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    Signs of a Dehydrated Baby

    Breastfeeding can be a big learning curve in the early weeks. Initiating breastfeeding in the first hour of life, nursing frequently day and night and keeping your baby skin to skin all help get feeding your baby off to a good start and to establish your milk supply. Wondering if your baby is getting enough milk regardless of if feeding seems to be going well  is a common thought on new parent’s minds.  Every baby is different and even if this is not your first baby, everything is new as you and your baby get to know each other.

    Babies lose some weight initially after birth. By getting nursing off to a good start, they will begin to gain back that weight and be back to their birth weight or more by their second week of life. A baby’s body weight is 70% - 80% water.(1) A loss in total body water can quickly lead to dehydration. Dehydration happens when your baby loses more water than is being taken in when they eat. 

    Breast milk typically increases in volume between days 2 -5, but some parents experience a delay.(3) Sometimes babies are really sleepy or have a hard time at breast and it makes feeding even more complex. When your baby doesn’t take in enough milk over 24 hours, dehydration is a risk. 

    When not enough milk is transferred from the lactating parent to the baby there is a risk of the baby becoming dehydrated. This might happen if the baby is not able to nurse efficiently and transfer milk well. A baby needs to be latched on deeply to the breast/chest to remove milk. 

    Low milk supply may be a reason your baby is not getting enough milk. Decreased milk supply is not always noticed right away. When your baby is latched on and appears to be sucking well, but they are not having plenty of  wet diapers or seem hungry after feeding, it is a good idea to contact an IBCLC to help determine if your milk supply is low and why that may be happening.

    Dehydration can seem like it comes on quickly and can happen to babies who are nursing or being fed formula. Recognizing the signs of dehydration allows you to get help sooner than later if you suspect a problem. If you notice signs of dehydration, contact your care provider right away.

    It is normal for a baby to eat at least 8 times per 24 hours. Many parents find their baby eats more in the range of 10-15 or more times per 24 hours.(2) Keeping your baby skin to skin, unswaddled will help you notice when they are giving cues that they are ready to eat. This might include rooting, smacking or licking their lips, turning their head searching for the breast/chest even if their eyes are closed or a late feeding cue of crying. Pacifiers can interfere with seeing your baby’s cues and result in delayed or missed feedings at least until breastfeeding is well established.(7) When your baby is kept on  your chest, they often eat more frequently keeping them hydrated and happy.

    Getting used to this new rhythm of life with your newborn and waking often is a big transition. Babies' sleep patterns are not the same as an adult. Your baby will need to feed every 1.5 - 3 hours during the night. Being next to the lactating parent helps your baby naturally rouse on their own to feed. Sharing safe sleep let’s you meet the nighttime needs of your baby and allows you to get more overall sleep.(5) Keep your baby comfortable, but not in too many layers while sleeping to avoid being overheated which can cause them to sweat and lose body water.

    Remember that learning curve we mentioned? Getting to know your baby and their cues can be easier said than done. Sometimes breastfeeding challenges complicate feeding your baby. Your local IBCLC is there to help you uncover the root cause of feeding challenges and create a care plan that is individualized for you and your baby.

    Signs of dehydration can be mild, moderate or severe.If you notice any signs of dehydration even if they are mild, it is best to contact your healthcare provider since dehydration can escalate quickly in newborns. 

    Early signs of dehydration:

    A baby has lost fluid up to 5% of their body weight 

    Reduced number of wet diapers

    appears and behaves like normal.


    Moderate signs of dehydration:

    6-10% weight loss

    Baby seems irritable and hard to console

    Dry lips or cracked lips

    Less than 6 very wet diapers in 24 hours

    Very loose stool or decreased number of poopy diapers

    Urine is dark yellow or has appearance of orange crystals

    Cold hands or fingers do not have normal color

    Sunken fontanelle

    Skin appears wrinkled and skin pinch is slow to return to normal

    Very few or no tears when baby cries


    Severe signs of dehydration:

    10% or more weight loss

    Baby is lethargic,  very hard to rouse or becomes unconscious 

    Pulse and breathing may be rapid

    Very sunken fontanelle

    Skin pinch takes a long time to return to normal 

    Eyes appear sunken

    No tears when crying

    Babies do sleep a lot, but if your baby is difficult to wake or not waking to be fed this is a red flag.

    Babies should have 6-8 or more wet diapers per 24 hours which is one wet diaper at least every 3 hours around the clock. A wet diaper is one that is saturated with pale yellow colored urine with no strong odor. You can pour 2-4 Tablespoons of water on one of your baby’s clean diapers to get an idea for how a wet diaper should feel. If your baby is having less than 6 wet diapers a day, this is a concern for dehydration. 

    Breastmilk is very easily digested by your baby. It contains everything your baby needs. This includes bacteria that help in the development of their immune system. Some of the components in breastmilk do not get digested but pass through your baby’s system and exits in their poop. Your baby will poop anywhere from 2-5 times per day or more.(6)  A reduction in how much and how often they are pooping can be a warning side for dehydration.

    The skin on your baby should be plump. If your baby’s skin begins to appear thinner or more wrinkled, this can indicate too much weight loss and possible dehydration. Do a pinch test - lightly pinch your baby’s skin between your thumb and index finger so it lifts. Their skin should bounce back into place easily. If there is a delay in the skin returning to normal, this is a sign of dehydration.

    A fontanelle is a space between the bones of your baby’s head that will form a tight junction and close. It is often called their soft spot. The fontanelle on top of your baby’s head should be flat and in line with the skull bones. If it is sunken in, dehydration should be considered. They become closed between 9 -18 months old. 

    Illness, including diarrhea and vomiting can lead to dehydration.(1) These illnesses cause a lot of water loss. Diarrhea is very loose and watery poop diapers. If your baby is having diarrhea or is vomiting, you should contact your healthcare provider and your IBCLC right away. Certain medical conditions like Type 1 Diabetes can also cause dehydration. Type 1 Diabetes is rare and can be diagnosed at your doctors office.

    A baby may have only some of the signs and not all of them. Anytime you notice any of the signs listed, it is best to contact your doctor to further evaluate your baby right away.


    Footnotes:

    1. Vega RM, Avva U. Pediatric Dehydration. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436022/
    2. Lawrence & Lawrence, Breastfeeding: A Guide For the Medical Profession 8th edition, 2016, 8;267 
    3. ABM 2009, Mannel et al 2013, Mohrbacher 2010
    4. Vega RM, Avva U. Pediatric Dehydration. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-
    5. Mosko S, Richard C, McKenna J. Maternal sleep and arousals during bedsharing with infants. Sleep. 1997 Feb;20(2):142-50. doi: 10.1093/sleep/20.2.142. PMID: 9143074.
    6. https://www.llli.org/breastfeeding-info/constipation/
    7. Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD007202. doi: 10.1002/14651858.CD007202.pub2. Update in: Cochrane Database Syst Rev. 2012;7:CD007202. PMID: 21412899.

    References:

    https://www.ncbi.nlm.nih.gov/books/NBK436022/


    https://www.llli.org/breastfeeding-info/frequency-feeding-frequently-asked-questions-faqs/#:~:text=Starting%20with%20your%20infant's%20second,against%20or%20treat%20jaundice5.


    https://kellymom.com/ages/newborn/when-will-my-milk-come-in/#:~:text=Milk%20production%20begins%20around%20the,between%20days%202%20and%205.


    http://www.nancymohrbacher.com/articles/2012/11/27/how-much-milk-should-you-expect-to-pump.html#:~:text=Because%20newborns'%20stomachs%20are%20so,per%20day%20(900%20mL).


    https://www.utmb.edu/Pedi_Ed/CoreV2/Fluids/Fluids9.html


    https://www.psychologytoday.com/us/blog/moral-landscapes/201302/normal-human-infant-sleep-feeding-method-and-development


    https://pubmed.ncbi.nlm.nih.gov/9143074/


    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414019/


    https://www.llli.org/breastfeeding-info/constipation/




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