Mothers should be aware of their babies' wet
and dirty diapers: after the first day or two,
six to eight wet diapers (five to six disposables,
although determining wetness in disposables
can be difficult) and two to five bowel movements
every twenty-four hours means a baby is being
nourished adequately. When a three- or four-day-old
baby is not producing wet and soiled diapers,
the mother should seek help immediately from
someone knowledgeable about breastfeeding.
Mothers should be attentive to a baby's activity
level and possible symptoms: Does he suck actively?
Is he enthusiastic at nursing? Is he nursing
8-10 times every twenty-four hours? Is he swallowing?
Is he sleeping through too many nursings? Has
his activity level decreased over time? Hydration
can be assessed by observing an infant's general
responsiveness and skin tone. A baby who is
dehydrated will be listless and act sick.
A baby's weight gain is also an indication
of sufficient nourishment at the breast, although
each baby gains at his own rate, and it can
take up to three weeks to regain birth weight.
Many health professionals who advocate breastfeeding
suggest that breastfed babies be seen by the
doctor at one week of age to be certain that
everything is going well. At a pediatrician's
examination, the lethargy, dryness of mucous
membranes, and possible malnutrition associated
with a dehydrated infant would be immediately
recognized. The degree of hydration is best
determined by the extent of rapid weight loss.
In rare situations, an infant's failure to
thrive or dehydration can be due to a mother's
inability to produce enough milk. A retained
placental fragment can delay adequate milk production.
Previous breast surgery, particularly breast
reduction, may have severed necessary nerves
or removed too much glandular tissue. Perhaps
a birth defect or injury to the developing breast
does not permit full lactation.
In a few case reports, diminished lactation
has led to elevated sodium levels in mother's
milk that could cause dehydration in newborn
infants. Excessive sodium levels can also occur
when there is an unusual delay in the maturation
of Colostrum to breast milk. Sodium levels can
be normalized with appropriate lactation counseling,
including pumping between feedings to increase
a mother's milk supply more rapidly.