Identifying Infant Dehydration in Breastfed Babies
Edited by Alicia Clemens Booksh
Kenner, Louisiana, USA
From: NEW BEGINNINGS, Vol. 11 No. 6, November-December 1994, pp. 184-5
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
In the middle of World Breastfeeding Week , and just one week after a long-awaited announcement by the US to reverse its position and support the WHO code (which protects against abuses by infant formula manufacturers), a television news program aired a story focusing on the "dangers of breastfeeding" or "why some women should choose not to breastfeed." The promotional spot for the program showed part of an interview with a mother who said, "If I knew before what I know now, I would never have chosen to breastfeed." What timing! Lactation consultants, pediatricians, La Leche League Leaders, La Leche League mothers, and others concerned about support for breastfeeding tuned in.
The story focused on mothers whose infants suffered from dehydration--cases so severe that a child suffered brain damage and another suffered limb amputation. The mothers blamed their choice to breastfeed for the birth tragedies, although each mentioned things about their babies' behavior (sucking improperly, sleeping constantly, etc.) that immediately caught La Leche League Leaders' attention.
It seems clear that the title of the program should have been "The Dangers of Dehydration" or "The Need for Better Lactation Support and Education."
Dehydration most often occurs in infants born to first-time mothers new at breastfeeding and child rearing. The warning signs of dehydration are often present at discharge from the hospital. There may have been a difficult delivery or maternal medication for pain before or after the baby was born. This can lead to a less vigorous or sleepy baby and thus, inadequate feeding at the breast. Often, supplementary bottles of water or artificial baby milk products are given in the hospital instead of working on improving the baby's breastfeeding skills. None of these important details were offered in the television story.
One of the most common questions raised by new mothers who breastfeed is "How can I tell if my baby is getting enough?" This question is one that is addressed at LLL meetings, and one that should be addressed by an informed and knowledgeable hospital staff, qualified to provide current and accurate information. In addition, this staff must be willing to pass out creditable breastfeeding support and information with the same regularity that the free pamphlets supplied by artificial feeding product manufacturers are distributed at discharge time.
Mothers should be aware of their babies' wet and dirty diapers: after the first day or two, six to eight wet diapers (five to six disposables, although determining wetness in disposables can be difficult) and two to five bowel movements every twenty-four hours means a baby is being nourished adequately. When a three- or four-day-old baby is not producing wet and soiled diapers, the mother should seek help immediately from someone knowledgeable about breastfeeding.
Mothers should be attentive to a baby's activity level and possible symptoms: Does he suck actively? Is he enthusiastic at nursing? Is he nursing 8-10 times every twenty-four hours? Is he swallowing? Is he sleeping through too many nursings? Has his activity level decreased over time? Hydration can be assessed by observing an infant's general responsiveness and skin tone. A baby who is dehydrated will be listless and act sick.
A baby's weight gain is also an indication of sufficient nourishment at the breast, although each baby gains at his own rate, and it can take up to three weeks to regain birth weight. Many health professionals who advocate breastfeeding suggest that breastfed babies be seen by the doctor at one week of age to be certain that everything is going well. At a pediatrician's examination, the lethargy, dryness of mucous membranes, and possible malnutrition associated with a dehydrated infant would be immediately recognized. The degree of hydration is best determined by the extent of rapid weight loss.
In rare situations, an infant's failure to thrive or dehydration can be due to a mother's inability to produce enough milk. A retained placental fragment can delay adequate milk production. Previous breast surgery, particularly breast reduction, may have severed necessary nerves or removed too much glandular tissue. Perhaps a birth defect or injury to the developing breast doesn't permit full lactation.
In a few case reports, diminished lactation has led to elevated sodium levels in mother's milk which could cause dehydration in newborn infants. Excessive sodium levels can also occur when there is an unusual delay in the maturation of colostrum to breast milk. Sodium levels can be normalized with appropriate lactation counseling, including pumping between feedings to increase a mother's milk supply more rapidly.
Mothers can also watch for signs that their breasts are functioning normally. Did her breasts increase significantly in size during pregnancy? Did the mother feel her milk "coming in" a few days after birth? Does she feel thirsty? Does she feel a let-down? Does she see any milk dribble or squirt from her breast? Pumping or hand expressing a bit of milk may relieve a new mother's concern about whether or not she is actually producing milk.
A more likely possibility to explore is that the baby is unable to suckle properly. Someone with an understanding of proper breastfeeding (an LLL Leader or a knowledgeable health professional) should observe the baby's position at the breast and determine whether or not the baby is latched on properly. The mother can be helped to determine what baby is doing as he sucks and can be taught how to work with her baby to improve his breastfeeding skills. Successful breastfeeding is a partnership; the experience of both partners should be assessed in the case of insufficient milk supply.
As mothers, our hearts go out to those who shared their stories of dehydration to warn parents about its realities. Unfortunately, their tragedies have been linked to breastfeeding in the minds of some. "The people I've talked to aren't remembering the breastfeeding benefits discussed in this news story," said one lactation professional. "They are remembering the suffering infants and connecting that suffering to breastfeeding."
We in La Leche League can help prevent tragedies that occur because of failure to identify infant dehydration. We can further educate our health care providers and the general public as to what makes breastfeeding successful. We can promote the benefits of providing a child with his mother's milk and teach mothers ways to determine whether or not their infants are thriving. We can help an uncertain, uninformed, or isolated mother learn more about the factors that affect her ability to breastfeed her infant. Finally, we can continue to offer Group meetings where everything a woman needs to enjoy a successful breastfeeding relationship is provided in an extended, mother-to-mother context that can make all the difference in the world. Problems with breastfeeding can be solved before they become serious; no one should have to feel regret over her decision to breastfeed. Breastfeeding is too important, too precious. Every mother should have the help she needs to breastfeed successfully.
Branski, D., E. Kerem, E. Gross-Kieselstein et al. Bloody diarrhea--a possible complication of sulfasalazine transferred through human breast milk. J Pediatr Gastroenterol Nutr 5:316, 1986.
Huggins, Kathleen, RN, M.S., The Nursing Mother's Companion, rev. ed. Harvard Common Press. Boston, MA 1994.
La Leche League International, THE WOMANLY ART OF BREASTFEEDING, 35th Anniversary Edition. LLLI, Franklin Park, IL, USA, 1991.
Lawrence, Ruth A. Breastfeeding A Guide for the Medical Profession, 4th ed. St. Louis: Mosby, 1994.
Mohrbacher, Nancy and Julie Stock. THE BREASTFEEDING ANSWER BOOK. LLLI, Franklin Park, IL, USA, 1991.
Neifert, M. R. et al. Failure of lactogenesis associated with placental retention. Am. Obstet Gynecol 1981;140(4):477-78.
Neifert, M. R. et al. The influence of breast surgery, breast appearance, and pregnancy-induced breast changes on lactation sufficiency as measured by infant weight gain. Birth 1990; 17(1):31-38.
Riordan, Jan and Kathleen G. Auerbach. Breastfeeding and Human Lactation. Jones and Bartlett Publishers, Boston, MA, 1993.
Sofer, S. et al. Early severe dehydration in young breast-fed newborn infants. Isr J Mod Sci 1993; 29(2-3):85-89.
Thullen, J. D. Management of hypernatrenic dehydration due to insufficient lactation. Clin Pediatr 1988; 27(8):370-72.