Apologies for the hard-to-read post of mine yesterday. I had copied
it from elsewhere on my computer and didn't realise that it wouldn't
come out the same.
I will attempt to re-send with it so it is clearer. I also used the
wrong signature for Lactnet - too tired when I sent it!!
Ellen Steinberg wrote:
>I think that it is very important for lactation consultants to have a gauge
>for milk supply volume. Since most of the mothers I work with understand
>ozs better than kgs, I use the requirement of 2.5 oz/lb/24 hour day. (This
>translates to 90-120 kcal/kg/24 hours.) Biancuzzo and others have reported
>that this is an appropriate intake for normal, healthy babies under 4
>months of age. I am not aware of specific guidelines for babies over 4
>months of age. If anyone has research on this, please share.
Ellen, this is an excerpt from:
Cox D, Owens RA & Hartmann PE, 1996, Blood and milk prolactin and the
rate of milk synthesis in women, Exper Physiol 81: 1007-1020
Note: This article is primarily about level of prolactin and how it
declines despite maintenance of milk supply. Quote from page 1016 in
the discussion:
<<We found no change in milk production from month (708 plus or minus
4.7 ml/24 hr (n=11)) to 6 months (742 plus or minus 79.4ml/24 hr
(n=9)) of lactation. Similar milk intakes have been reported for
longitudinal studies in the USA by Neville, Keller, Seacat, Lutes,
Neifert, Casey, Allen and Archer (1988) (range, 739 plus or minus
47.3ml/24 hr (n=12) to 787 plus or minus 24.4 ml/24 hr (n=13)) and
Dewey & Lonnerdal (1983) (range, 673 plus or minus 48.0 ml/24 hr
(n=16) to 896 plus or minus 36.8 ml/24 hr (n=11)). However,
concurrent prolactin measurements were not made in the earlier
studies. In the present study, while milk production remained
relatively constant until 6 months of lactation, the concentration of
prolactin in plasma declined. This is consistent with Huang et al
(1987), who reported that between 40 and 60 days postpartum there was
no change in milk production (1160 plus or minus 102 and 1125 plus or
minus 108 g/24 hr, respectively), while there was a decline in the
concentration of prolactin in the plasma [figures of prolactin] in
mothers selected from groups of women on the basis of 'adequate' milk
volume. Therefore, 24 hr milk production was not controlled by either
the basal or suckling-stimulated concentration of prolactin in the
blood.>>
I think this clearly shows that this knowledge has actually been
around quite a while - just not amongst non-researchers, such as
lactation consultants - that a baby's intake *does not* increase
correlated to body weight.
I am not disputing your clinical judgement that the particular baby
to whom you refer is not getting enough milk to grow - just that the
calculations you quoted are not necessarily accurate.
Joy
--
******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Australian Breastfeeding Association counsellor
Perth, Western Australia. mailto:[log in to unmask]
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