I can't remember who originally posted this case. I have several posts
in our archives about this if you can do a search.

Remember, diaper output is just ONE indicator of sufficient intake.
Other signs would be quality of latch, quality of feeding, frequency
of feeding, softening of breasts, satiety, and most importantly
GROWTH. It is not so unusual to see output that we would consider
satisfactory, but no growth.

The way I look at it is that the baby is taking in just enough to stay
hydrated and to "get by" but not enough for growth.

Since most cases of poor wt gain are due to insufficient intake
(meaning not enough volume), then one must determine this first: You
have to prove that baby is taking in an appropriate volume. If the
baby is a few days old and not significantly underweight, and things
look good with milk supply, then usually there is a need for more
frequent feeding, offering second breast each time, responding to more
cues, discontinuing the pacifier, and such measures. Making sure there
is another wt check in a couple days. You would not have to precisely
measure intake. Look for tongue tie etc as that is a common cause of
poor milk transfer, as you know.

If things are a bit more serious and we really need to measure intake,
then there are several mathematical computations to help you. For
example calories per kg per day or ml's per kg per day (consult a
textbook or search online). I sometimes use 75 mls x wt in pounds =
ml's per day needed. Therefore, a 5 pound baby needs 75 x 5 or 375 mls
per day. That would be approximately 38 mls at each feeding x 10
feedings.  Measurements can be done with pre/post weights or (hate to
have to do it but sometimes we do esp with premies) pumped milk which
is measured and fed to baby for a day or two.

 Rarely, it will be shown that baby is indeed taking in enough volume
(and therefore calories) but is still not gaining or is losing. That
is when the whole team needs to look for "zebras" which would be
metabolic, sepsis, heart problems etc. It is rare to have this be the
problem, but it can't be ruled out yet.

Hope this was helpful,
Laurie Wheeler RN MN IBCLC
Mississippi USA

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome