If the baby's weight gain is not yet known, Leaders can suggest that the baby's weight be checked with a health care provider. In many communities such weight checks are provided free of charge by the doctor's office or the public health department. Some mothers request a weight check immediately; others may choose to wait for an upcoming, previously scheduled appointment. In either case, the mother is prepared for the possibility of poor weight gain. At the health visit the mother can explain that breastfeeding difficulties may have affected the baby's weight, however, she has contacted La Leche League for assistance and has implemented changes. If the weight gain is then shown to be low, the mother is in an especially strong position to request a probationary period of weight checks while she continues working to improve breastfeeding.
If baby's weight gain is so poor that temporary supplementation is recommended, the mother's own expressed milk is considered the first choice of supplement, especially the rich, high-calorie hindmilk which she can express after feedings. The BREASTFEEDING ANSWER BOOK, page 134, states:
The mother and her baby's doctor will need to discuss how much supplement to give. It may be helpful for the mother to know that babies need about 2 to 2 1/2 fluid ounces of nourishment per pound of body weight (60-75 ml per 454 grams) every 24 hours to maintain a normal weight. An additional 1 to 2 ounces (30-60 ml) per pound (454 grams) of body weight per day may be needed to compensate for a previous lack of weight gain.
The mother can use alternate feeding methods to avoid the risk of compounding a possible sucking problem with artificial nipples. A nursing supplementer used at the breast may encourage effective sucking and stimulate the mother's milk supply. Other choices include a medicine dropper, syringe, spoon or small cup. The mother may want to take special care to first give the baby the creamy milk off the top of expressed milk if it has been sitting long enough to separate.
If a mother has complications surrounding her efforts to breastfeed, the Leader may want to refer her for additional help (medical, lactation or social) while offering continued support for breastfeeding. Some mothers faced with the possibility of breastfeeding difficulties or changes prefer to discuss supplementation or weaning. While referring her to medical help for artificial feeding, the Leader can convey respect for the mother's choices and encouragement for her mothering efforts.
While multiple daily bowel movements are expected for thriving breastfed newborns, there are exceptions to be noted. Rarely, a healthy, well-nourished newborn with infrequent stooling will have weight gain within the acceptable range. The BREASTFEEDING ANSWER BOOK states newborns may have a 5% to 7% weight loss up to the fourth day after birth, then gain 4-8 oz (113-227 grams) or more per week. If a newborn is spacing bowel movements days apart rather than hours apart, each bowel movement would be very large. Since experts list infrequent newborn stooling as a "red flag" symptom requiring professional evaluation, confirming the infant's overall health and monitoring weight gain with the health care provider are prudent precautions.
Although breastfeeding provides infants with extensive protection against infections, illnesses do occur. Diarrhea symptoms include 12 to 16 bowel movements with offensive odor in a 24-hour time period. Infants with diarrhea need medical supervision and continued breastfeeding is especially beneficial.
Frequent bowel movements which are consistently green and watery may be caused by a sensitivity to food or medication that baby or mother is ingesting. Careful consideration of any medications, home remedies, foods or drinks may uncover a possible cause.
Consistently green, watery and foamy stools are also thought to be caused by a low intake of hindmilk, referred to as foremilk-hindmilk imbalance or "oversupply syndrome." Baby may act colicky, gain weight slowly and bowel movements may be very forceful. An overabundant milk supply or overactive let-down reflex may be involved. Breastfeeding techniques to improve the baby's control of the milk flow and intake of hindmilk may quickly reduce these symptoms.
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