Kathy Catone:
I was going to e mail you privately but I thought the group would benefit
from the information.
 You ask :  >>But, do we know exactly when/how the fat content begins to be
accessed?
 I have been asked this a million different times by moms, and when I decided
I'd better make sure of my facts, I found several different 'facts'.  :-) ! I
can't recall which resource, but remember one said the hind milk begins very
quickly = like within a few minutes.  So, how does this relate to Overactive
Let-down Syndrome?<<

We are up to about 1000 cases of overactive let-down (overfeeding) syndrome
in the clinic now.  95 percent of the colic cases we see are the result of
overfeeding. 3 percent are related to food allergies the remaining 2  percent
are other causes including: colicky mothers and unknowns.
Most of our hypothesis comes from visual observation and a few educated
guesses. So I hope I'm not going way out on a limb here.

1. I believe that we have to find another name for this. In most cases the
*force* of the let-down is only a small part of the overall syndrome.

2. Almost all of our cases are iatrogenic -- mothers doing everything the
books told them to do to increase supply.

3. If foremilk is what is produced in the breasts between feedings then some
women with a greater *storage capacity* will have higher amounts of foremilk
in the breast before the hindmilk appears.
We have tested this hypothesis with our overactives using a double pumping
set-up- pumping off one ounce at a time (with the pump still running--we
change bottles after each ounce). We have had women with as much as 6 to 8 oz
of foremilk before the change to hindmilk occurs. Their infants were among
the group with the worst *Colic* symptoms and huge weight gains (often 2
pounds per week).
So as far as deciding when  * the fat content begins to be accessed* I would
say that it is highly individualized.

4. If a baby fills up on high volume low fat calorie foremilk eventually we
see mother's supply dwindle and baby loosing weight.

5. According to Woolridge when the fat portion remains in the breast after
feeding-- it is reasorbed, leading to less and less fat production.

Thus the point I was trying to make about pre and post feed weights was that
they only measure volume. Not the quality of the feeding or the quantity of
fat intake.

In addition you write >> If I'm dealing with a very plump baby, with tons of
output (diapers), etc, then I rarely do a post feed weigh. For me, the pre &
post feed wts.are crucial if I'm dealing with a baby whose intake I'm not
sure of (FTT, etc), or if I'm trying to evaluate the effectiveness of the
infant's suck, usually in these situations it's confirming what my clinical
skills have already told me.  I'm not worried at this point about whether
they are getting fore or hind milk, just any milk at all!<<

I agree. Where I have the problem is when clinicians begin to rely on a
device such as a scale to say everything is OK. I especially have problems
understanding why a lactation consultant would recommend the rental of an
expensive baby scale so the mother can do pre and post feed weights at home
(unless mother has premature where intake is critical and ususally if its
that critical, the baby is still in the hospital anyway.)

Just my humble opinion.
Marie Davis