Newish research on counting diapers
Hi - not sure where the best place to put this is, but I've been poring over the 2010 Breastfeeding Answers Made Simple, and the data on counting diapers is not quite as clear as it seemed.
Here's what it says:
"There are several ways to gauge whether the baby needs a supplement. The most reliable is the baby's weight gain. ....
A less reliable gauge of milk intake - but one that can be helpful in combination with weight checks - is diaper output. In the first week of life, some aspects of diaper output can provide good clues about whether the baby is receiving the milk he needs. A transition to yellow stools by Day 6 or earlier was associated with acceptable levels of weight loss and earlier weight gain (Shrago, Reifsnider & Insel 2006). Day 4 breastfeeding inadequacy was predicted by less than three stools per day along wtih the mother's perception that her milk had not yet increased within 72 hours postpartum (Nommsen-Rivers, Heinig, Cohen & Dewey 2008). However, breastfeeidng was actually going well with 41% of the mothers with these indicators.
Although diaper output is not as accurate as weight gain in determining wehther a baby is getting enough milk, it can be used as a rough gauge between weight checks. During the first 6 weeks or so, daily stool output can be a helpful sign of whether milk intake is adequate. An average is at least four stools the diameter of a US quarter (2.5 cm) or larger (Shrago et al 2006). If the baby is having fewer stools but gaining weight well, this is not a problem. After 6 weeks of age, stool count is no longer reliable because many breastfeeding babies have fewer stools, even when getting plenty of milk." (p108)
"Two US studies examined whether diaper output accurately reflects adequate milk intake. Both found that there was much room for error. One study of 73 exclusively breastfeeding mother-baby couples monitored the babies' weight loss and gain, breastfeeding patterns, and diaper output for the first 14 days (Shrago, Reifsnider & Insel 2006). Th researchers found that more stools during the first 5 days were associated with positive infant outcomes. More stools during the first 14 days were associated with the lowest weight loss and early transition to yellow stools. (Mean number of stools per day was four, but some babies had as many as eight.) The first day of yellow stools was a significant predictor of percentage of weight loss (the earlier the babies' stools turned yellow, the less weight was lost.) The average number of daily stools was not an accurate predictor of initial weight loss, but the more stools passed during the entire 14-day study period, the earlier birthweight was regained.
Because some newborns breastfed ineffectively, number of daily feedings at the breast were not related to initial weight loss, start of weight gain, regainin of birthweight, or weight at Day 14. (Mean number of daily feedings at the breats was 8.5, with a range of 6 to 11.) In fact, the researchers considered unusally frequent feeding with low stool output a red flag to check baby's weight, as the study baby who breastfed the most times per day had the poorest weight outcomes. They found that frequent feedins with good stool output was a sign of effective breastfeeding, but frequent feedings without much stooling should be considered a red flag of breastfeeding ineffectiveness.
The second US study followed 242 exclusively breastfeeidng mother-baby couples, also for the first 14 days of life. These reserachers found that "diaper output measures, when applied in the home setting, show too much overlap between infants with adequate versus inadequate breastmilk intake to serve as stand-alone indicators of breastfeeding adequacy" (Nommsen-Rivers, Heinig, Cohen & Dewey 2008 p32). The most reliable predictor of poor milk intake was fewer than four stools on Day 4, but only when paired with the mothers' perception that her milk had not yet increased. But even when both of these criteria were true, there were many false positives, meaning that many of these babies' weight was in the normal range.
So at best, diaper output can be considered a rough indicator of milk intake. While it can be helfpul to track diaper output on a daily basis between regular weight checks, diaper output alone cannoe substitute for an accurate weight. Regular weight checks during the first weeks are vital to identifying breastfeeding babies at risk of low milk intake.
Also, diaper output patterns change over time. Four stools per day are average during the early weeks, but after 6 weeks of age stooling frequency often decreases, sometimes dramatically. Some breastfed babies older than 6 weeks may go as long as a week between stools, which is not a cause for concern from a breastfeeding perspective as lon as the baby is gaining weight well." (p215-216).
Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.