The oldest article in my files dealing with this is: "Human milk intake and
growth in exclusively breast-fed infants" Journal of Pediatrics 104:187,
1984, Butte et. al.  There was also a commentary on this article in JHL
2(3) [don't have the date] by Maureen Minchin entitled "Nutrient Needs of
Infants:  Newest Findings."  The Peds article found that the calorie needs
of breastfed infants were way lower than had been assumed (the assumption
having been that they were the same as artificially-fed infants, which is
easily studied) and that the intake of breastmilk increased only slightly
from 1 to 4 months.  Any study I've read since seems to echo this finding,
Peter Hartmann's included.

So for years I've been giving advice based on this assumption.  I tell
working moms that whatever amount they're pumping and feeding when they
return to work is about what baby is going to be taking until he starts on
solids; that they are not going to have to pump greater and greater
amounts.  I tell them to never expect that baby is going to take 8 oz.
bottles like the formula-fed kids, and that they don't WANT him to take
large amounts.  I explain that their baby needs a certain amount of
calories in 24 hrs., and in order to keep producing enough milk they need
to spread it over the 24 hrs.--the baby might be able to adjust to taking
most of his calories during the day when mom is at work, but her body
won't.

<<Then why is it that a mother who is pumping for her baby while she is
employed must leave more and more milk in the bottles?  Is this happening
because someone believes it should happen?  Or is it all so different when
it doesn't come from the breast?>>  I think both.  Most people (especially
daycare providers) *expect* babies to take more milk as they grow, unless
they're told different, and babies are usually happy to oblige.  And at the
breast the milk comes fast in the beginning but baby can nurse for a long
period and still get "driblets"--can't do that with a bottle.  When babies
are "needing" more than mom can pump, they sometimes do just fine with less
in a bottle that gives them more time to suck (I usually suggest they try
an Avent newborn).

<<And what of that formula of 2.5 times the infant's weight as a guide for
how much milk to leave?>>  Personally, I only use that formula (and the 118
cal./kg./day tables) to give guidelines for the first couple weeks of life.
 Which is also why I've never used that nice tear-off sheet on pumping that
Medela has--the amounts are way off from what the research and my
experience indicates.  ***Hint, hint--how about a revision, Pat Bull?***

I think one of the biggest reasons so many working moms "lose" their milk
at 3-4 months is because that's when so many babies start sleeping longer
periods at night.  When I was primarily a LLL Leader I remember lots of
calls from stay-at-home moms whose babies at that age were now "eating all
the time."  When we'd chat we'd figure out that the number of feeds in 24
hrs. was usually about the same, it just seemed like "all the time" because
the feeds were closer together during the daytime because baby was sleeping
a longer time at night.  Working moms whose babies cut out the nighttime
feedings have no way to increase the number of daytime feeds because that's
when they're separated.   And for chronically-fatigued working moms,
encouraging baby to cut out the nighttime feeds is often a priority.

Becky Krumwiede, RN, IBCLC, Appleton, WI  (Hospital practice & Sanvita)
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