Star wrote:

Do you know how many feeds this baby  
had per 24 hours? Also, in your opinion how many ounces or cc's  
should a 5 month old baby consume in 24 hours and what references are  
you using?

Star, I welcome your questions.  This particular baby ate 9 times in this 24
hour period.  Mom told me that this is a typical day for her.  The baby
usually feeds about every 
2 1/2 to 3 hours, day and night.

I think that it is very important for lactation consultants to have a gauge
for milk supply volume.  Since most of the mothers I work with understand
ozs better than kgs, I use the requirement of 2.5 oz/lb/24 hour day.  (This
translates to 90-120 kcal/kg/24 hours.)  Biancuzzo and others have reported
that this is an appropriate intake for normal,  healthy babies under 4
months of age.  I am not aware of specific guidelines for babies over 4
months of age.  If anyone has research on this, please share.  My
understanding is, and my experience has shown, that babies between 4 and 6
months require fewer calories per lb (or kg) of body weight.  However, it
would be unlikely that the 5 or 6 month old would require fewer total
calories (and therefore total volume of milk) than the 4 month old.  I have
also noticed that the required proportional caloric (and milk volume) intake
seems to decrease when the baby reaches 12 lbs, pretty much regardless of
age.

For example, the baby I was describing had a birth weight of 7 lbs, 8 ozs.
Multiply that by 2.5 oz/lb and it is likely that (after the first few days
of colostrum) he would consume approximately 18.75 oz/24 hours.  I have
noticed that when a baby eats the appropriate amount he usually gains weight
steadily at approximately 1-2 oz per day in the first 4-6 weeks and then
somewhere around .5-1 oz per day thereafter.

At 5 months of age, this baby weighed 12 lbs.  Multiply that by 2.5 oz/lb
and I would estimate that this baby should require approximately 30 ozs/day
to show a weight gain.

On day 2 of working with this family, I instructed mom to do triple feedings
- breastfeed, supplement and pump.  She used previously stored breastmilk
from her freezer as well as some of her freshly pumped milk as a supplement.
In addition to the 20 oz that he breastfed again on day 2, she supplemented
with 7 extra ounces.  In 24 hours, the baby gained 3 ounces!  It was very
clear to me that the baby's intake was the reason for the inadequate weight
gain during the last month.


============================================
Ellen A. Steinberg, RN, LCCE, IBCLC
Tarzana, CA





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