What is most important in a three week old baby is that he/she be 
pooping a lot. Like at every feeding or at least 4 large yellow bowel 
movements per day. The newer disposable diapers hold a lot of liquid. 
Many parents do not change baby until it is heavy, heavy, heavy. So 
about 2-3 pees worth before changing. Also, pee can hide under the poop 
and look like "just poop."

It is hard to know about this baby. We need to know how much baby 
weighed at day 5-7 to assess if baby was gaining from the early 
supplementation or from currently breastfeeding well. Test weights would 
tell how much baby is removing from the breast.

I am working with a baby with a recessed chin, who looks like he has a 
short tongue or is tongue tied. He did "fine" supposedly at first and 
the weight gain was "okay" at 2 months. But now he is not doing fine, 
looks thin and has not gained properly for the last month. He could not 
remove milk well during test weights (the SLP or OT says he is not 
coordinated enough at sucking and eating -- my paraphrase).

The test weights showed us that intake at the breast was very poor.

The moral of this story is how staff thought this baby was suffering 
from too abundant milk supply in the beginning because of the green 
stools and fussiness at the breast and "okay" weight gain. It did sound 
reasonable at the time.

Without test weights, I would look at how large the BMs are, how often, 
how many per day, the color, and recheck the weight in the near future  
(waiting no more than a week). If baby is removing large quantities of 
milk from the breast and is not getting formula, the BMs will be 
abundant at this age. Large, yellow, and big enough to coat his bottom 
-- not just little smears.

Kathy Eng, BSW, IBCLC

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