In a message dated 97-11-19 11:30:22 EST, you write:

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 Date:    Wed, 19 Nov 1997 07:30:11 -0500
 From:    newman <[log in to unmask]>
 Subject: normal diaper count

 Your comments emphasize why diaper count is probably the *least*
 useful of all the various measures we use to tell over the phone
 whether a baby is doing well on breast alone.

 Probably the best (over the phone) is information about bowel
 movements.  A few notes:

 1. A baby doing well on breast alone will start having yellowish bowel
 movements by day 3 of life, certainly by day 4 or 5.  Any baby with
 meconium like bowel movements after day 4 is in big trouble.

 2. A baby doing well on breast alone will usually have many small
 bowel movements in a day, with at least 3 or 4 of them being
 substantial.  I ask "does he ever fill a diaper?".

 3. Though there are exceptions, most of the time, when a mother says
 of her baby that he has infrequent bowel movements (none for 24
 hours), this is an indication for immediate consultation in person.
 (Because there are exceptions).  After three or four weeks of age,
 however, there are many babies who are doing well, who have bowel
 movements only every 3 or 4 days, and some only every 10 days or even
 less.  This is not a concern in itself, if the baby is continuing to
 gain and is content.

 The second most useful (over the phone, because in person it is the
 best indication) is the pause in the baby's chin as he opens his mouth
 during a suck.  If the mother definitely describes an
 open--pause--close type of sucking for several minutes, this baby is
 probably doing okay.

 Also useful is a baby who comes off the breast after drinking and is
 content.  A wide awake baby who is not rooting has probably had a
 decent feeding.  A sleeping baby about whom the mother cannot say he
 was *drinking* is a concern.

 Sleeping through the night at a young age is a concern, though there
 are definitely lots of exceptions.

 Hope this helps.

 Jack Newman, MD, FRCPC

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