Neena Modi

Avoiding hypernatraemic dehydration in healthy term infants
Arch Dis Child 2007; 92: 474-475 [Full text] [PDF]

BIRCH66DG{at}HOTMAIL.COM SIMON BIRCH

Neena Modi writes a generally very good perspective on this important issue. In particular, there is sensible comment in a call for reason now that a sense of McCarthyism seems to surround any suggestion that breast feeding can be difficult. However, I think it often unwise to be reassured by mother and baby being 'well'. In my experience, the very fact that nothing seems to be wrong is often a major contributor to the tragedies that occur unless some kind of screening process is implemented. These are typically firstborns, so mothers may be happy with latching and sucking even when it is ineffective. 'Wet nappies' from immature renal function may give reassurance when they are not familiar with how heavy they should become. More mature, professional women (as they often are) may feel they should not ask for help with such a 'natural' process, even if exhausted after surgery and blood loss. Perhaps ironically, 'acopia' in asking for help, getting the baby weighed or changing to bottles will almost always allow the short-term problem to be relatively easily addressed - local experience suggests that even weight loss significantly above 10% is not a major concern provided it is recognised. Healthcare professionals reviewing progress may lack the skill, or perhaps more crucially the time, to allow the ideal solution of early detection and support - especially when these babies often do not appear 'dehydrated'. Unless far greater post-natal support can be given, I feel this is one case where routine weighing of babies does have merit.