Infant dehydration at 5 days (forced to supplement)
Just returned from her week-old check up at Amelia's pediatrician. She's been diagnosed with infant dehydration - while the pediatrician said she's an otherwise healthy looking baby (pink coloration with no jaundice, no sunken eyes or frontanel), she is displaying some other worrying symptoms, namely red urine crystals in her diaper and significant weight loss.
The red crystals are due to uric acid, which is common 24 - 48 hours after birth because they are only feeding on colustrum, but once your milk comes in (I was engorged on days 3 - 4, and I have hand-expressed and there is definitely milk), the urine output should be clear. She is also making fewer than expected stools/poopy diapers. And she's dropping a lot of weight, fast.
Her birth weight was 9 lb. 10 oz.
At discharge (day 2) her weight was 9 lb. 3 oz.
Her weight today (day 5) at the check-up (on two different scales, for verification) was 8 lb. 3 oz.
(Other vital statistics: 20-1/2 inches in length, and 37 cm head circumference. I highly doubt she grew 3/4-inches in 5 days, so there's some measurement inaccuracy there...)
Newborn babies are expected to lose 5 - 7% of their birth weight in the first week. Then once your breastmilk comes in, to start gaining 1 oz. a day.
Amelia has already lost 1 lb. 7 oz in 5 days, a whopping 15% of her birth weight.
The pediatrician is hoping this is her low point in weight loss, and maybe we'll start to see an upswing over the next few days (next appointment on Monday, Amelia's day 9), but she said medically at this point, we have to supplement, which makes me feel like a failure of a mother, ugh. My boobs are not working! And I know we can recover and get her back on the breast (Erika was 100% exclusively breastfed for a year! And now I'm 5 days in and I've failed already!) if we work at it, and I know formula-fed babies turn out just fine (I was one!), but I wanted to do this, I thought I could do this, I thought I was doing well, and now I feel a little like a disappointment? Failure? Worried about Amelia getting more dehydrated and possibly needing the ICU?
I'm nursing her 10 - 12 times a day for the past 5 days, and I thought I was doing a good job, letting her nurse for 30 minutes sometimes, letting her comfort suck, letting her nurse to sleep, letting her nurse when she's upset... essentially I've got my boobs hanging out so much, my mother-in-law commented not just twice but three times in a day to say "wow that baby nurses a lot".
The problem (self-diagnosing here) is she's a very sleepy nurser compared to Erika. Erika would vigorously suck, and I'm noticing Amelia will nurse for 5 - 10 minutes and then fall asleep at the breast. I tickle her cheek, chin, rub her back, change her diaper, take her blanket off so she's really awake, but she still falls asleep.
So the bottom line recommendation-- no, firm instructions--- from the pediatrician is to put her on the breast often (continue 10 - 12 times a day) for only 15 minutes a side, offer her both sides, and when she is done, make her drink another 1 oz. of formula after each nursing. She said no more expending energy suckling at the breast for longer than 15 min because she'll empty it in that amount of time if she is vigorously sucking, and continued suckling will expend too much energy. We are to continue this from now until first thing Monday morning, and then we'll reevaluate her then.
The red crystals are due to uric acid, which is common 24 - 48 hours after birth because they are only feeding on colustrum, but once your milk comes in (I was engorged on days 3 - 4, and I have hand-expressed and there is definitely milk), the urine output should be clear. She is also making fewer than expected stools/poopy diapers. And she's dropping a lot of weight, fast.
Her birth weight was 9 lb. 10 oz.
At discharge (day 2) her weight was 9 lb. 3 oz.
Her weight today (day 5) at the check-up (on two different scales, for verification) was 8 lb. 3 oz.
(Other vital statistics: 20-1/2 inches in length, and 37 cm head circumference. I highly doubt she grew 3/4-inches in 5 days, so there's some measurement inaccuracy there...)
Newborn babies are expected to lose 5 - 7% of their birth weight in the first week. Then once your breastmilk comes in, to start gaining 1 oz. a day.
Amelia has already lost 1 lb. 7 oz in 5 days, a whopping 15% of her birth weight.
The pediatrician is hoping this is her low point in weight loss, and maybe we'll start to see an upswing over the next few days (next appointment on Monday, Amelia's day 9), but she said medically at this point, we have to supplement, which makes me feel like a failure of a mother, ugh. My boobs are not working! And I know we can recover and get her back on the breast (Erika was 100% exclusively breastfed for a year! And now I'm 5 days in and I've failed already!) if we work at it, and I know formula-fed babies turn out just fine (I was one!), but I wanted to do this, I thought I could do this, I thought I was doing well, and now I feel a little like a disappointment? Failure? Worried about Amelia getting more dehydrated and possibly needing the ICU?
I'm nursing her 10 - 12 times a day for the past 5 days, and I thought I was doing a good job, letting her nurse for 30 minutes sometimes, letting her comfort suck, letting her nurse to sleep, letting her nurse when she's upset... essentially I've got my boobs hanging out so much, my mother-in-law commented not just twice but three times in a day to say "wow that baby nurses a lot".
The problem (self-diagnosing here) is she's a very sleepy nurser compared to Erika. Erika would vigorously suck, and I'm noticing Amelia will nurse for 5 - 10 minutes and then fall asleep at the breast. I tickle her cheek, chin, rub her back, change her diaper, take her blanket off so she's really awake, but she still falls asleep.
So the bottom line recommendation-- no, firm instructions--- from the pediatrician is to put her on the breast often (continue 10 - 12 times a day) for only 15 minutes a side, offer her both sides, and when she is done, make her drink another 1 oz. of formula after each nursing. She said no more expending energy suckling at the breast for longer than 15 min because she'll empty it in that amount of time if she is vigorously sucking, and continued suckling will expend too much energy. We are to continue this from now until first thing Monday morning, and then we'll reevaluate her then.