Jack Newman has said that it's merely a laundry problem *if baby is
thriving*.  In the case out of which this particular thread arose, we don't
know for sure that the baby is thriving, so it may be a problem for the baby
and not just for whoever does the laundry and Jack would agree with that.

Regarding how to advise parents on what normal intake is, there is a large
gray area.  Since it is true as Nikki points out that mothers of thriving
babies vary widely in daily milk production, it is not possible to give
parents an absolute number of ounces or ml for a particular baby.  All we
can do is tell them that the very rough rule of thumb is around fifteen per
cent of body weight per day and you better believe I am glad to live in a
place where the metric system is used because I would go nuts trying to
figure out what fifteen percent of pounds and ounces is.  Then we are also
obliged to tell them that the rule of thumb is derived from average
metabolism of breastmilk *substitute*, by the average baby, and some babies
take a lot less breastmilk and still thrive, while others will ingest much
more and not gain weight.  The bottom line is not whether they managed to
get the requisite amount into the baby, it is whether the baby starts to
thrive.  This is an important point.

When I am devising a plan with a family for the time between one appointment
and the next at our breastfeeding problem clinic, I strive to be accurately
vague about the amount baby should be taking, and to relate it to our goal.
It is well to note that we only talk about amounts in cases where baby is
getting some or all of its milk by alternate means and not directly from the
breast; if baby is capable of taking all food at the breast it's rarely a
weight gain problem.  It may come out as 'parents advised to aim for
*approximately* 500 ml per 24 hours, and we will be expecting a gain over
the next three days of at least 60 grams'.   I spend at least as much time
reviewing what hunger cues look like and that it is *just fine* to respond
to them no matter how often they are shown, as well as signs of possible
poor intake, especially reduced output of stools and urine, and
listlessness, and more than one between-feed interval of more than four
hours in any 24 hour period.  It never ceases to amaze me how well babies
gain when they start taking most of their nutrition at the breast, even when
the supposedly objective means of measuring intake are not reassuring at
all.  I've also seen babies gain impressively, complete with peeing and
pooping copiously, on half the amount of breastmilk they should need
according to the tables.  I scarcely need to mention that this approach
presumes frequent contact, at least twice a week, until we see that the baby
is doing fine.

Lately I also have to remind myself that most people don't ever need this
much scary information.  I don't have any trouble understanding how a plan
like this requires the possibility of frequent follow up in order for the
baby to be safe (and the LC to sleep well at night!).  In a place where I
could not offer such care, where I didn't know that people would come back I
think I would get more black and white and bombastic about amounts too.

Rachel Myr
Kristiansand, Norway

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