You know I was very pleased to see the mention of stethescopes as a potential tool.  Cathy Genna uses a stethoscope and I think I have to get over my own reluctance to use something that feel far more medical to me than a scale.  The beauty of a stethoscope is that you can augment one sensory organ -- your ears -- as a tool to assist you in one of the most IMMEDIATE indicators of a baby drinking -- which is swallows. Plus Cathy hears all sorts of things that are important for suck swallow disorders when she uses a stethoscope.  

When I talk to parents about indicators, I start with swallows.  What to look for, how to listen, and what to feel (for the moms only of course).  After the baby swallows then you get the behavior that results from drinking -- which can be signs of satiety such as a nice quiet alert stage or sleep, signs of lethargy such as not waking for feeds and falling asleep very quickly during feeds, signs of hunger and discomfort etc.  Between those two you can often spare the parents from the late term indicators that result from inadequate intake -- such as very low diaper output and poor growth.  You don't really want parents to have to go there.

Now, in terms of the stethoscope, I don't think it is as accurate as a scale in determining the ml or g of intake.  But really you aren't as interesting in ml or g of intake as you are did this baby get enough -- so coupled with behavior you have a fairly good screening tool.

Nikki asked about the cutoffs I use for diapers.  I give parents a 7 day diaper diary (and tell them not to bother tracking after that) and for all the cutoff I use the cutoffs in the ILCA publication on establishing exclusive breastfeeding.  What I've done is put the indicators in order of immediacy from swallows, to behavior, to diapers, to weight in two boxes -- one box is "watch more closely", the other box is "relax".  And I tell them when some of the indicators shift to the "watch more closely" box - -then get some help.  If most or all in the indicators are in the relax box -- do so.  And if THEY sense something is wrong or are sure -- then by all means get some help. 

And I have a little circle with back and forth arrows to indicate that when a baby is healthy these things work together to create homeostasis -- a little adjustment in intake can lead to a little adjustment in activity can lead to a little adjustment in growth -- and when things are working well they go back and forth and the baby remains healthy.  When the adjustments start falling apart and activity levels or growth or intake are really out of wack, then you have a problem where you have to intervene.  

Best, Susan

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