Heather,
You are right that the baby doesn't necessarily need so much milk the first
few days. Remember, this is not an exact science and follow-up is very
important. However, I have seen too many underfed babies and part of that is
because the parents are not offering adequate quantities to the baby or
offering enough feeding opportunities to get in enough calories. Often the
parents just don't know what to give.
Also I want to make the point again, that these calculations are for babies
*not feeding effectively* at breast. In other words, the situation is not a
normal one. I watch the weight loss prior to discharge, and I find jaundice
goes hand in hand with this. Almost every baby with a larger weight loss is
not feeding well, or not feeding often, or the mom seems to have scant
colostrum, and baby is becoming visibly jaundiced. If we send the parents
home and say just keep working with the baby then the baby may present at
the end of a week in severe trouble and so may the mom (engorgement/low
supply). I usually give the caveat that in the first 48 hrs the baby may
take a bit less but generally by day 3, I expect the baby to be taking the
larger amounts. Often the baby begins to feed effectively by day 2 or 3 and
no supps are needed. (EBM always your first choice, of course).
Here's an example: Baby is 7 pounds. I calculate he needs 2.5 oz x 7 = 17.5
oz per 24 hrs (approximately). If he's only taking in 1 oz every 3 hrs, he
is getting 8 oz in a 24 hr day, which is going to get him into trouble very
quickly if he persists with this amount. It would help if he took 1 oz
every 2 hrs, but that would only give him 12 oz in the 24 hr day, which
still would not give him enough for growth. Some parents even give 1 oz or
less every 4 or 5 hr; they just do not know baby needs more. If the baby
truly cannot or will not take in the necessary amounts by about day 3, then
this needs to be evaluated further with the physician. And f/u is so
important.
Hope this helps to clarify how I manage these babies. Thanks.
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA
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