From LLLI’s Breastfeeding Answer Book 2003:

 

If a baby has not regained birth weight within 10 to 14 days after birth, or
when baby’s weight gain is less than 4-5 ounces/113-142 grams per week (or
1-1.5 pounds/454-681 grams per month) in the first 3-4 months, supplements
may be recommended.  If the baby is healthy, responsive and alert, but
gaining less than the average of 6 ounces/170 grams per week, improved
breastfeeding management may increase weight gain without supplementation.

 

If a baby is gaining 3 ounces/85 grams per week, 2 ounces/60 ml of pumped
breastmilk and/or formula after 2 or 3 feedings in 24 hours might be
recommended.  If the baby is gaining less than 3 ounces/85 grams per week, 2
ounces/60 ml of pumped breastmilk and/or formula after 4 or 5 feedings in 24
hours might be recommended.

 

Offer supplements more frequently in smaller quantities rather than once or
twice a day in large quantities to prevent the baby from becoming overly
full and skipping a nursing.

 

Set appropriate goals for decreasing the supplement while increasing
nursing:  “8 ounces/240 ml of supplement in 24 hours this week, 6-7
ounces/180-210 ml in 24 hours next week, with a target weight gain of at
least 4 ounces/113 grams per week.

Published online March 1, 2006  - full text at
http://pediatrics.aappublications.org/cgi/content/full/117/3/e387
PEDIATRICS Vol. 117 No. 3 March 2006, pp. e387-e395
(doi:10.1542/peds.2005-1417) 

	

Volume and Frequency of Breastfeedings and Fat Content of Breast Milk
Throughout the Day 

Jacqueline C. Kent, PhDa, Leon R. Mitoulas, PhDa, Mark D. Cregan, PhDa,
Donna T. Ramsay, PhDa, Dorota A. Doherty, PhDb,c and Peter E. Hartmann, PhDa

 

OBJECTIVE. We aimed to provide information that can be used as a guide to
clinicians when advising breastfeeding mothers on normal lactation with
regard to the frequency and volume of breastfeedings and the fat content of
breast milk. 

METHODS. Mothers (71) of infants who were 1 to 6 months of age and
exclusively breastfeeding on demand test-weighed their infants before and
after every breastfeeding from each breast for 24 to 26 hours and collected
small milk samples from each breast each time the infant was weighed. 

RESULTS. Infants breastfed 11 ± 3 times in 24 hours (range: 6–18), and a
breastfeeding was 76.0 ± 12.6 g (range: 0–240 g), which was 67.3 ± 7.8%
(range: 0–100%) of the volume of milk that was available in the breast at
the beginning of the breastfeeding. Left and right breasts rarely produced
the same volume of milk. The volume of milk consumed by the infant at each
breastfeeding depended on whether the breast that was being suckled was the
more or less productive breast, whether the breastfeeding was unpaired, or
whether it was the first or second breast of paired breastfeedings; the time
of day; and whether the infant breastfed during the night or not. Night
breastfeedings were common and made an important contribution to the total
milk intake. The fat content of the milk was 41.1 ± 7.8 g/L (range:
22.3–61.6 g/L) and was independent of breastfeeding frequency. There was no
relationship between the number of breastfeedings per day and the 24-hour
milk production of the mothers. 

CONCLUSIONS. Breastfed infants should be encouraged to feed on demand, day
and night, rather than conform to an average that may not be appropriate for
the mother-infant dyad.

 


New Study Finds Hospital Practices Strongly Impact Breastfeeding Rates
Friday, 20 March 2009 


Objectives. We sought to assess whether breastfeeding-related hospital
practices reported by mothers were associated with achievement of their
intentions to exclusively breastfeed. 

Methods. We used data from Listening to Mothers II, a nationally
representative survey of 1573 mothers who had given birth in a hospital to a
singleton in 2005. Mothers were asked retrospectively about their
breastfeeding intention, infant feeding at 1 week, and 7 hospital practices.


Results. Primiparas reported a substantial difference between their
intention to exclusively breastfeed (70%) and this practice at 1 week (50%).
They also reported hospital practices that conflicted with the Baby-Friendly
Ten Steps, including supplementation (49%) and pacifier use (45%).
Primiparas who delivered in hospitals that practiced 6 or 7 of the steps
were 6 times more likely for achieve their intention to exclusively
breastfeed than were those in hospitals that practiced none or 1 of the
steps.Mothers who reported supplemental feedings for their infant were less
likely to achieve their intention to exclusively breastfeed: primiparas
(adjusted odds ratio [AOR]=4.4; 95% confidence interval [CI]=2.1, 9.3);
multiparas (AOR=8.8; 95% CI=4.4, 17.6). 

Conclusions. Hospitals should implement policies that support breastfeeding
with particular attention to eliminating supplementation of healthy
newborns.

Hospital practices such as supplementing newborns with formula or water or
giving them pacifiers, significantly reduce the chances that mothers who
intend to exclusively breastfeed will achieve that intention, according to a
new study led by a BU School of Public Health researcher. 

In the  <http://www.ajph.org/cgi/reprint/AJPH.2008.135236v1> study, which
appears online March 19 in the American Journal of Public Health, a research
team led by
<http://sph.bu.edu/index.php?option=com_sphdir&id=239&Itemid=340&INDEX=595>
Eugene Declercq, professor of Maternal and Child Health, found a significant
drop-off between the numbers of mothers who intend to exclusively
breastfeed, and those who fulfill that intention one week after giving
birth. Among first-time mothers, 70 percent reported an intention to
exclusively breastfeed, but only 50 percent achieved that goal at one week. 

The study found that hospital practices were strongly related to those
outcomes. Specifically, the practice of hospital staff providing formula or
water to supplement breastfeeding was significantly related to the failure
to achieve exclusive breastfeeding.  Mothers whose infants were not offered
supplementation were far more likely to achieve their intention to
breastfeed -- 4.4 times more likely among primiparas (first-time mothers),
and 8.8 times more likely among multiparas. 

Other hospital practices also influenced outcomes. First-time mothers who
delivered in hospitals that practiced at least six out of seven recommended
steps to encourage breastfeeding -- such as helping mothers get started and
not giving babies pacifiers -- were six times more likely to fulfill their
intention to exclusively breastfeed than mothers who reported experiencing
one or none of these practices. 

"Very often, research studies yield conclusions that don't translate easily
into changes in practice or policy," Declercq said. "In this case, the
message is loud and clear -- hospital practices can make a difference in
early breastfeeding success and in particular, every effort should be made
to avoid supplementation of healthy babies of mothers who intended to
exclusively breastfeed."  The study's findings indicate that many hospitals
routinely employ practices that discourage mothers from exclusively
breastfeeding, despite large-scale programs, such as the "Baby-Friendly
Hospital Initiative" launched by the World Health Organization and UNICEF,
to encourage breastfeeding. 

About half (49 percent) of first-time mothers who intended to exclusively
breastfeed reported that their babies were given water or formula for
supplementation, while 74 percent reported being given free formula samples
or offers. 

The authors said the difference between "intention and practice" among women
who intend to exclusively breastfeed represents "a huge lost opportunity to
encourage and support breastfeeding in the United States." They said the
study data suggests that nationwide, more than 400,000 infants a year born
to mothers who intended to exclusively breastfeed were instead not
benefiting from that option. 

The authors cited recommendations from the American Academy of Pediatrics
and other medical organizations that infants consume only mother's milk for
at least the first six months of life. 

The study analyzed data from Listening to Mothers II, a nationally
representative survey of 1,573 mothers who had given birth in a hospital to
a single infant in 2005. Mothers were asked retrospectively about their
breastfeeding intentions, infant feeding practices at one week, and hospital
practices. 

The study was supported by the Robert Wood Johnson Foundation Investigator
Award in Health Policy Research and Childbirth Connection.  Other authors
were: Miriam Labbok, MD, School of Public Health, University of North
Carolina at Chapel Hill; Carol Sakala, PhD, Childbirth Connections; and
MaryAnn O'Hara, MD, University of Washington. 

The study will be published in the May print edition of the American Journal
of Public Health. 

 


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