Hi Laurie,
I try to get the moms to get up to the 32-36 oz a day as quickly as they
can.  Research on milk intake by bf infants (lots of it done by Neifert
and Neville, with others) shows that they pretty rapidly reach peak
intake, and that almost all babies take less than a quart a day at peak.
 The baby with the highest intake in Neville et al's studies took 40oz a
day.

In my own practice, one little girl with a congenital heart defect grew
and thrived on 12-13 oz ebm a day as her sole food intake when she was
5-6 mos old.  (Exactly opposite to what we were taught, huh?)  I've had
other kids take 28 oz daily.  There seems to be a wide range of normal,
but I want mom to calibrate high because research shows that moms
exclusively pumping for premies with the best supplies by 2 weeks were
better able to sustain long term supplies.  (Sorry, don't have the
citation for this, it was one of the research presentations at the ILCA
conf in Washington DC about 4 years ago.)  Now of course there could be
confounders here, but it has not failed me as a guideline for mothers
wishing to exclusively pump.

As for calorie content, it is more a factor of babies whose moms have
lower supplies bf more often that increases their average fat content.
 Infant weight gain is more dependent on volume than calorie density or
fat percentage, in fact in another recent study (somewhat deceptively
entitled "effect of sucking characteristics on breastmilk creamatocrit"
Paediatric and Perinatal Epidemiology 2002, 16, 355–360.  The only
sucking characteristics they studied was duration and volume taken, but
you can see how the title got my attention!) the moms with the lowest
creamatocrits had the kids with the greatest milk intake and the
greatest weight gains (75%ile vs 25%ile for those with higher
creamatocrits/lower volumes).  (In this study, they momentarily
interrupted bf every few mins to take a one drop sample for
creamatocrit.)  This agrees with Peter Hartmann's work.  So I think we
can reinterpret Woolridge's ideas in light of this and not worry about
the fat content of milk, as long as baby is getting enough volume.
 Since mom is giving pumped milk which becomes mixed together in the
bottle, lactose overload does not seem to happen.
Catherine Watson Genna, BS, IBCLC   NYC

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