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Thread: Newish research on counting diapers

  1. #11
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    Default Re: Newish research on counting diapers

    right, jenna, and i very much don't want unnecessary supplementation and all its associated problems either. and i really liked being able to tell parents to count pees and reassure them. but what the research is saying is that counting pees is actually not a particularly good way of assessing it - and as meg was saying above about missing pees, with a poop or with superabsorbent diapers or whatever, pee turns out NOT to be something they can easily count every day. it's important to me that i actually give *accurate* advice as well as *easy to follow* advice.
    DS1 6/7/11
    DS2 10/29/13

    Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.

  2. #12
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    Default Re: Newish research on counting diapers

    I don't think the article changes my position though . I still think it's accurate advice in the context I give it, as do other sources.

    This is a favorite article of mine

    http://drjaygordon.com/pediatricks/newborns/scales.html

    http://www.askdrsears.com/topics/bre...-milk-how-tell

    I still think that output is a big factor for the moms who come on here year after year to measure ALONG with watching their baby for normal signs of a hydrated baby. There have been moms in the past who tell stories of babies who we think have a problem, and what I see is that we as a community have responded immediately that the baby need to see the doctor right away and have suggested (begged in a few cases) for the mom to use formula. I think that you will see this advice from us as you stick around and notice when these problems obviously arise.

    On a personal note my second son is tiny. He gained only a few oz for several months, but I watched his output ( pee and poop) his other physical signs and his milestones NOT only the scale. To me it's not the best indicator of how baby is doing. Out pedi is very well versed in BF babies and behavior ( Dr. Paul Fleiss) and he agrees. He didn't blink an eye at the tiny weight gain because he took the health of my son in as a whole not by what a scale says.
    Last edited by @llli*jenna562; June 10th, 2012 at 10:29 AM.
    Mommy to Maxwell 10-9-07 weaned with love (a party and a remote control monster truck) on his 4th birthday
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  3. #13
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    Default Re: Newish research on counting diapers

    I think the standard advice here and in general is that as long as weight gain and diaper output is good then your baby is getting enough to eat, which is entirely consistent with "Breastfeeding Answers Made Simple" as well as most of the go-to internet resources on the matter such as KellyMom (my impression is that all of these sources are basing this recommendation on the same research).

    I don't think anyone here has ever suggested that anyone use diaper counts as a replacement for weight checks. Babies should be taken in for standard pediatrician visits, where weight checks are done. The recommendation to keep track of diapers to gauge intake is something that can be done between weight checks. Diaper counts are a proxy for milk intake. All proxies are subject to some degree of error, but that doesn't render them useless as long as they are used properly (in this case as a supplemental data set to weight gain). No they are not good stand alone indicators of milk intake, but I don't think anyone here has ever said that they are. If weight history has been good and baby is alert and meeting milestones, then I think the advice to look at diaper output until the next weight check in order to ease one's mind about not knowing the exact number of ounces being taken in at the breast is perfectly sound. "Breastfeeding Answers Made Simple" even says as much from what you've written:

    Quote Originally Posted by @llli*auderey View Post
    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.
    I guess I just don't see how this changes anything. The recommendation to look at diapers until the next pediatrician visit is completely consistent with this. This is my thinking exactly:

    Quote Originally Posted by @llli*jenna562 View Post
    Well I mention output to mothers because they most likely don't have a hospital scale at home, theyre desperate and needing reassurance, and they are between doctor appointments. I guess I didn't read why that's not still ok to say
    Diaper counts may not be as accurate as running out and purchasing a scale, but I really don't think that obsessing over daily weights on a scale is necessary or even healthy behavior. And the truth is that daily weights don't give a very good picture of overall weight gain trends anyway and can lead to a lot of anxiety over nothing. If weight gain is truly such a concern that daily weight checks are necessary, then I think it is time to seek professional help in addition to online support which is what is generally recommended here from what I've seen.
    K. Sophia - Mama to my little lactivore, the amazing Mr. X (11/10).

  4. #14
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    Default Re: Newish research on counting diapers

    It's perfectly fine to mention output, talk about output, talk about counting poops as a good indicator baby is getting enough milk. I think what the studies in BAMS is saying is "weight gain is number one indicator all is well, output (poops) is the number 2." But if the scales and output are in contradiction, it may get more tricky. And I think "output" in the first 6 weeks (or so) should ideally be measured in poops not pees if one is looking at whether baby is actually getting enough milk to grow as expected as opposed to simply warding off dehydration.

    I would also add that we (society in general) often seem to assume a breastfed baby is in serious jeopardy of not getting enough milk. But if breastfeeding is going well, (and in cases even where there are issues but not affecting milk transfer or supply) there is no cause for such an alarm. But as I understnad it, ALL babies in the early weeks are weighed frequently, not just breastfed babies, to make sure all is well.

    Again from BAMS-
    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.

  5. #15
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    Default Re: Newish research on counting diapers

    Quote Originally Posted by @llli*jenna562 View Post
    I still think that output is a big factor for the moms who come on here year after year to measure ALONG with watching their baby for normal signs of a hydrated baby. There have been moms in the past who tell stories of babies who we think have a problem, and what I see is that we as a community have responded immediately that the baby need to see the doctor right away and have suggested (begged in a few cases) for the mom to use formula. I think that you will see this advice from us as you stick around and notice when these problems obviously arise.
    . i finally beleived DS needed supplements when Mommal told me.

    i had a baby that pooed all.the.time. and wasnt gaining. and was meeting milestones ahead of schedule. and looked skinny (like gollum from lord of the rings in fact. once the common weight mistakes (changing scales, always naked/dry diaper, and artificially inflated birth weight) are dealt with weight is really important. but for modt babies it is not something moms should be worrying about on a daily basis. diaper count is.
    proud but exhausted working mammy to two high needs babies

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  6. #16
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    Default Re: Newish research on counting diapers

    i don't think i'm fundamentally disagreeing with what y'all are saying, and i'm CERTAINLY not trying to say that the forum collectively isn't recommending supplementation enough. i am, in contrast, totally impressed with the timely, research-based, compassionate support given to so many people on here!

    but i guess what i wanted to point out is that i, a relatively newbie but with acccess to the research, definitely got the message over the last few months on the forum that if there are enough pees, the baby is getting enough milk. and i definitely repeated that message to other moms here! except for meg, i haven't really seen anyone talk about counting poops, and that is what BAMS says matters as far as counting, in the first 6 weeks. i've seen moms asking how to tell if a diaper is wet, and the old BAB had specific amounts to tell if it "counted" as a pee. but the BAMS doesn't, and only talks about counting poops.

    of course, all these things are useful to look at together: weight checks, poop & pee output, efficient nursing, milestones. and you're right, i haven't been around all that long so i haven't seen over and over and over yet the moms afraid of not producing enough. and you all "old timers" have the patience of saints to keep repeating the same answer over and over, when it would be so much better if we just were more familiar as a culture with breastfeeding and less scared about it and if our medical practitioners as a group actually knew much about it too.
    DS1 6/7/11
    DS2 10/29/13

    Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.

  7. #17
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    Default Re: Newish research on counting diapers

    and you all "old timers" have the patience of saints to keep repeating the same answer over and over, when it would be so much better if we just were more familiar as a culture with breastfeeding and less scared about it and if our medical practitioners as a group actually knew much about it too.[/QUOTE]

    Good stuff! I agree

  8. #18
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    Default Re: Newish research on counting diapers

    Sorry I messed up the quote! I was agreeing with audrerey!

  9. #19
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    Default Re: Newish research on counting diapers

    Yes Auderey, The thinking about output has definitely changed in the literature. Both BAMS and the latest The Womanly Art were published in 2010 and both reflect this change. Counting pees used to be seen as much more important and now it's all about poop. This has changed completely in the short time I have been a Leader.

    It’s not that one source is wrong-after all, the same author wrote both the Breastfeeding Answer Book and Breastfeeding Answers Made Simple-but rather, that one has more up to date info than the other.

    I saw Dr. James Murphy, a tongue tie expert, lecture and he talked about how, when he was in medical school, he was told “in four years, 50 percent of what your learn will be out of date.” Or something like that-I forget the actual quote. Basically he made the point that much of what is accepted as good medicine today will be outmoded tomorrow. This is very dramatically illustrated in the recent changes in thinking about tongue tie.

    To me, this shows that we are learning more and more about all the aspects of breastfeeding and how to best support moms all the time. And that it's important if a bit difficult sometimes to keep up with the changes!

    I also think that often internet content, interestingly, lags behind when it comes to this stuff sometimes. It's just the nature of the beast, info stays out there and accessible long after it has become outdated. I try to remind moms to look at the dates of what they are reading (if available) both online or in print-and consider that.

    Btw, The Breastfeeding Answer Book, which was published in 2003, has recent updates available online. I have not looked at them to see if they changed the info re: output….

  10. #20
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    Default Re: Newish research on counting diapers

    Quote Originally Posted by @llli*lllmeg View Post
    Yes Auderey, The thinking about output has definitely changed in the literature. Both BAMS and the latest The Womanly Art were published in 2010 and both reflect this change. Counting pees used to be seen as much more important and now it's all about poop. This has changed completely in the short time I have been a Leader.

    It’s not that one source is wrong-after all, the same author wrote both the Breastfeeding Answer Book and Breastfeeding Answers Made Simple-but rather, that one has more up to date info than the other.

    I saw Dr. James Murphy, a tongue tie expert, lecture and he talked about how, when he was in medical school, he was told “in four years, 50 percent of what your learn will be out of date.” Or something like that-I forget the actual quote. Basically he made the point that much of what is accepted as good medicine today will be outmoded tomorrow. This is very dramatically illustrated in the recent changes in thinking about tongue tie.

    To me, this shows that we are learning more and more about all the aspects of breastfeeding and how to best support moms all the time. And that it's important if a bit difficult sometimes to keep up with the changes!

    I also think that often internet content, interestingly, lags behind when it comes to this stuff sometimes. It's just the nature of the beast, info stays out there and accessible long after it has become outdated. I try to remind moms to look at the dates of what they are reading (if available) both online or in print-and consider that.

    that's all i was trying to say
    DS1 6/7/11
    DS2 10/29/13

    Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.

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