Although it is correct that a breastfeeding infant’s clenched fist may indicate hunger (Item 98-20), there are better ways to assess a newborn for adequate intake in the early postpartum period. In the first few days of life, a breastfeeding newborn consumes colostrum, which is small in quantity and prevents him from experiencing a full stomach. This encourages him to nurse frequently and results in a full milk supply for the mother (usually by day four). A provider looking for a relaxed hand as the signal that a newborn is “getting enough milk” may erroneously advise supplementation in those early days and interfere with the milk supply. Consider the whole picture instead—an alert baby who feeds vigorously 8-12 times per day, is not excessively sleepy, is stooling and voiding, and has lost <10% of his birth weight.
—Stacy D. Kucharczk, MSN, CPNP, Virginia Beach, Va. (107-18)