5 day old hasn't pooped since day 3 -- how bad is that?

[msmiranda]

My best friend has a 5 day old who hasn't pooped in almost two days. He is very, very sleepy and falls asleep nursing, when he will wake up. (He was born a few weeks early and she had an epidural, so I am thinking those two things combined are causing it). Fortunately I had sent her a breast pump and earlier today I advised her to start pumping after feedings and feed the expressed milk to the baby via syringe or dropper. Baby was born Sunday morning, her milk came in yesterday (Wednesday). Meconium was all passed in the hospital and he had a brown poop on Tuesday but nothing since then (but has had wet diapers so is not dehydrated). I'm thinking he's not getting enough hindmilk because he's falling asleep before he gets to it. I just hope that her milk supply hasn't taken an irreversible dip.

I told her that her goals are two: (1) get more milk into the baby; and (2) pump to help maintain her supply while the baby is working on nursing. The stupid LC she saw yesterday told her not to pump for a month! (what she meant was, no bottles for a month, but that's not what she said). Baby has lost more than 10% of birth weight and because of the lack of poop I am concerned for them. I am afraid that when she goes in tomorrow to the ped they will give her a can of formula and tell her to supplement.

I know what I've told her is the right advice, but I'm worried about her. Anyone else have thoughts?

[GoBecGo]

My thoughts are that my DD didn't poop between days 3 and 7 and then pooped everyday (normal yellow BF baby poop) for about 5 weeks and i never considered there was anything wrong with that because she seemed fine. 10% birth weight loss is normal. Being sleepy when they are a few weeks early is normal.

Encourage her to encourage him to feed - offer the breast with baby undressed so the skin-to-skin will rouse him, and have her change his nappy or rub his feet or even wipe him with a warm damp cloth to wake him for a bit more if he falls asleep mid-feed (how long is he feeding? Mid-feed might be post-feed if she has a lot of milk and he is small). 2-hourly feedings would be good, as would pumping off the foremilk and offering the breast after (so he's getting hind milk but from the breast) also, but only if his weight loss continues.

I wouldn't be overly concerned about her supply after 5 days. Mother Nature knows it can take some babies a few WEEKS to get a hang of feeding and prolactin remains high to counter this for several weeks after the birth (which is why many women who NEVER put baby to breast still leak milk everywhere for a few weeks). Remember to reassure her that she's doing great and her son is beautiful.

[Bookworm?]

Everything you said is correct. Late preterm babies tend to be very sleepy and need extra help nursing. Encourage her to nurse him very frequently, strip him down to feed, hold him skin to skin to get him to wake up. Make sure he is drinking at the breast instead of just latching and falling asleep.
10% weight loss is fairly normal but also a sign that baby isn't getting quite enough. I would be slightly concerned about the lack of bowel movement too. Breast compressions can help the baby get more milk as well as keeping him sucking at the breast. Make sure he has an optimal latch. Dr. Newman has some good video on how to get an optimal latch and how to know baby is drinking. Supplementaion is not neccessary but more breastmilk is. Milk supply should be okay as long as baby starts taking in more milk in the next week or so. Congratulations to your friend and good for you for offering such great information and support. If things don't improve in the next day or two, encourage her to get in touch with a good IBCLC.

[sunshynbaby]

10% is normal, and I wouldn't pump that early on either. My ds didn't poop for a week after his first poop, and then he didn't stop pooping I would do frequent feedings, etc. as PP suggested. Kellymom.com has a lot of good resources.

[PatioGardener]

If Mama didn't have an IV in labour, 10 % is the highest end of normal - usually 7% is average. How are pees? 6 heavy wet diapers by day 6 is what you are looking for. Heavy is 3 tablespoons of water in a diaper.

Has anyone checked for a tongue-tie?

With no poops and a sleepy baby I would err on the side of caution and pump/express after a feed and syringe/cup/finger feed the expressed milk. Just a day or 2 of that will likely give baby the boost needed to get enough on her own. IMO, if that keeps baby exclusively breastfed and away from formula for 'excessive' weigh-loss it will be worth it.

[Heba]

Yes, I agree with everything you said. 10% weight loss and no poos are signs that he isn't getting *quite* enough calories at the moment, although the wet nappies is a good sign = not dehydrated. It is more than likely that he will "wake up" soon and I'm sure he will be just fine (as will her milk supply), but in the meantime I too would be trying to get more calories into him to be on the safe side (as well as to avoid having formula prescribed - if it's necessary, then it's necessary, but more often than not it's prescribed not as a last resort but because many HCPs may not have bf management expertise).

Most the techniques I would suggest to keep baby on the breast longer have already been mentioned by pps:
- s2s
- changing nappy mid-feed
- cool damp cloth
- rub feet
- breast compressions

Other stimulating techniques Mum could also try:
- circle baby's lips with a fingertip
- express milk onto baby's lips
Other techniques to keep baby interested at the breast:
- support the breast (with hand not holding baby) so the baby doesn't take the weight of the breast on his/her chin
- switching breast as soon as baby begins to lose interest (I know, may give more "foremilk" and not hindmilk, but more milk is better than no more milk)
- try a different feeding position (e.g. football hold instead of cradle hold; baby-led attachement/Biological Nurturing)
- massage baby's crown in a circular motion while feeding

Good luck to your friend and her little one, and let us know how they get on!

[msmiranda]

Hi all, thanks for the responses. She took him in this morning and his pee was orange and he was almost dehydrated, so she's supplementing with formula (using a SNS or syringe). I guess by the time she called me it was too late to avoid that. [She's 6 hours ahead of me, in Italy]. The doc says he wants baby to get 2 oz. at every feeding, doesn't care whether formula or expressed milk. I told her very clearly that she should pump after every feeding and give expressed milk and try to get off the formula ASAP. She is a first-time mom (obviously) and I'm afraid that this experience has scared her into not believing in breastfeeding. (Though there is an LC at her ped who gave her the SNS and said not to use bottles, so that's something).

I'm still worried that he is not latching properly because last night she told me that he had had two good feedings where he sucked strongly and swallowed for 15 minutes (at 6 and 8:30), so I'm not sure what happened during the night such that he was dehydrated by morning.

I have a bad feeling this situation is not going to end well. I am not sure of her commitment to breastfeeding and I know that it must be frightening to feel like your baby is starving. I've never had latch/milk delivery problems with either of mine so I can't speak to her specific problem. And I'm definitely not sure she's committed enough to pump after every feeding. I tried to be as encouraging as possible but she knows how I feel about breastfeeding and I suspect that she will stop calling me once she has made that jump in her mind not to stick it out with breastfeeding. It's so sad. Just like with her birth, she's going to end up as yet another statistic and no matter how much I supported her there is nothing I can do to stop it.

[Heba]

You are a great friend, and your support are increasing the chances of breastfeeding succeeding. Unfortunately, while support is so important, there are more factors at play and sometimes our friends end up not breastfeeding - and I know how frustrating and disappointing this is .

It sounds as if she has at least some trained support there - and I'm heartened by the fact that an SNS was suggested. I would imagine one of the first things an LC would have done is observe a feed - I wonder if you know whether this happened. Without knowing what the problem is, there is no real way for them to fix it. Could be a simple problem which can be addressed, or could still be that baby was too sleepy to latch on in the early days - lack of calories can lead to less energy to feed which leads to a vicious circle - which may right itself once baby has more nutrition.

Here's hoping it works out well for your friend and her little one.

[msmiranda]

I think it was partially the sleepiness and maybe partially the latch, but because I'm not there I don't know for sure. The LC has observed feeds yesterday and the day before, so I guess she has pointed out any potential issues there. I know they have to still wake him up for feedings sometimes. Right now she is still using the SNS to supplement with formula and I know that she has not been pumping, which worries me for her supply. She has been giving him an average of 1 oz. of formula to supplement at each feeding. I told her to try to get off the formula ASAP, but I don't know that that will happen. She's probably scared not to use it at this point. I'm not hearing any commitment to pumping and supplementing with EBM, despite the fact that I sent her a pump and a ton of accessories as a gift, which is a shame. I'm trying not to be overbearing, but this is about level of commitment and the fact is that what she is choosing to do and not do right now will influence whether breastfeeding is successful or not. Grrrr . . . so frustrating.

[spughy]

Been there. You know what? You have done everything you can. Please don't beat yourself up. The mama will do what she will do, and your job as a friend is to listen, sympathize, encourage and reassure - not to tell her what to do. That's the LC's job, and it sounds like she's doing it well.

As someone who's been through the hell of having a sleepy, poor-weight-gain baby, AND a milk supply issue, let me tell you that fear is a huge motivator at that point and - even if you were like me and vehemently dedicated to breastfeeding - formula is so, so reassuring. Please don't ever blame a mama for supplementing maybe a little bit more than she strictly needed to. It is HARD to see your little one not thriving on your milk, and it can make mama feel a whole lot better to see a really quick rebound on formula than a long, long struggle with pumping. Pumping can be quite uncomfortable, too.

FWIW, I supplemented my little girl for several months, then got off the formula, and nursed her for nearly three years. But, I went through all kinds of hell getting there - it is hard, hard work, all the hassle of both bottles AND breastfeeding, with few of the benefits of either - and since then I have nothing but sympathy for women who can't do it. If I'd had any kind of additional responsibilities during those months - like another child, or domestic duties - I would have fallen apart.

So, be easy on yourself, be easy on your friend, encourage her without badgering her and if she can't do it, please don't desert her. (If she would like to talk to someone who has been through it, PM me and I would be happy to talk to her via e-mail. One of the things that got me through was talking to other mamas who had to supplement.)

[msmiranda]

Another update: just talked to her. Baby STILL has not pooped since Tuesday, even though he has been getting formula for three days! I said I guess he must be saving it up and will have a huge mudslide when he does go. The ped checked yesterday for potential bowel obstruction and said no, and baby is still passing gas. Another weird development . . .

Also, I clarified what the LC found -- she says his latch is great, and that his suck is effective. So it is the sleepiness that is the problem. He is still sleepy now, seven days after birth. They have to wake him for most feedings.

Good news is, she is pumping now, and called with pumping questions.

Thanks so much for the kind responses! I can't imagine how hard it must be to have a sleepy baby who won't wake up for feedings since I've never dealt with that. How long might this last, I wonder?

[mama2annabelle]

Hang in there with supporting your friend. I know first hand both sides of this issue...the support person and the person needing support. I have had 2 babies with nursing issues, low weight gain, low supply, etc. I KNOW how important it is to have someone cheering you on when you're in the thick of getting baby to nurse well enough to thrive. As a LC and a LLL Leader, I went through these issues with my last 2 children and even with all my knowledge and experience and extensive support system it was SO so hard and I struggled to persevere.
As far as how long it might last...it's hard to say. Hopefully baby will gain enough energy to nurse effectively quickly. My personal experience with my children...my son was finally fully breastfed at the breast at 8 weeks old and my daughter took much longer...4 months for her. Now my son is 2 yrs 9 months and my daughter is nine months and they are BOTH still nursing! =-)

[mama2annabelle]

Also, I wanted to add:

Several people posted that 10% weight loss is normal and not to worry about sleepiness and lack of bowel movements. I want to strongly caution against making statements that encourage disregarding possible warning signs. I know these statements were meant to encourage and were made with good intention. I also know that any one of these things on it's own can be within the realm of normal (not so much the lack of BMs though...in a newborn no pooping should be seen as a warning sign up until about 6 wks of age.)

But these 3 things together (lack of bowel movements, overly sleepiness, and more than 7% weight loss) are definitely a cause for concern and should be investigated immediately. Sure there are some mom/baby pairs who seem to be able to work through these combination of issues without any intervention and that is great. But newborn babies can go into a downward spiral very quickly from lack of sufficient calorie intake which leads to loss of energy to nurse properly which leads to inabililty to stay awake to nurse which leads to lack of weight gain, no pooping, etc. It is a vicious cycle that, once entered into, is VERY hard to get out of.