I have just read something like 70 digests in the last few days and have been
interested in the discussion of milk intake and growth spurts.  Thank you, Chris
Mulford, for a really thought-provoking post.

I read an article in Journal of Pediatrics in 1984 that found that milk intake
of breastfed infants increased only slightly over the first 4 months, and since
they continued to grow well their metabolic needs must decrease.  It made sense
to me and I've been going on that assumption for about the last 10 years.  Now,
that's an old article, and their conclusions may not be completely correct (is
it metabolic need, better absorption of nutrients, or does the calorie content
change), but I've not seen any evidence that milk supply increases much over the
period of exclusive breastfeeding.

I find this information *really* important in dealing with working mothers.  I
think it gives them a sense of relief that they're not going to somehow have to
pump greater and greater volumes of milk when they're separated, and that it's
appropriate for their baby to be having smaller volumes of breastmilk per
feeding that the ABM-fed kids with their 8 oz. bottles.  I, too, find the
amounts listed on Medela's tear off sheets distressing, and won't use that sheet
because it seems so blatently inaccurate.

I also think it's interesting that there's no evidence that milk supply does
increase with "growth spurts."  Even though I believed that in general milk
supply did not increase, I thought it did go up and down a bit.  Like Denise
Fisher I assumed that when babies were going through a slow growth phase milk
supply dropped a bit and when they went through a fast growth phase they bumped
it up again.  Doesn't seem inconsistent to me.

Becky Krumwiede, RN, IBCLC, Appleton, WI
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