Breastfeeding and top ups

[tinkerbell419]

We tend to get a lot of babies in our unit that seem to breastfeed really well. Good latch-on, sucking well for 20-30mins but nappies are only slightly damp with baby passing either small amounts of green poo or no poo at all. Does this always indicate dehydration if the stools are green?

In this situation what would you do? Give the baby half or full top ups of milk? Would you tell mom to give the baby bottle feeds? Wouldnt this cause the baby to become confused as some peopke say you shouldnt give baby bottles if breastfeeding.

Looking for advice on what you do in your units.

[Red Kryptonite]

As an experienced mother of five and a dedicated breastfeeder, I will tell you that it took a couple days after birth for the peeing to really take off. As to greenish stools, that's just finishing up the meconium. I found the stools didn't completely turn into that bright yellow, seedy breastmilk stool until after a few days. As long as some urine is coming out, the baby can pee, and will. Look at other indicators, like skin color and turgor, baby's behavior, etc.

The first couple days, a breastfed baby is only getting colostrum, which is as low in volume as it is packed with goodness. So you wouldn't expect a lot of urine. I'm curious as to how you think formula feeding would solve this problem? Putting in more water to make more urine, but at what cost to the breastfeeding relationship and baby's gut health? You say these babies are good feeders, so they don't need intervention in that area. Just producing pee to make the nurse feel better about output is not appropriate.

[prmenrs, RN]

It might depend on what the infant is in the hospital for: jaundiced babies are frequently dehydrated and need oral feedings in addition to IV fluids; premies are not strong enough to take enough breast milk to gain weight. They might have a feeding tube to use instead of nippling more breast milk in order to save calories.

If the babies you are describing are normal term babies w/o any issues, I don't think you need to supplement their feedings. Keep them w/their moms and let them nurse adlib on demand. If there's something else going on, maybe you could describe it?

[tinkerbell419]

If mom isnt expressing much milk we would supplement with formula. We have to use formula if we run out.

For babies who are pretty much breastfed all the time there is debate about what to do if mom is unable to feed due to a breastfeeding priblem or she cant come in. Do we tube feed the baby expressed breastmilk or bottlefeed. Some say that bottles will interfere with babies latching on.

We do wait a while but if a breastfeeding baby doesnt open its bowels within 24-48 hoyrs we do get a bit worried about that. Surely a bowel movement indicates digestion of the milk ans that bowels are working even moreso for premature and low birth weight babies.

If a breastfeed baby doesnt poo within 48 hours we take that as a possible sign of dehydration and not getting enough milk. Baby is getting moms foremilk. We would start weighing nappies too for urine output