I am working on a presentation for the nurses and one of the topics will be  
composition of breast milk and another on blood sugar management.  
As I have reviewed some of the literature I am having a problem with both  
the ABM and AAP which state that babies should receive intakes of 10-15 ml/kg if 
 there is low blood sugars.  There is nothing identifying the age of a baby  
when this recommendation is made.  
We repeatedly hear that a newborn in the first day of life takes in an  
average of 5-7 ml per feeding and on the second day the average intake is 7-15  ml 
per feeding.  This is NOT based on the size of the baby but on their  age.  On 
the third day this changes where babies take much larger intakes  coinciding 
with mom's increase in milk production and recovery of the  infant.
But it is not just the small amounts that are to be focused on but the  
composition of the breast milk.  The colostrum has 3x the protein of mature  milk 
which significantly helps to stabilize release of insulin.  Another  quality of 
colostrum is it's thick constancy which helps to slide down more  easily, 
sticking to the walls of the GI track that is in a bit of an  upheaval.  
When force feeding babies larger amounts based on the above criteria for  
intake, I want to know who has actually studied how much a newborn actually  
keeps down.  
A case in point; there was a baby at our hospital who was small for  
gestational age and the mother did not want to breastfeed.  I observed the  nurse 
feeding this baby at around 3 hours old.  The baby did not show  interest in 
feeding, the nurse pushed the bottle in and after a small amount the  baby is 
leaking formula all over, she stops and the baby vomits up the  feeding.  Than she 
repeats this stating the vomiting was good because the  baby was getting up 
that "mucous."  The baby repeatedly vomited up each  amount of formula given at 
this feeding.
I am trying to make the case that skin to skin and small amounts of  
colostrum will help stabilize babies at risk of hypoglycemia but having these 2  
medical organizations print 10-15 ml/kg intake does not help us or the  babies.  I 
find it difficult to site these 2 sources since they contradict  what I am 
trying to teach the staff.
I am looking for feedback on this and wondering about any future changes in  
these policies.
Thanks,
Ann Perry, RN IBCLC
Boston, MA



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