Dear all:

I haven't attended an IBCLC conference in a couple of years because air fare is expensive 
and the economy is tight.  So, I don't consider myself especially up to date.  Cathy Genna 
posted something on Lactnet that was at least a year ago giving at least four references 
for the fact that the fat content doesn't matter, it is the volume of milk that influences 
growth. I remember one study in particular in Africa where the mothers with the lowest 
fat content had the babies that grew the fastest because their babies were drinking a 
greater volume of milk.  Now, I think if I had enough time to really explore that article, 
the actual difference in fat content may not have been biologically important.  Just 
because something is statistically significant, doesn't mean it is of biological importance. 

The knowledge that the fat content is a continuum has been around since I started taking 
infant and young child nutrition classes in the 1980s.  

And I don't see anything that really is NEW in these discussions.  We've always know that 
infants and mothers vary.  Therefore, you cannot apply "rules" such as x amount of time 
on a breast or "always/never switch breasts".  

You can apply general parameters to keep an eye on things.  A baby that feeds for 2 
hours and only takes a 15 minute break to return to eating again --- is a baby that you 
might want to keep an eye on.  A baby that eats 4 times a day for 10 minutes each time 
is also a baby that you might want to keep an eye on.  

But --- to make one standard rule based on time makes no sense.  The more important 
information is how the baby is swallowing and behaving.  Mothers should be assisted to 
start honing their observations skills (which are usually better than they or anyone else 
thinks they are) and to use these skills to develop a relationship in which they and their 
babies respond appropriately to each other and INTERACT. 

In my small little corner of the planet, mothers describe when their babies are not 
swallowing as "using me like a pacifier".  Invariably I find that they really do spot when 
the baby is "no longer swallowing while sucking".  This can be used to reinforce that the 
mother has good observational skills and to then, depending upon the baby help her judge 
what her response will be.  

Best, Susan Burger 

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