This is just a success story.  The baby's behavior met my alarm criteria,
and the stooling non-frequency supported my alarm.

I was recently contacted by a mother whose first baby was 5 days old.  She
had come home from hospital that day.  Baby was exclusively BF in hospital
and she had ample milk, lots of leaking, pumped once for comfort and got
about 4 oz. in no time flat.
She phoned at 830 p.m. because baby had not fed since she left the hospital
that morning.  Weight loss had been 6.6% from birthweight of 4500 g (9 lb 14
oz, a high normal birthweight here which does not cause any extra
surveillance or treatment).  Baby only wanted to sleep.  Had not stooled
since passing meconium on first and second day of life, but diapers very wet
at least 4 times that day.
I suggested she keep the baby with her all night, hand express into baby's
mouth, hand express into a cup if need be to relieve pressure, and take baby
in next a.m. to well child clinic for weight check and a look-over if no
stools and no feeding by then.
Next evening at around 8 she phoned again, baby had suckled many times in
the night but she felt it was ineffective and didn't feel baby had taken
much milk.  Gave 2.5 oz. (70 ml) expressed milk by bottle at 130 p.m. and
went to weigh baby after that.  Up 120 g (4 oz.) from 2 days previously,
still no stools, and only meal baby got that day was the bottle, had been
asleep the rest of the time.  Unfortunately the nurse had gone for the day
and the person doing the weighing, a clerical worker, did not offer her any
opportunity to make contact, nor make a plan to follow up.  She lives over
30 miles from me so my only option was to advise her to take baby to the
doctor then and there to see whether they could identify some good reason
why the baby was not awake and not demanding food.  I felt a bit silly but
reminded myself that a baby on day 5 or 6 should be awakening when hungry
and demanding to be fed, and should have passed some kind of stool by now.

She phoned back several days later to say she had been re-admitted to
hospital on the strength of my referral to the doctor, despite there being
no outright signs of illness in baby.  In hospital, bless them, they just
worked on getting the BF to work - fed the baby and helped mother keep up
supply, and gave them plenty of time to be together to learn.  They could
find no pathology and believe me, they looked!  Baby was stooling regularly
and amply and eating well when she called to check back.  The hospital
concluded that baby had not been taking adequate amounts and was getting
apathetic about feeding because of that.  Luckily they seem to have broken
the vicious cycle before the baby or the BF was compromised.

I found it actually reassuring that the mother knew to seek help, and the
docs knew to refer for investigation, and once she got to the hospital, THEY
knew how to prioritize.

Rachel Myr
Kristiansand, Norway

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