It's interesting how often people in other places are working on similar issues to one's own! I like what you had to say, Winnie, and may I use your words to help reassure our staff? We have tried very hard to find out any specific recommendations with respect to "when to supplement" for the first 24 hours of life, and there are none out there! We think we are too quick to supplement babies here in those first 24 hours and since we couldn't find guidelines to say when you should supplement, we decided to identify those reassuring characteristics/signs that tells us we DON'T need to supplement. Here is a copy of our first draft: Reassuring Signs for Breastfeeding In the First 24 hours Draft, May, 2001 If one or more of the following are present within the first 24 hours, we do not need to supplement the baby: Wakes spontaneously at least every 3 hours or comes awake when awakened Quiet and alert at breast (not screaming frantically) Licking/nuzzling at breast Doing skin-to-skin at breast The following should also be present: Normal vital signs At least one wet diaper At least one poopy diaper Choices for supplementation are, in order of preference: Mother's own expressed milk Banked human milk (not readily available here now, but may be in the future so let's not forget about it) Infant formula Please feel free to critique this. I already think we need to modify the "wakes spontaneously every 3 hours or comes awake when awakened", but this is our first attempt! Wanda Mertick, RN, MN, IBCLC Maternal-Child CNS Madison, WI *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html