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Lactation Information and Discussion <[log in to unmask]>
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Thu, 11 Jul 2013 09:44:48 -0500
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This particular test that is mentioned is not very useful for measuring an infant's intake at the breast IMHO.  IT is, however, a useful tool for moms who are pumping only for NICU babies who are struggling with milk supply.  There is more to this test than the 4 hour test mentioned.  I have used it for these moms, having them do the test two days in a row, also recording other pumps and the longest interval at night and volumes pumped after that interval.  This can be useful in showing moms how their volumes can be related to frequency not just duration of pumping.  Often, I've seen an increase in production as mothers begin to understand how breast storage capacity inter-relates with pumping frequency to dictate total production and they become more conscientious about what they are doing to influence supply.  And it's possible that the 4 in a row stimulation mimics a baby on a cluster feed which stimulates supply.  This tool, IMHO, is not for use for moms with babies at breast.  It is an attempt to help a less than best situation where a mom is pump dependent.  

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of vgthorley
Sent: Thursday, July 11, 2013 2:36 AM
Subject: Re: Pumps are not a complete test of milk production

Great post, Nina. I tell parents that numbers aren't the key thing, but observing theitr baby is - and that if I gave a figures, it would show that I didn't really know anything. Sure I can keep in mind a range. but not dictate what THAT baby "should" take at THAT feed.

I explain:  How does a mother know that her baby is getting enough? Observations, including growth, not numbers.  How does a a mother whose baby is bottle-fed some or all of the time know if s/he is getting enough?  Exactly the same, i.e. it should be based on the well-being and growth of her baby, not mere numbers that don't take into account individual variation.  If what is in the bottle is an artificial mixture made up from powder, she doesn't really know what is in the bottle, numerous studies having shown variation in making up the same recipe. If the mother is breastfeeding, yes, feeds will not be uniform, but in normal circumstances her body will interact with her baby and adjust the fat content and volume through the 24 hours (provided there is unrestricted access to the breast and a vigorous infant, and ruling out less usual maternal physical or endocrine anomalies).
Yes, I hear what other posts have said about the test that was cited, but my concern is that it is open to misinterpretation, and may not applied appropriately. If used, it would need to be part of other observations. I also acknowledge some posts have wondered what is being done about Rule 1 (Feeding the Baby) during the four hours of the test.

Virginia Thorley, OAM, PhD, IBCLC, FILCA Brisbane, Australia.

Nina Berry wrote, on the question of the 4-hour pumping test:
"Won't tell you anything about an infant's intake, though - and I would have thought that intake has a much more direct bearing on whether or not an infant thrives. 
Surely the issue is enough intake or not enough.  Since we don't actually have any good evidence of what number constitutes enough for any given infant (given there is such a wide range of volumes upon which infants have been observed to thrive), we have to use the clinical signs to determine whether any given baby is consuming enough.  The number that corresponds with enough for one infant may well be not enough for another.  Numbers, in this case, are a distraction and could well become a hindrance."
Nina Berry PhD
Australia

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