There continues to be discussion of the amount of weight loss "allowed" for bfg infants in early pp. I promised I would look up some ref. which would support my contention that the current 10% is too high, and that it reflects poor feed management rather than a physiologic process. Let me say in advance that this does not mean I am suggesting automatic supplements. Glucose water supplements, for example, have been shown in numerous studies to negatively impact infant weight status. Glover and Sandilands, (Supplementation of Breastfeeding Infants and Weight Loss in Hospital,JHL 6(4), 1990,) compared bfg babies supplemented and unsupplemented with glucose water. The glucose water supplemented babies lost more weight and had longer hospt. stays. What I am suggesting is that as babies are observed to be losing towards the 10% mark it is an indication that intervention should be begun to investigate and remediate the problem. That may or may not involve supplemental calories, but should definately involve hx taking, physical assessment of breasts and baby, observation of baby at breast, refinement of feed management plan and follow-up weight checks. With early discharge and the release of many bfg infants before adequate feeding has been documented, this puts an increased responsibility on the family pract. and pediatric communities to advocate for early well-child checks (on Day 3) or for home health care nurses who can get an accurate weight and make a referral to an LC and a report to the doc if the weight loss is excessive. It also means we need to keep the pressure on to normalize birth and to get babies roomed in and kept at breast in the early pp. I found the article I was hunting that discusses the issue of how feeding practices influence weight loss. It is A. Avoa and P. Fischer, The Influence of Perinatal Instruction About Breastfeeding on Neonatal Weight Loss. Pediatrics 1990 86(2):313-15. These authors make the point that some weight loss pp is normal. They cite an American pediatrics text as stating breastfed babies lose 6.9% of their birth weight before beginning to gain. Bottle fed American babies lose about 4.2%. In Lesotho, Kenya, breastfed babies lose just 3% of birthweight. "In a recent study in Zaire during which babies lost a mean of 7% of birthweight, the degree of loss was found to be correlated directly with the age at which the child was first breastfed." (pg.313.) The authors implemented educational interventions in a clinic in Zaire for mothers immed after birth to encourage bfg, early colostral feeds, freq. sucking. The results were compared with a control group who did not receive the intervention. The 162 study children lost 3.8% of birth weight before gaining. The controls lost 6.2%. Multivariate regression was used to control for other factors. The intervention was highly significant for decrease in weight loss. Michel Odent wrote a short article which appeared in Mothering Winter 1989. I wish it had been published in a journal, but he discusses his observation that during a 2 1/2 yr period he attended 70 homebirths in which one out of three infants didn't lose any weight at all. Typically, the infants maintained their weight, or lost a small amount which was quickly recovered. Odent questioned the long-standing assumptions of pp birth weight loss as being normal. He theorizes one mechanism may be the variance in colostrum intake if infants are unseparated and kept at breast, and if mother feels safe in her surroundings and can release colostrum in sufficient amounts.. He suggests that the enormous protein concentation of colostrum holds a "huge osmotic charge -- that is the capacity to hold water... [which may] correlate with an increased capacity for water retention in the newborn period." (pg.73.) Another study describes similar affects of early and frequent breastfeeding: Y.Yamauchi and I Yamanouchi, Breastfeeding Frequency During the First 24 Hours After Birth in Full-Term Neonates. Pediatrics, 1990, 86(2):171-75. The authors studied the frequency of bfg., intake, weight loss, meconium passage and bili levels . The frequency of bfg during the 1st 24 hours correlated significantly with frequency of meconium passage, maximum weight loss, b-milk intake on day 3, and weight loss from birth to time of discharge (Day 7). These researchers label as iatrogenic many of the problems exper. by bfg babies (like excessive weight loss). The frequent early feeders were compared with less freq. feeders. Early freq. feeders had maximum weight loss on Day 2 compared to Day 3, and the maximum weight loss was lower: 6.8%+/-1.7 loss in the 0-6 times/24 hr group compared to 5.8%+/-1.9 in the 7-11 times/24 hr group. What this tells me is that 'normal' (i.e. hospt. managed, sched. feeds following medicalized births) weight loss is probably about 6-7% of birth weight. That's demonstrably (thanks to these studies) higher than it needs to be. So to let things go all the way to 10% loss is really showing up a baby in trouble. We probably ought to be ready to assist when babies go above 8%. And by that I mean assist with skillful assessment and case-specific remediation which preserves the empowerment of the mother while it protects the status of the infant. Knowing or having some idea of what 'normal' may look like should help us better assess when we need to get busy to support a lactation which is faltering. Sorry this is so long. Barbara Wilson-Clay, BSE, IBCLC priv. pract. Austin. whose home birth babies fit the pattern Dr. Odent observed, but who saw a home birth baby just last week down 10%. Which goes to show you assess each nursing couple as individuals.