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Subject:
From:
Kay Anderson <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 24 Jun 2018 14:35:56 -0500
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Below is a screen shot from Who, Combined course on growth assessment and IYCF counseling, Geneva, WHO, 2012.
This document is a lengthy educational tool for developing countries to teach nutrition. 
IYCF stands for Infant and Young Child Feeding. 
I’ve used parts of this manual for parent and healthcare worker educational workshops in Tanzania and Honduras. 

Here is the description provided for the chart:
"Each column represents the total energy needed at that age (in kcal/day). The columns become taller to indicate that more energy is needed as the child becomes older, bigger and more active. The dark part shows how much of this energy is supplied by breastmilk.
From ~6mo onwards, there is a gap between the total energy needs and the energy provided by breastmilk. The gap increases as the child gets bigger. Therefore, for most babies, 6 mo of age is good time to start complementary foods." 

Other information that I gather from this chart is as follows:
Assuming breastmilk is 20cal/oz,
A 0-2mo old needs about 20cals/oz x 24oz/day = ~480 cals/day
A 3-5mo old needs about 20cals/oz x 28oz/day = ~560 cals/day
A 6-8mo old needs about 20cals/oz x 24oz/day = ~480 cals/day
A 9-11mo old needs about 20cals/oz x 21oz/day = ~420 cals/day
A 12-23mo old needs about 20cals/oz x 18oz/day = ~360 cals/day

If you want to use the expertise of the World Health Organization, who deals with malnutrition globally, here is your source!

Somewhere along the line in my 30 years of pediatric care, I came up with the following guidelines, which fortunately match up with the above pretty closely. I use increments of 8oz, since most parents think in terms of 1 cup = 8oz.
Within the first few weeks most term babies need about 24oz/day. 
Somewhere around 1-2months most peak at 32oz/day, which is where they stay through 6 months of age.
At 6months, solids are added, including more sources of Ca++ and protein, so milk intake can back off to 24oz/day and then 20oz/day.
By 1 year, other protein sources are well accepted in the diet, so milk intake can drop to 16oz/day +, where it should stay, as a source of Ca++.

Of course exclusively nursing mothers can’t measure the volumes, but I think most can get a general idea based on occasional pumpings and bottles. 

Hope this helps!

Kay Anderson, MD, IBCLC (prior RN) 
Pediatrician, Nebraska


> On Jun 24, 2018, at 9:09 AM, Laurie Wheeler <[log in to unmask]> wrote:
> 
> If I was counseling this mother I would take it from more of what she is
> feeling type of approach. There is no way to counter with exactly what a
> ten-month-old would need and how many feedings. So you could say something
> like "yes I've seen charts with various feeding amounts anywhere from 16 to
> 32 oz in X number of feedings." And you could also say "the pediatrician is
> probably expecting you will have your baby weaned exactly at 12 months
> old."  What are your thoughts and plans around continuing to nurse versus
> weaning over the next 6 months for example." And validating that she knows
> her baby better than anyone.
> Laurie Wheeler RN MN IBCLC
> Gulf Coast USA
> 
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