Heather, IMHO your misgivings about growth spurts are spot on! "is there any
good evidence that they happen in any *truly* predictable way? I have heard
so many times that 3 weeks, 6 weeks, 12 weeks or whatever are 'the' times,
and I have also heard people reassure mothers that at 2 weeks, 5 weeks, 10
weeks or whateve 'it's okay' to respond to the baby's apparent increased
need to feed 'because he's probably coming up to a growth spurt'."

The realization has gradually dawned on me over time that when breastfeeding
is going well, growth spurts simply don't seem to happen - the baby seems to
grow well from the beginning and just keeps on going.   However, I find
myself being a little paternalistic (maternalistic?) with a mom of a fussy
baby, if her baby has seemed to be doing well and now suddenly changes his
behaviour and seems to be "dissatisfied".  I say something like, "There's a
school of thought that believes that growth spurts occur at .....(whatever
the baby's age is) .. and you can usually increase your milk supply to meet
the baby's need by putting him to the breast *every* time he squeaks for 3 -
4 days".  Somehow I have managed to persuade myself that putting it like
this - as if it's the *baby's* "fault" (he's growing very fast right now),
rather than the *mom's* "fault" (you've allowed your milk supply to drop by
not draining the breasts frequently/thoroughly enough) then the mom may find
this information more acceptable and easier to act on.   Actually, I find
that if I'm really able to go into the history, the change in the baby's
demand has not occurred suddenly at all - there have been subtle signs for
some time, but the mom has been able to ignore them.  As the mom responds to
the baby's increased need (treats the Sx) she is often able to identify what
she *was* doing before (etiology) that caused the milk supply to drop too
far.  These things are always easier to see with hindsight of course.

I am becoming more and more sure that the first few days and weeks of
lactation and breastfeeding are an incredibly and intricately critical and
fragile time. If only mothers would not be afraid to maximize their milk
output during the first 2, 4, 6 weeks, and especially if they would just
trust the baby when s/he *first* shows signs of needing more milk, the
"growth spurts" would not be such obvious things, and we would see far fewer
babies who show low gain or FTT.

A few days ago one of the ultra-baby-friendly paeds sent me a baby who had
only gained 450g over her birthweight by the six-week check-up.  The baby
had weighed 4350g at birth and so she still looked great, and seemed very
"content" and undemanding.  Without the weight check probably no-one would
have been the wiser, and it might have seemed that this baby was growing
into her weight.  However, the birth photos showed that she had looked like
a little Sumo wrestler and the paed was concerned that something was going
on.  In order to illustrate his point he told me that he had seen seen one
baby that week who had gained 3 kg by six weeks, and five more who had
gained well over 2 kg, and all were exclusively breastfed. Because he is
seeing so many really disgustingly thriving breastfed babies these days he
is starting to believe that the general guideline we have always worked to,
of an expected gain of about 180 - 200g per week, needs to be revised
upwards - his observation is that when they are doing well, healthy
breastfed babies gain at a much faster rate than this.  I know this is going
to set the cat amongst the pigeons with all of you, but I really have to
agree.

For the low gain baby it turned out that around Christmas time the growth
spurts (faltering milk supply?) had been ignored.   Mom had been persuaded
by older family members to give the baby a dummy and try to get her to go
longer between "feeds".   Although she had been breastfeeding more often and
for longer times in her first couple of weeks (4400g at 10 days) mom was
proud that now she was only breastfeeding at 3 - 4 hourly intervals and
sleeping 8 hours at night.  Predictable with hindsight.  Consistent with
Heather's scepticism.

Pamela Morrison IBCLC, Zimbabwe
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