I basically agree with Joy's comments on all this: will repeat the post she
sent and add a few notes: mine are in square brackets.

Date:    Tue, 9 Apr 1996 13:55:37 +0800
From:    Joy Anderson <[log in to unmask]>
Subject: Re: Hartmann on baby's intake

Lisa wrote:
>Yes, babies *do* increase their volume of intake. In fact, I believe that
>there are also studies of how mother's supplies increase to a peak around 6
>months, then plateau, then gradually decline as solids are introduced and
>begin to replace the milk.

Lisa, I always thought this too, but now I am wondering. Do you know of any
specific studies that show this? [I don't. I've read a lot of company-based
asserions but no proof. In fact the only studies I know of suggest that
AVERAGE intake at 4 months (750ml) is unchanged from one month in the
exclusively breastfed infant, while the formula fed infant goes from 750ml
at one month to 950ml at 4 months. I noteded these findings in an old
JHL,1986 I think: Nutrient needs of infants: latest findings was the title.
However, it is crucial to state that averages are just that. There will be
some babies in that time frame who go from more milk to less (oversupply to
adequate), others who go from less to more (under-supply to adequate or
even oversupply briefly), and some who maintain the same average intake:
for a huge variety of clinical and physiological reasons including patterns
of feeding, efficiency of suckling, maternal breast function, and the rest.
Studies that talk of averages don't explain individual variation, and
Hartmann shows that some babies get over a litre while others are fine on
500mls.]

 >It makes perfect sense to me! We know that a 6 lb baby is going to need
less milk than a 12 lb baby.

Do we? We do know that a larger, over-one-year-old toddler needs less
calories than a fast-growing under-one-year-old. So could it be that the
fast-growing 6 lb baby needs as much as the 12 lb one? I don't know - but
it's possible. [Amen. And what caloric density is the milk we are talking
about? We have the Drewett/ Woolridge studies from way back showing that
infants drinking high fat milk take less by volume and those on low-fat
more. SO is the mother a Jersey or Friesian? And does the baby need lots
more fat in the period of rapid brain growth, more protein in the second
year, and does the breast deliver that?...]

>Also: it has been noted by some that Australian women complain more of
>"oversupply" problems while north American women complain more about
>"undersupply"; could this observation, which we have loosely tied to opposite
>hemispheres, be true more for one half of the world than the other? We need
>more research on these variations!

I have always thought that this may be more to do with general management
of early breastfeeding in the slightly different cultural settings. Things
like more common routine supplementation in US, more restricted feeding in
first few days, etc. Am I right in thinking that this goes on a lot in US?
It happens here too, but not as much, as far as I know. [Amen, alleluia. It
is not a genetic variant between north and south of the equator, and can be
readily altered, as can be witnessed by those of us who suffered through
the damage done by mid 1980's recommendations in hospital to feed "one side
only" : within a week the mothers who had been complaining of miserable
crying overfed babies were complaining of miserable crying underfed babies.
"Finish the first side first and offer" the other rapidly became routine.]

Arly wrote:
>I don't get it.  The baby is bigger, but doesn't take in more kcal?  The
>baby is more active, but doesn't take in more kcal? Is there supposed to
>be something different about babies than other people?

I am glad some of you are questioning this, as I did. In general, though,
bigger people don't necessarily eat more food. A lot depends on their
metabolism, whether they are growing quickly, etc. You know, the sort of
person who gets fat at the whiff of a cream cake, compared to those who can
"eat like a horse" and never put on weight, and the skinny teenagers who
seem to have hollow legs!! [Yes indeedy,  and remember all those young baby
loose sloppy stools which were excess nutrients disappearing down the
toilet: we need to consider changes not only in input, but in output and
throughput, in metabolic efficiency, in caloric density (stronger feeder->
higher fat content?). Then there's the faster rate of growth birth to four
months and the deceleration from then on, with the change in type of growth
over the first and second year.And then for the individual baby there are
other possible extraneous nutritional demands such as early eczema
clearing; early crying settling....Food is the fuel of more than growth,
after all.]

Anyway, the data Peter showed just had me puzzled, and being the
questioning sort, I would like to know what actually *is* happening.[ That
we don't know and can't without many more careful studies such as his and
other medical scientists. And what we know in general is not always true of
the individual, to repeat myself ad nauseam.]

Do babies stimulate an increase in milk supply at "appetite increases" or
"growth spurts" (as we have always believed) or is something else going on.
Peter's data implies the latter.

[The something else might not be to so with volume of intake at all, it
might be a need to raise steadily declining basal prolactin levels to the
particular individual's optimal production level (again hugely variable
between women and within the one woman over time.) I don't know, but we can
speculate about the meaning of the behaviour endlessly. Fact is, that's
what many babies all over the world do, and maybe they're the ones who are
going from less to more milk.]

Don't you just love puzzles??!! (:-D) [Yes, and we all need to keep in
touch with the scientists (as distinct from the doctors) via books such as
the superb Human Lactation Series and by subscribing to the newsletter of
the Mammary Gland and Cell Biology group/International Society for Human
Milk Research. I hope to find they're developing a web page.]

Joy Anderson IBCLC, NMAA Breastfeeding Counsellor,
 and Maureen Minchin, inveterate speculator about breastmilk and
breastfeeding, lurking in square brackets because I don't need to repeat
what Joy has said so well.

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