Can a healthy newborn go 24 hours without a feeding?

  1. Does anyone have any articles or evidence that support a healthy infant not having to eat for 24 hours if medically stable? One of our LCs said healthy infants can go a day without food if medically stable. If this is the case then I'll definitely change my practice. Normally of an infant doesn't eat within 6 hours , whether medically stable or not the providers usually suggest formula. Of course we always attempt to breast feed first and have Mom pump or manually express as well.
    •  
  2. Visit BSNbeauty profile page

    About BSNbeauty, BSN, RN

    Joined: Jan '13; Posts: 1,972; Likes: 4,302

    15 Comments

  3. by   Miiki
    Women don't start making milk until at least the 2nd day. If you follow the natural progression of things, a baby will only get the tiniest amounts of colostrum the first day or two. Evidence --> billions of children born before formula. If you're worried, you can check their blood sugar and supplement if it drops. I'd input something along the lines of "exculsive breastfeeding in first day of life" or something like that to get your search going. I'm not going to search it for you though. I have my own homework to do.
  4. by   BSNbeauty
    Miiki I don't want you to search anything for me. I came to AN after I've searched and didn't find much. This is not my homework by the way just in case you're wondering. I don't start NP school until May .
    Thank you for your opinion. I think the key is blood sugar checks every 3 hours and as long as it's find then no formula is needed!
  5. by   ashleyisawesome
    We let our kids go about 24 hours without a feed (but they have to be attempting during that time of course). We will only check a blood sugar if they are LGA/SGA, GDM, they have a low temp, or they appear jittery. We don't just check blood sugar q3 on a baby with no risk factors. We will get an order for formula if they have a low sugar, lose more than 7% of their birthweight, or have a high bili. I always encourage pumping or hand expression for a kid who doesn't properly latch after two attempts so we can at least syringe feed some colostrum.

    Sorry I don't have an literature on this, it's just what we do at my facility.
  6. by   BSNbeauty
    Quote from ashleyisawesome
    We let our kids go about 24 hours without a feed (but they have to be attempting during that time of course). We will only check a blood sugar if they are LGA/SGA, GDM, they have a low temp, or they appear jittery. We don't just check blood sugar q3 on a baby with no risk factors. We will get an order for formula if they have a low sugar, lose more than 7% of their birthweight, or have a high bili. I always encourage pumping or hand expression for a kid who doesn't properly latch after two attempts so we can at least syringe feed some colostrum.

    Sorry I don't have an literature on this, it's just what we do at my facility.
    This was extremely helpful ! I will definitely change my practice for on. I know to get our unit on board I would need literature but at least I can start with myself.
  7. by   adventure_rn
    In the healthy, unstressed term baby, neonatal glycogen stores should be sufficient to prevent hypoglycemia in the first day of life while mom's milk is coming in. Babies are only getting a couple of mLs per breastfeed during that time.

    That said, I'd caution you against changing your own practice if it isn't in line with the rest of the unit, especially the providers. I could see parents (and providers) getting really upset about inconsistency and mixed messages if you encourage parents not to supplement, and then the provider comes in soon after and recommends supplementation. As in any other aspect of nursing, I'd definitely defer to your unit policies and order sets when it comes to supplementation, checking sugars, etc.

    You can definitely work on changing your unit policies and culture in a breastfeeding-friendly way, but I'd imagine you'll draw some fire if you go rogue and butt heads with the providers' standard of care. If you do want to work on making your unit more breastfeeding-friendly, perhaps you could reach out to lactation about research and evidence to support your topic; I'm sure they've got tons of resources that they'd love to share.
  8. by   llg
    I strongly agree with adventure_RN above. Don't change your practice if it goes against the standards of your workplace.

    Also, you should not be changing your practice because some stranger on the Internet says something is OK.

    Raise the question within your workplace and go through the proper channels and procedures to create up-to-date policies and practice standards.
  9. by   BSNbeauty
    I'm not changing my practice based in strangers opinions. I'm changing my practice based on the fact that the unit culture is to push supplementation for babies that dont eat in 6 hours. I agree that this needs to be a unit based plociy so that care is consistent. After talking with our LCs and providers they are okay with nurses changing their practice if the parents agree and baby is medically stable. A policy isn't going to develop overnight. As nurses we can use our own judgement as long as it aligns with the order set and parents wishes. Thank you to everyone who gave constructive feedback back. Moderators you can close this thread if you like. I found the feedback I was looking for.
  10. by   BSNbeauty
    Quote from llg
    I strongly agree with adventure_RN above. Don't change your practice if it goes against the standards of your workplace.

    Also, you should not be changing your practice because some stranger on the Internet says something is OK.

    Raise the question within your workplace and go through the proper channels and procedures to create up-to-date policies and practice standards.
    Not changing my practice based on internet strangers. Sorry to disappoint you.
  11. by   BSNbeauty
    Quote from adventure_rn
    In the healthy, unstressed term baby, neonatal glycogen stores should be sufficient to prevent hypoglycemia in the first day of life while mom's milk is coming in. Babies are only getting a couple of mLs per breastfeed during that time.

    That said, I'd caution you against changing your own practice if it isn't in line with the rest of the unit, especially the providers. I could see parents (and providers) getting really upset about inconsistency and mixed messages if you encourage parents not to supplement, and then the provider comes in soon after and recommends supplementation. As in any other aspect of nursing, I'd definitely defer to your unit policies and order sets when it comes to supplementation, checking sugars, etc.

    You can definitely work on changing your unit policies and culture in a breastfeeding-friendly way, but I'd imagine you'll draw some fire if you go rogue and butt heads with the providers' standard of care. If you do want to work on making your unit more breastfeeding-friendly, perhaps you could reach out to lactation about research and evidence to support your topic; I'm sure they've got tons of resources that they'd love to share.
    I agree with you. Parents already get mixed messages . We do need a unit based policy in this. Until then, I will change my practice as long as it aligns with our current order set and parents wishes. I truly believe fed is best and will advocate for what the parent wants as long as baby is healthy.
  12. by   RNpathoteacher
    As long as they attempting to feed and blood sugar is stable , then we let them go to 24 hours.
  13. by   caliotter3
    When reading the title to this thread, could not help but think 'too bad I can't go 24 minutes without thinking about feeding myself'. Poor babies. Please don't ask admins to close this thread because it would be nice to see if someone can provide some references about this.
  14. by   Nurseinprocess
    Where I work we let the breastfeeding babies mess around and not seriously nurse for about 24 hrs before we would intervene and insist on formula supplementation (moms always get the option to pump and try to provide colostrum if they can get enough). I tell my patients that they need to attempt to feed the baby every couple of hours, and if they don't latch or are too sleepy or uncooperative that the skin to skin time with the baby will at least help the milk to come in. This is of course barring any low sugar issues or other problems like high bilis. I bet half my babies are little non latching stinkers the first 24 hrs. Lactation won't even see any pts until after 24 hrs have passed (which I don't agree with). I can't imagine a hospital where they are making moms give formula within 6 hrs without a good feeding. That is so early! We use the babies' wet and dirty diapers and their weights to determine if they require supplementation.

close