The Lancet 1979 "Pattern of Milk Flow in Breast-Fed Infants" by A.Lucas,JD Baum and P.J. Lucas:July 14,1979 122 six day old infants were test weighed during breastfeeding.Milk flow conformed to a definite pattern: a mean of 50% of the feed from each breast was taken in the first 2 minutes of sucking and a mean of 80-90% was taken by four minutes.The second half of a 10 minute feed from eighter breast was almost non-nutritive.Preliminary studies suggest that the pattern is the same after ONE month of lactation. You can see from the above that there are some problems with the method of study..."Cross-sectional data were built up in the following manner.Infants were weighed before the feed and at either TWO minutes(n=20),four minutes (n=13),or seven minutes (n=12) after the beginning of the feed. 3 other groups were wighed at the same times during feeding on the second breast.Another was wighed before the start of the feed on the first breast,again during the change over to the second side,and finally after the end of the feed on the second breast N=33. In the 7 groups studied the infants' sex ratio 62M / 60 F,birth-weight (overall mean 3368 grams),and distribution of maternal palrity was similar--overall primipara/multipara 2/1 ratio. My question is:who ended the feeding?baby or mom?and how was the feeding determined to be over,after babe fell asleep(and when the test-weighing person left babe woke up to finish the feeding maybe) or at the pre-determined time of 10 minutes??? "our observations are supported by videotape studies in this department(M.W.Woolridge and R.F. Drewett) which show that the pattern of suckling ina group of breast-fed infants changes after four minutes' feeding froma predominance of short suck-to-suck intervals to a substantial proportion of long intervals between bursts of sucking.This independently suggests that there is a major physiological change in a feed at about four minutes which might relate toa change in milk composition or flow or both." "It should not be assumed,for example,that mothers are underfeeding their infants if they elect to feed them for periods of time shorter than is recommended by the obstetric unit." This was a 2 page(barely) write up of the study which I have saved since working in Alabama where in 1988 women were instructed by their pre-printed(formula company authors)Md's instructions to scrub breasts with BETADINE prior to each feed and where there was no electric breast pump until I repeatedly questioned the powers that were,the rest is history.We got the OB's to write their OWN instructions up-to-date,but the 4 minute breast is empty feeding is complete rule in the Peds remained printed by the formula companies til the day we moved to Indiana in 1991....I haven't checked on that but the instructions were horrendous:"3 minutes per side for the first day,4 minutes per side on day 2 etc,etc (I have copies I think,if anyone would like some historical fiction) Denise Ferrell, I guess this didn't really help the problem. But the methodology has a lot to be improved upon. Requests for reprints should be addressed to A.L.