Pat's reference to beginner vs expert, I presume, was related to health
professionals. But we do need to remember that most of our moms ARE
"beginners", relying on numbers. It is also the mentality of our society, as
a bottle-feeding culture. I cannot tell you how many parents tell me "I want
to bottle feed so that I know how much the baby is getting" (which I promptly
always follow with, how much the baby takes does not tell you the correct
information--ie, how do you know he is getting enough, did he overfeed or
underfeed when he took that 2 oz). They also focus on minutes, as if the baby
feeds in "ounces per minute".

    With these beginners who are looking for tangible evidence of baby's
intake, it is difficult for them to see proper suck and swallow, even when it
is pointed out to them. I like to give them a chart for two weeks, that helps
them focus on the output rather than ounces or minutes (look at it as the
lesser of evils), as it puts them more in touch with observing what the baby
is doing. I describe MINIMUM numbers of wet/soiled diapers as the same as how
many days old the baby is, which levels off at a week. I also describe the
change in stooling pattern over those days, as well as the type of urine
output that I would be concerned with (dark, tea colored or absent).

I find that my parents are very receptive to using the chart, which also has
a place to track numbers of feedings per day, with a suggested goal of 8-12
feeds by day 3. I call this form the "worry point". The parents are usually
very reassured as their babies are usually exceeding the minimums.

Also, in our area, it is common for the Peds to see the couple at age 2
weeks. If the baby has not regained birth weight (don't ask--it is their
thing) by that point, they invariably tell the mom she must supplement. I
would rather have the moms calling me well before the 2 week point if the
baby is not exhibiting the usual patterns that I have described, so it can be
assessed and addressed well before seeing the MD who will be quick to
supplement.

So the charts can be a valuable teaching resource if used appropriately.

Kathy in NJ IBCLC RN C (Maternal-infant), APN C (Family Nurse Practitioner)
PhD student hoping to study labor and lactation issues

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