This discussion goes on, and I realize that when trying to get a baby who
has lost an unacceptable amount of weight, to start gaining again, it's a
different ball game from just supporting the establishment of normal
breastfeeding.  We NEVER answer the question of 'how much does the baby need
to eat' with a number of milliliters if we are talking about a healthy baby
who is feeding only at breast.  We say they need to eat enough so they can
grow, and that if baby is offered the breast when it is interested, it will
generally see to its own needs perfectly.  Parents are advised to watch
output as a rough measure of adequacy of intake, and encouraged to get baby
weighed as soon as possible if more than a day goes by without baby stooling
in the first 6 weeks.

That said, I know that the amounts we recommend for babies in trouble are
sometimes far in excess of what is needed, and even in these cases, it is
essential to LOOK AT THE BABY.  I worked with a baby who had lost nearly 15
percent of birthweight and hadn't started gaining after a week.  The
pediatrician came in and talked to the parents, emphasizing that this baby
needed to take in a minimum of 14 ounces over the next 24 hours.  Baby was
being bottle-fed EBM which fortunately was in good supply, only baby was so
weakened she was unable to feed effectively at the time.  The parents
nodded, got the info in writing, and were instructed to come back the next
day for a new weigh-in.  They showed up bleary-eyed the next day and
shamefacedly reported that they had been unable to get the baby to take more
than 8 ounces all told.  Baby had stooled once in the intervening time, for
the first time in many days, and gained 4 ounces besides.  In other words,
the bottom line was fine, even though the numbers didn't seem to add up.
It's hard to argue with a baby who looks and acts much better than the day
before.  This baby continued to do well and breastfeeding resumed without
problems.

Rachel Myr
Kristiansand, Norway
Where I saw babies in clinic yesterday who had gained anything from one to
three ounces per day on days 3 to 5, but all were happy and thriving  

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