Nina, I have not presumed that all mothers milk begins with the same caloric value at all. We all know that is not so. Some moms make 28 calorie milk, others make 15. Most moms avg around 20-22, as Pat Young replied. (this having been discovered thru research and milk banks) Haven't we all seen the visible differences in the EBM - some have only a cm of fat at the top while others have about 10 cm! (and yes, they change throughout the day) In the clinic, we are not testing the caloric value of the mother's milk. It is a matter of first determining if the baby is able to transfer the milk well from the breast, then determining moms supply. If both those are WNL and baby still isn't gaining well (doubling birth weight by 4-6 months and maintaining percentage on growth curve -whether that be 10% or 5% . they just don't want to see the babies growth curve spiral downward) then they look for metabolic or structural problems. (celiac, reflux, cystic fibrosis .) If baby has no symptoms for any diseases, then we try "other" things, depending on what the parents prefer. Many moms are more comfortable with just adding a scoop of formula to a bottle of expressed milk than to offer an entire bottle of formula. This is usually used when babies are not willing to take in more quantity, so we have to finesse the quality. And I absolutely would prefer breastmilk lacto-engineering, and have seen great results with that! (scooping off the fat from one and adding it to the other; or even, scooping off the fat and spoon feeding it to the baby, for those that don't take bottles) But for those moms who have no excess . it isn't always an option. Yes, putting in that scoop of formula will also change the overall eloctrolytes . but these babies are usually a bit "nutritionally deprived" and so don't show any signs of an electrolyte overload. (nausea/vomiting/diarrhea/lethargy/cramping) Moms are instructed to watch for those symptoms and to report them if noticed immediately. I want to believe that breastmilk-alone always works for every baby and every mom . but that just isn't the case! In regards to the different "scoops" provided by the different brands around the world . I would assume that if one scoop (of whatever size provided from the manufacturer)mixed with 2 oz water = 2 oz formula . then that same scoop will be the same for the "recipes" I provided. Linda Hill RN, IBCLC Austin, TX *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome