Chris Mulford gave a lenthy discussion about recommended amounts of EBM and
ABM.  I would like to point out with my reply to Ellen Shein's reasonable
question I gave what I believe to be an appropriate and factual answer. She
specifically asked for amounts relating to newborns. I may have only quoted
from only one textbook, if I went to the library I could have quoted very
similar figures from several textbooks. I believe lactation consultants,
counsellors or other health care professional dealing with mothers and
newborn babies need to have a knowledge and an understanding of basic fluid
requirments eg. what if the mother is too sick breastfeed or the baby too
sick to breastfeed and she needs to express adequate amounts of EMB to meet
the baby's caloric requirements.  What about the cases of breast refusal
that from time to time are posted on the Lactnet--the lactation counsellor
or consultant needs to be know the baby's fluid and caloric needs if some
other means of giving EBM is temporarily employed?  Yes the figures given
are ball park figures and there is scope for variation--thats why I added
the quote from the text book which supports demand feeding for the healthy
bottle fed infants, but then at least we have some basis to judge whether
the infant has consumed a reasonable amount for the day.  Some babies may
consume more, some less and as long as weight gain appropriate and all the
other signs such as alertness, output etc (that we look for in a breastfed
baby) are OK then there is no need for concern.  And as you rightly pointed
out Chris as the baby gets older the caloric requirement per unit of weight
decreases and this is the reason the breast fed baby's weight begins to
level off around 4 months.

As regards "the mathemetrical symmetry" of the feeding schedule I quote and
whether the author calculated backwards from 150 to 0 on day zero this is
not the case or all the other authors of the numerous neonatal textbooks I
have read over the last 25 years have also got the formula hopelessly wrong.
  Newborn babies are born well hydrated and don't need high volumes of fluid
over the first couple of days--no mother produces 150mls/kg/day of colostrum
over the first couple of days.  If the baby is artifically fed (for whatever
reason) we all know this is not as well tolerated as breast milk, and the
gradual increase enables better tolerance.   Dramatically overfeeding
formula (particularly) to a day 1 or 2 will almost invariable lead to
vomitting. However over the first few days mothers milk production steadily
increases so that it approximates the 150 mls/kg.day table that I quoted.
Demand fed babies who are alert and sucking well would usually take
somewhere within this ball park figure by about the end of the first week.
Marian Rigney RN

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