Dear all:

Perhaps practices are different in your subcultures, but I always have to remind myself to 
check how often mothers are breastfeeding or draining their breasts when I get the call 
with "my baby is four months old and I'm losing my supply".  I still can't quite wrap my 
mind around how abnormal infant feeding practices are here in Manhattan.  There are at 
least two lay books that suggestion feeding 3-6 month olds only 4 times per day.  There 
is one pediatrician who recommends 12 hours per night sleeping --- which gives you only 
12 hours to get in the 8-12 feeds per day that would be normal.  Even if a baby is taking 
only 6 feeds -- that means feeding every 2 hours within that 12 hour stretch.  Yes, in 
most of the literature I ever read that was admittedly developing country data 8-12 feeds 
per day was STILL NORMAL.  I've been plenty of babies who, in Manhattan culture, will 
appear to drop down to 6-8 feeds per day in the 3-6 month range with no apparent 
adverse effects, but once it dips down below that --- I see the milk supply crash.

I've become so tired of the "oh, but I read such and such and my baby seems fine on 4 
feeds a day" that I now explain in the prenatal breastfeeding class why no baby should 
ever eat less than 5 times a day --- by comparing it to toddlers who need three meals 
and two snacks and how toddlers have bigger stomachs than babies.  And I explain that 
while you can stretch a stomach (like the Japanese guy who mostly wins the Nathan's 
hotdog eating contest in Coney Island) it is not a healthy way to eat --- opening the door 
for later eating disorders.

So, while working with the 4 month milk supply crash, I highly recommend you 
investigate whether or not it is due to an abnormally infrequent feeding schedule first.  
While I have seen other causes --- I'd say that 95% of the time it is the feeding schedule.

Best, Susan Burger

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