is "NO!".  Sometimes even with ALL the clothes on!





I think that there is a wide variation in not so much what is normal but, what can be overcome.  Long term Underfeeding and dehydration is not going to work. 




Long term underfeeding will lead to loss of height and failure to thrive.  Overfeeding short term leads to stomach upset and long term obesity.




But a little of either can be overcome.  




The big question in my mind is when to supplement with formula (when express
ed breastmilk is not available) !  When do the risks outweigh the benefits.  If an infant can't feed 

or is getting dehydrated then we must supplement!  IF an infant does not demonstrate increasing weight gain with good breastfeeding management, 

use of galactogogues over a period of a few weeks then, we are going to  have to supplement.  Weight loss can't be allowed to continue but, what about weight maintenance?










A few days, a week--very gray area! And the mom may have a very definite opinion about all of this and her infant's physician may also be a part of the equation. For example, you might let a 10 lb newborn go a little longer than a 4 lb preemie.  




But, I think that this is the crux of the question--Not, "what is normal?" but, What can be overcome without the use of formula and without endangering the infant and while supporting

the mother and her milk production.  What is acceptable for this unique dyad?  







Christine M. Betzold NP CLC MSN








 




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