Jan asks
> then how can a 15 pound
> baby continue to grow appropriately on 850 ml/day (which is approximately 28
> ounces) -- about enough according to the calculations we use of
> 2.5ounces/pound of body weight/day to support an 11 pound baby.

Really important to try to look outside the normal conventionally accepted
views to look for an answer for these questions. We have two variables here
both the baby and the milk. So far, we have only discussed the milk intake.
We can then look at the baby - The following is supposition only, as an
example: One baby may metabolise milk quite differently from another. Just
as adults appear too - some are long skinny people who eat their hearts out
and others just have to look at a piece of food to put on weight - when do
these differences begin?. This may account for the Michelen type breastfed
babies (with all the fat rolls) who only feed 6 times a day - (although my
daughter was one of these and now she's skinny as hell like all my side of
the family!) 

We can then look at the milk (which we have all been doing so far) Although
the AVERAGE milk intake from 1-6 months is 800mls there is a large variation
or standard error (from something like 500 - 1300mls). As with all things a
lot of people fit into the average but others still truck along quite well
out there on the edges.

And then there are both variables working together that we need to consider.
Does the mother's body know something about the baby she is growing inside
her? Are there some triggers that tell the body what sort of personalised
milk this baby will require? And does the body get it wrong sometimes? (like
it can do with anything).

On the subject of Fat (and energy)
>The only way this could be tested for would be to feed the babies in
>the study on expressed breastmilk only, which had previously been
>tested for fat, protein or energy (what does he mean by energy?

Its always important to question methodology as you have done, but Leon is a
very precise researcher and his methodology is very rigorous, more so than
any of the studies gone before. He determined milk fat content and fatty
acid composition (and total energy) by having mothers (the saints)
collecting fore and hind milk samples from each feed, from each breast over
24 hours periods at 1, 2, 4, 6, 9 and 12 months of lactation (along with vol
intake - total fat for the feed can then be calculated).
Energy is the basic unit that food is converted to. Sources of 'energy" in
breast milk are protein, carbohydrates and fat (fat comprises approximately
only 50% of the energy available to the infant) All breastmilk can be
measured for its energy content. So fat is not the "be all and end all" of
energy intake for the infant, although it obviously comprises half the
intake. 

Perhaps there are other factors in milk (or in the baby) that work in
synergy with available energy that allow babies to utilise it differently at
different ages (Jan - your question).

My interpretation of all this? Let mothers and babies feed according to
instinct (no prescriptive directions about getting hindmilk, feeding one
breast, feeding two breasts etc) - all mother/baby dyads are individual with
an apparent wide range of normal, they'll work out what's right for them
(mostly). When things don¹t go right THEN lets look at what we know and see
how we can apply it to help the situation.

Regards
Cathy Fetherston
Perth Western Australia

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