1.  Assessing Milk Supply Ways to tell whether a mother is making adequate milk for her infant

2. Goals and Objectives  Identify the approximate capacity for a newborn’s stomach.  Name 3 ways to assess the adequacy of breastmilk supply.

3. How much is enough?  Scammons and Doyle  Stomach capacity of newborn  Day 1: 7cc/feed (1 tsp)  Day 2: 13cc/feed (1 Tbs)  Day 3: 27cc/feed (<1oz)  Day 4: 46cc/feed (1.5oz)  Older infants  Stomach capacity is approx size of infant’s fist

4. Feeding Assessment  Listen to the concern  Ask questions  Decide if intervention is needed

5. Questions

6. Examples  How are you feeding the baby?  How do you know when it’s time to feed the baby?  When did the baby last feed? What about the time before that?  Does he/she latch on right away or take some stimulation to wake up?  When the baby latches on do you hear swallowing or see milk at the corner of the mouth?  How long on each breast does the baby feed for? Is this different than he/she previous fed?  How many wet diapers has he/she had in the last 24hrs? Is this a change from normal?

7. Concerning Answers  Less than 8 feeds/24hrs  Poor knowledge of hunger cues  Frequent stimulation to wake up and feed  No audible swallowing  Change in feeds from baseline  Decreased number of wet diapers

8. Weight Gain  Most accurate sign of supply  Normal to lose up to 10% of BW  Most regain BW by 2 weeks  20-30g/day on average  Growth charts

9. Urine Output  Diaper count  Beware the super absorbent diaper!  Pattern more important than numbers  Hospital setting  Strict I&Os  Approx 1cc/kg/hr

10. Stool Output  Huge variation  Large range of patterns  Once per feed to one every 3-4 days  Reasons to refer:  Hard stools  Blood in stool  Black, white or green stools  Thin, watery stools

11. Hydration Status  General appearance  Mucous membranes  Tears  Skin tenting  Fontanelle  Vital Signs

12. Last Thoughts  Questions?  Take home points…