Judy writes:
[regarding jaundiced baby]

"I did speak to the other and  with the exception of stools not turning
yellow by day 4, things sounded as though they were going well.

I talked with the neonatologist about how the number of voidings and
stools were what we consider to be wnl (voids 3-4 day 3,   4-5 day 4,
stools  2 or more).  He said that probably amount was not sufficient and
ofcourse his suggestion was supplementing with formula any baby that
didnot settle and sleep after nursing."

Let's talk poop.
By day 4 there should have been an increase in mom's milk supply and with
this an increase in "output".
I look for 1-3 pees and 1-3 poops the first 1-3 days [increasing each day
hopefully] with a gradual change to loose yellow stools in an exclusively
breastfed baby**.

By  the 4th day [to the 4th week] I use the "rule of  4's " and look for (at
least) 4  yellow stools  per day. (and 6-8 pees)
If the color's  not  yellow  [or  almost  yellow]  I'm concerned.  **However
all bets  are off on the color if the baby's been  supplemented with
formula. Yellow is not that meaningful if the baby's had an ounce or two of
formula [which is not that unusual in my neck of the woods, unfortunately]

Counting poops on the phone is difficult as well.  "Smudges" or little poops
don't count as one poop for me.  I want to hear the parents say "Oh my, it
was everywhere".  One sure sign breastfeeding is going well is one of those
"up the back" of the diaper poops.  I tell parents that.

Regarding the comment by the neonatologist:
"his suggestion was supplementing with formula any baby that did not settle
and sleep after nursing."

Give him 1/2 credit. He hasn't been trained regarding breastfeeding.  He
does recognize that that behavior is consistent with not getting enough, but
he doesn't know how to evaluate Latch or milk transfer so he is  only able
to suggest "fixing" the bottom line by recommending supplementing with
formula.

Personally, I'd assess for good latch and milk transfer in person.  If
supplementation is needed I go first for expressed breastmilk,  "served" at
the breast via an sns-type arrangement.

The earlier you catch a problem, the better chance you have of avoiding
other problems.

Gail Hertz, MD, IBCLC

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