By Dr. Christie del Castillo-Hegyi, M.D.

The Fed is Best Foundation has written about countless cases of serious complications caused by poor standards of breastfeeding management established by multiple exclusive breastfeeding advocacy organizations. The primary causes of these poor outcomes are:

• • the persistent denial of the seriousness of newborn weight loss
  • the lack of transparency about the consequences of insufficient feeding complications in patient education and health professional training
  • and the dangerous obsession with exclusivity in breastfeeding.

Exclusive breastfeeding, according to the WHO, means “the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicine.” While breastfeeding is a positive thing to support, the obsession with exclusivity in breastfeeding promotion results in approximately 190,000 newborn admissions a year in the U.S. alone, mostly from complications of jaundice and dehydration caused by underfeeding. This article will discuss the actual reason why exclusively breastfed newborns lose weight and why newborn weight loss is not due to IV fluids given to mothers before delivery. This is to address a commonly circulated unsafe recommendation by exclusive breastfeeding advocates and lactation professionals suggesting we increase the AAP recommended maximum weight loss threshold of 7% and to weigh infants at 24 hours, which would likely increase newborn insufficient feeding complications, hospitalizations, and brain injury.

Part 1: Why a Newborn Loses Weight in the First Days

Let’s start the conversation off with why newborns lose weight in the first days of life. Exclusive breastfeeding advocates have hypothesized that infant weight loss is caused by fluid shifts and “diuresis” or elimination of fluid through urination. Diuresis is defined as overproduction of urine caused by excess body fluid, which should be at least 6-8 wet diapers a day, the normal urine production of a hydrated newborn. In fact, exclusively colostrum-fed newborns, only produce 1-2 wet and dirty diapers a day the first 2 days of life, which is lower than the normal number of wet diapers a day for a hydrated newborn. Therefore, weight loss is not in fact caused by fluid loss. 

Here are some basic facts about newborn nutrition:

• The caloric requirement of a newborn from birth through the first weeks of life is 100-120 Calories/kg/day, a figure that is determined by the number of living cells a baby has to keep alive. 
• The fluid requirement of a newborn is more variable, which can be affected by how much fluid reserve they are born with. But according to the pediatric literature it is approximately  60-80 mL/kg/day the first 2 days then 100 mL/kg/day thereafter. 
• That means a 3 kg newborn needs 300 to 360 Calories per day and 180-240 mL of fluid for the first 2 days and 300 mL thereafter. 

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