Infants regulate milk production, and the amount of milk available to
infants is not the most critical determinant of the amount the baby takes
in.  Hartmann has demonstrated this.

But there is a body of research that does look at normal ranges of milk
production and infant intake at various ages.  It seems to suggest that milk
supply builds rapidly in the early postpartum and remains relatively stable
(unless artificially stimulated).  Infants appear to grow rapidly at first,
and to reduce their energy intake over time, so that the relatively constant
level of milk production remains suitable for their growth needs.  Ref:   K.
Dewey and B. Lonnerdal, Acta Paediatr Scand 1986, 75:893-98. "...breast-fed
infants do not increase their milk intake between 2 and 4-5 months...".

Butte (1984) describes how infant energy intake in exclusively bfed infants
declines over time.  This study describe  a normal range of human milk
production that is consistent at between 600-900 gm/day (for singletons)
over the first 3-5 months of life.  So the theoretical idea that a baby
takes in more and more milk over time as they get bigger may SEEM logical
but it is not supported by evidence.

Never the less, it is important to understand that the initiation period of
lactation is an important calibration period.  Woolridge describes 'acquired
low production' as a problem that is often irreversible past 6 weeks
postpartum.  Pamela Hill and Jean Aldag published two wonderful articles on
calibration of milk supply that appeared in JHL in 1999 and 2001.  All LCs
should be familiar with these articles because of the clinical importance of
their findings to moms who are exclusively pumping for preemies.

Margaret Neville has two brilliant anatomy and physiology of lactation
articles in the 2001 Pediatric Clinics in N. America that also describe
changes in milk volumes during lactogenesis stage II and over time.

 For those who lack the time or access to acquire journal articles, this
type information is well described in the basic texts on lactation such as
Dr. Lawrence's book.  It is, I'll admit, often rather dry reading, but we
have an obligation to be conversant with basic lactation science -- esp.
when people are paying us for our opinions.  I don't mean this as a harsh or
critical comment, merely that we must all encourage each other to keep
studying.  There is a tremendous amount we are still discovering, and a lot
of these ideas really blow our belief systems right out of the water.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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