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From:
Ellen Steinberg <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 6 Feb 2006 14:02:18 -0800
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I'd like to respond to several of the continuing posts on this topic.

Nina - apology accepted.  However, what I guess I didn't state clearly was
that this was a new client - I had never spoken to her before I saw her when
her baby was 5 months old.  She told me that she had been advised by LLL to
increase her milk production by feeding on one breast and pumping on the
other.  I have no idea what the LLL person's credentials were or if she was
a leader.  She may have just been a LLL mom participant.  Of course, I was
completely frustrated that my client was given this information and had
chosen to try it for some time before contacting me.  I immediately told her
to stop this technique and to just FEED THE BABY!

Rachel writes: The reason that milk volume doesn't increase after about 3
months, is that
babies don't grow as fast in their second three months of life as they do in
their first, not to mention what happens in the second 6 months of life, or
the second year.  Look at a growth chart, preferably one that shows
intrauterine growth as well.  The steepness of the slopes of the curves
shows graphically how growth slows down.  The same amount of milk that
supports rapid growth in a newborn, supports normal growth in an older baby,
precisely because we don't need as much food the older we get.

And Diane writes: ...the baby stops pooping at night, he poops less often 
during the day, his super-fast growth slows... all those point to a 
combination of increased efficiency and decreased per-kg need.  And 
then, at the point where he might really need to drive the supply up, he 
starts adding solids instead.  
When we nurse through that first year, we don't get hungrier and hungrier,
we 
don't get thirstier and thirstier, our shirts don't get tighter and 
tighter, we aren't able to pump more and more...  Everything about our 
*own* physiology indicates that things have stabilized.

You are both making an important point.  I frequently have to reassure
mothers who are worried that as their babies get older, the baby seems to be
gaining weight more slowly or the mother's breasts just don't seem to feel
as full.  As for the slowing of the weight gain, I think that both of you
have addressed the issue very well.  And Diane addresses the changing
sensations in the breasts, too.  It is clear to me that older babies need
fewer calories per lb of body weight, just as older children need fewer
calories per lb of body weight as compared with babies.

Joy writes: Milk volumes in the Hartmann labs use the method they have
developed 
and used for many years now where they weigh the mothers (not the 
babies - found to be more accurate) plus do volume calculations on 
the breast using a computer, video camera and stripes projected 
across the breast. They have written it up as a 'computerized breast 
measurement' system and it is very accurate.

Joy, I think then that the answer to my question about whether these
researchers were measuring mom's production capability or baby's actual
consumption is that they were more closely measuring mom's production
capability.  I do not doubt the accuracy of these measurements, especially
since they have been corroborated by several studies.  And I also accept
that milk production capability remains relatively constant from 1-6 months.

What I am still left wondering is whether babies who are larger eat more.  

Betsy writes: I have out my older version (Second Edition)of Riordan and
Auerbach here 
on my lap. It says that if one converts the baby's weight in pounds to 
total ounces, and divides that number by 6, the answer will be the amount 
of milk the baby neds in 24 hours to secure a 4-6 ounce gain in weight per 
week.

Doing this calculation, it appears that this equation gets you approximately
the same result as 2.5 ozs/lb/day.  Riordan and Auerbach as well as The
Breastfeeding Answer Book are quoting these equations in relationship to
breastfeeding even though, as Joy states: the mathematical formula for milk
according to 
weight was originally for calculating formula volumes.  

So if we use either one of these equations based upon being able to
accurately measure consumption volume for abm (easily measured as the abm is
poured into a bottle and then it disappears as the baby consumes it), and we
say that the caloric content per ounce of abm is roughly equivalent to the
caloric content per ounce of breast milk (even though, as Rachel writes: And
babies who are not getting breastmilk need a higher volume, because it costs
them more to digest and burn the food, and not as much of the food is
biologically available to them), it stands to reason that larger babies need
more milk than smaller babies.

Also, the BAB states that most older BF babies need 28-32 ounces a day for
moms exclusively pumping.  So I accept this as a top-end of the range for
healthy, exclusively breastfed or breastmilk-fed babies.  

So, if we use Riordan and Auerbach's equation, an 8 lb baby would require 8
X 16 = 128/6 = 21.3 oz/day.  A 12 lb baby would require 12 X 16 = 192/6 = 32
oz/day.  A 16 lb baby would require 16 X 16 = 256/6 = 42.7 oz/day.  However,
given that the feeding requirements taper off to somewhere between 28-32 oz
per day, it would be likely that this 16 lb baby would probably be eating
about the same amount as when he was 12 lbs.  

The math in the paragraph above makes sense to me.  In fact, I've seen it
consistently corroborated in my practice.  And, I reconcile it with the
studies cited by Joy in that these studies show that the mom's potential
milk production remains relatively stable, even though the baby's actual
intake may increase as he grows - to the point at which he is eating
approximately 32 oz per day.

I apologize for the length of this post, but I thought I would integrate my
responses instead of doing them one at a time.

============================================
Ellen A. Steinberg, RN, LCCE, IBCLC
Tarzana, CA




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