When mother and baby are not separated after birth, nurse ad lib with
transfer of colostrum->milk I expect to see at birthweight by day 4or above,
anything else is a RED flag IMHO.  I used to do 24-48 hour post birth home
checks for a HMO group in MI (that is discharge at 24 hours, seen by me in
next 24).  I became quite accustomed to seeing this pattern.  Slightly below
birthweight in 2nd 24 hours, at birthweight or gaining by day 4.  When milk
"came in" did not seem to be the major difference, access to the breast was!

So I firmly believe that these babies who are still below birth weight at 1
week, 10 days or 2 weeks are in trouble.  Whether it is poor positioning,
poor latch, or poor suck, something is causing poor milk TRANSFER!  This is
why AAP recommends that BF babies be seen shortly after discharge.  A week
or 2 out it is much harder to figure out the problem and repair the
situation.  So I believe that if you see a newborn BF baby at 5-7 days and
s/he isn't at or above birth weight you are wrong not to investigate why.
It can be simple (mom limiting time  or times at breast, poor positioning,
whatever) or something complex (all those exotic reasons we know) but it
still needs somebody to pay attention to it so the LC doesn't get a train
wreck at 3 1/2 weeks of age!!!

Climbing down off of my soapbox, Pat in SNJ

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