I joined in this discussion late so forgive me if this was already said. I 
get a little nervous when the baby has lost over 7% and very nervous when it 
becomes 10%. WHY? Because around here, there is no one teaching mom how to 
breastfeed properly and the babies are so drugged up (epidurals and 
c-sections). Also, many are induced a bit early and totally clueless about 
sucking. What I observe is many babies aren't sucking effectively at the 
breast, therefore not removing milk. The pediatrician sees the baby in the 
hospital and then says come for a check up at day 14, which I feel is too 
late.

I do look at the total picture: how many BMs in the last 24 hours, what 
color, how big, etc. I watch baby at the breast and see if there is active 
sucking. What is common for my practice is to get babies with over 10% loss 
who are totally lethargic, can't wake up to feed, no BMs in 2 days, etc. 
What others have called a train wreck. These babies are beyond being able to 
suckle properly and remove milk.

This is why I LOVE test weights before and after nursing. Baby does have to 
be a few days old to really get a good test weight. I check the baby and see 
what he can remove. If it is a good intake, I don't stress too much at the 
weight loss -- as long as the BMs increase and the weight jumps back up 
quickly. I teach mom how to do breast compressions or possibly use a 
periodontal syringe at the breast to encourage more active sucking. 
Encourage her to nurse more often, wake baby up, skin to skin contact, etc. 
And get another weight check in 2 days with baby wearing only a fresh 
diaper.

I am very uncomfortable about allowing a poorly feeding baby to piddle 
around for 2-3 days to see if things improve. I feel I am often a safety net 
for these babies. I also see quite a few babies with oral motor difficulties 
that are FTT (or very close to it) by the time I get them at 2-3 months old. 
All of these babies have had weight losses more than 7% in the first week. 
And I am always astounded that their pediatricians allow such huge weight 
losses and slow slow weight gain.

Kathy Eng, BSW, IBCLC 

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