Responding to Date: Wed, 19 Oct 2005 23:22:43 -0400 From: PATRICA A Bucknell <[log in to unmask]> Subject: Nipple Confusion . . . Since Peter Hartmann & his team's research has been published, I have changed what I tell moms about how much breastmilk their baby needs while separated. Hartmann et al say that once a BF baby is 3-4 weeks old, they only need about 24 oz of breastmilk/24 hr to gain and grow through the first 6 months. I just think it is so amazing how our milk can reconfigure itself to meet the age of the baby and so the baby doesn't need more ounces to gain and grow!! . . . *********************************************** Hi Pat, My understanding is a bit different from yours. Maybe I need to update! The top graph on page 82 of 'Nutrition during Lactation' (originally from an article by Neville et al that reviewed 16 studies of milk volume from the 1980s) shows that the mean milk intake of exclusively breastfed babies rises from about 700 to 800 grams per day between 1 month and 6 months. That's abut 23 to 27 ounces, so it's close to your 'about 24 oz,' but it's an *average,* so there will be some babies who need more ounces per day as well as some babies who need fewer. The graph actually shows the mean plus one standard deviation. The babies one SD below the mean varied from about 550 to 650 grams per day over the same time period. The babies above the mean varied from 800 to 900 grams per day. So, looking at milk intake by---what is the mean plus one SD? 90% of the population?-a large majority of the exclusively bf babies, their daily intake could be anywhere from 550-800 at 1 month to 650-900 at six months. I still think '24 ounces a day' is a useful fact-especially since it's easy to remember and understand. I try to stress it when I talk to moms who are worried about milk production. I tell them that the average exclusively breastfeeding mom makes just over an ounce an hour. I intend this to be reassuring to moms who are able to pump 'only' 1-2 ounces at a sitting. Moms with bigger babies probably need to work toward pumping a bit more. You say that the milk changes, 'reconfigures itself to meet the age of the baby.' That's where I'd love to see your sources. Woolridge reports that milk increases in caloric content when suckling is more frequent, but I think this happens because of changes in the suckling pattern/breast drainage pattern, not because of the baby's age. Lactose is pretty constant at 7%. Are there significant changes in protein content between 1 and 6 months? We do know that the baby's gut changes. Klaus and Kennell's forward to Lawrence and Lawrence tells us that the 19 GI hormones released by both mom and baby during suckling cause an increase in the number of intestinal villi, thus giving a greater area of surface to absorb food and making better use of the nutrients ingested. So it's not just about the milk! Perhaps it's the growth in the baby's gut that allows the baby to double his or her birth weight by six months, while the milk supply increases by only about 12 to 18 percent. It's all so amazing, and there's still so much to learn. Cheers, Chris Mulford, RN, IBCLC LLL Leader Reserve working for WIC in New Jersey Co-coordinator, WABA Women & Work Task Force Institute of Medicine, Subcommittee on Nutrition during Lactation, Committee on Nutritional Status during Pregnancy and Lactation (1991) Nutrition during lactation. National Academy Press, Washington. Woolridge MW (1995) "Baby-controlled breastfeeding: biocultural implications. In Stuart-Macadam P & KA Dettwyler, Breastfeeding: biocultural perspectives.Aldine de Gruyter, New York, pp 217-42. Woolridge MW and JD Baum (1991). Infant appetite control and the regulation of breast milk supply. Children's Hospital Quarterly 3:2, 113-119. *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html