Marsha Glass asked
<<My question is, is it possible to not be getting enough milk and still
have
the wet and dirty diapers that indicate sufficiency?  My feeling is no,
their
body isn't going to get rid of waste if it is not getting enough nutrition
to
meet needs.  >>

At our local ILCA chapter meeting today, Netta Dickerson (IBCLC and neonatal
NP) answered this very question in reference to premies who are discharged
before they can breastfeed well enough to gain weight.  She said a premie
needs 150-180 cc/kilo/day to gain weight, but 80 cc/kilo/day will give
sufficient pee and poop.  (I'm quoting from my notes, so take this with a
grain of salt.)

Diaper counts are a very imprecise measure, after all.  One mom's wet diaper
is another mom's dry-enough-for-another-three-hours diaper.  And just how
big
IS a big poop?  If there is any doubt about the adequacy of the baby's
intake, we need to use a scale.

There's something else about output that has been a theory of mine for a
long
time, based on my experiences nursing one of those babies who transitions
from many poops a day at one month to one poop a week at four months.  When
I
heard the theory that a woman's milk production stabilises in the early
weeks
and then does not increase very much after it is set, I looked for ways that
a baby can go on gaining weight if its intake doesn't increase.  One way
would be to use its food more efficiently.  So I reason that the copious
poops of the first few weeks may indeed represent excess milk that the baby
is not utilising, whereas the less frequent (but still copious) poops of
some
three and four month old babies represent the output of a baby that is
utilising a larger percentage of his intake and has less left over to show
up
in the diaper.  But of course, poop is made of the waste products of the
baby's gut bacteria colonies as well as the residue of the baby's diet.
Maybe changes in the gut flora also play a role in normal stool pattern
changes...I wonder...

Chris Mulford (still amazed at how much we DON'T know about this stuff...and
we're the experts?!?)

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