Marcia,

Lactoengineering is mostly considered for babies who cannot take 
increased milk VOLUME but need more calories (those with certain kinds 
of heart disease or very preterm infants, whose kidneys are stressed by 
too much volume). It's not a one size fits all solution to slow growth, 
because growth requires proteins, and feeding extra cream does not 
increase the baby's protein intake.

There are several situations in which babies don't grow well, and they 
all need to have solutions aimed at the root cause. Common ones include 
lack of bf/milk: baby doesn't nurse often enough, nurse efficiently 
enough, mom is mismanaging bf, or has a physical problem that interferes 
with milk making. For the first 3, we fix the problem and give the baby 
access to more milk and all is usually well. The last is a bigger 
problem, but some maternal issues can be resolved. (I strongly recommend 
Lisa and Diana's book Making More Milk for a great review of all the 
issues that can cause reduced milk production and what to do about those 
things).

The less common issues where babies don't grow well are illness related: 
allergy/malabsorption syndromes; airway problems that make it difficult 
to sneak sufficient numbers of swallows in to get food; and genetic 
disorders.  There are some good studies on a few specific genetic 
disorders that demonstrate that no matter how much food you pump into 
them with tubes as infants, childhood and adult size stays the same, so 
many docs are now allowing kids with genetic disorders to follow their 
own curve as long as they are able to access normal amounts of milk. 
There are special curves for Down Syndrome, Cri du Chat syndrome/ 5p-, 
and several others.

Oh, and the not gaining due to oversupply was a HYPOTHESIS that has not 
been proven, based on a case report published by Michael Woolridge. I am 
much more likely to see a lb a week weight gain (450 g for those of you 
everywhere but the US) in kids whose moms are hyperlactating. Green 
stools are the result of fast intestinal transit, which is usually just 
because the milk is lower fat, but can also be due to an intestinal germ 
or an allergy, especially if the stool is mucousy or mildly bloody.

Hope this helps. Now back to work for me!

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 2/24/2011 9:56 AM, [log in to unmask] wrote:
> Hi everyone,
>
> Another point I always wonder about when foremilk and hindmilk are discussed - everyone seems to be assuming that consuming higher-fat milk will cause more weight gain.  I do understand that babies with green frothy stools, in other words, with mums with over-supply, may not gain weight well.  But the solution may be very frequent smaller feeds, which goes against the idea that babies won't get the 'good' milk until the breast is significantly emptied.  And we know that humans aren't designed so that foremilk needs to be expressed or pumped out so that baby can get to the hindmilk.
>
>    Americans went on a big low-fat kick and ended up gaining tons of weight because of too much sugar and not enough fats in their diets.  Is there good evidence that higher-fat milk makes babies gain faster?  Might it not increase satiety and lead to lower total intake instead?  Or do babies given lacto-engineered milk gain because by feeding by bottle you can feed them past satiety?  I don't feel I understand how all these pieces - including frequency of feeds and milk composition - fit together.
>
> Anybody able to explain more of this to me? (This is not a sarcastic question, by the way.  Milk composition is not my forte.)
>
>   Marcia in MN
>
>
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