Finding normal in a bottle-feeding culture
Article Title: Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day
Journal: Pediatrics
Article Highlights
Main Takeaway:
This is a guide for the clinician of typical breastfeeding behaviors, volumes, and fat contents of breast milk, with exclusively breastfeeding infants, 1-6 months, and demonstrates a wide range of normal.
Why?
What is normal for breastfeeding babies, especially in a bottle-feeding culture that for generations has the multi-billion-dollar formula industry working (too successfully) to undermine this, must be made clear.
Quotable Droplet with the most kCals per mL:
“Breastfed infants should be encouraged to feed on demand,* day and night, rather than conform to an average that may not be appropriate for that mother-infant dyad.” (Kent, et al., 2006, p. e387)
*This reviewer suggests substituting a more current view of feeding on “cue,” rather than on “demand.”
A few more details:
Frequency and volume ranged from fewer larger feeds to smaller frequent ones. Importantly, “… the infant distributed the number evenly…” (p. e392) when comparing times of day, with fewer feeds at night.1, 2, 3 There was an inverse relationship between number of feeds/day and average feed volume. Volume of an individual feed depended on whether it was from the more or less productive breast, paired or unpaired, first or second of the paired feeds, and time of day. One breast was sufficient for 53% of meals; 44% were paired, others defined as “cluster.” If the more productive breast was second, the volume was greater from that than if the second was the less productive called a “top up.” Larger feeds were in the morning, especially for babies that did not feed at night. For night feeders, nocturnal feeds from more productive breast were the largest of the 24-hour period. Some mothers wish to extend time between feeds, but babies have their individualized patterns. Some feed within an hour of prior feed; some wait even up to more than 8 hours. The babies of the 5 mothers who had the smallest storage all fed in the night; most infants of mothers with larger capacity also chose to feed at night.
Total 24-hour milk production average was 798 g,4 with a wide standard deviation. Variation in production is related to growth rates.5, 6, 7 Intake for boys was greater than for girls8 and consistent with a higher growth rate.9 There was no significant difference associated with age of infant or mother, parity, nor hot and cold months. Milk intake was consistent over the 1-6 months period. Overall, infants consumed 64% of their feeds between 6AM and 6PM and least between 2PM and 2AM.10 This confirms the need of observing a full 24-hour period, for accuracy.
Night feedings were common (64% babies nurse at night, 1-3/night), contributing 20% +/- 7% of the 24-hour intake. Yet 24-hour production was not significantly different whether babies fed during the night or not, similar to Butte et al.1
Storage capacity, degree of fullness, and available milk, “it is likely that the storage capacity of the breast is able to change to meet an increase in demand for milk.” (p. e393) For unpaired feeds, with the more productive breast, there was more milk available, and the infant took a greater percentage of that available milk. Differences between capacity of right and left breasts had been noted with the right being more productive.11, 12 The breasts were rarely drained, as noted also by Dewey et al.13 This study found infants removed 63% to 72% of available milk, indicating there is no need to thoroughly drain breasts to maintain an adequate supply.
Fat content of breast milk average was similar to findings of Dewey and Lönnerdal.4 24-hour fat intake was similar to prior studies and not associated with time after birth or number of feeds during the day.4, 5 Fat content differed at times of day, reflecting higher degree of removal during day and evening and higher degree of fullness in morning and night. Changes from beginning to end of a feed as described by Woodward, et al,14 can be explained by the calculation in this study: lower fat from first breast at the beginning and higher fat content from it at the end. Because the breast was not full at the beginning of each feed for the whole day, the fat content of the foremilk was not always low. Fat intake is not related to frequency of feeds. This can reassure mothers. All breasts do not yield the same volume at the same rate. This is particularly important for women who need to pump: settings and regiments need to be customized.
Citation details
Article Title: Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day
Authors: Jacqueline C. Kent, Leon R. Mitoulas, Mark D. Cregan, Donna T. Ramsay, Dorota A. Doherty, and Peter E. Hartmann
Journal: Pediatrics, vol 112, number 3
Publication Date: March 2006
References noted:
Butte NF, Wills C, Jean CA, Smith EO, Garza C. Feeding patterns of exclusively breast-fed infants during the first four months of life. Early Hum Dev. 1985;12:291-300
Cregan MD, Mitoulas LR, Hartmann PE. Milk prolactin, feed volume, and duration between feeds in women breastfeeding their full-term infants over a 24-hour period. Exp Physiol. 2002;87:207-214
Hörnell A, Aarts C, Kylberg E, Hofvander Y, Gebre-Medhin M. Breastfeeding patterns in exclusively breastfeeding infants: a longitudinal prospective study in Uppsala, Sweden. Acta Paediatr. 1999;88:203-211
Dewey KG, Lönnerdal B. Milk and nutrient intake of breast-fed infants from 1 to 6 months: relation to growth and fatness. J Pediatr Gastroenterol Nutr. 1983;2:497-506
Butte NF, Garza C, O’Brian Johnson Smith E, Nichols BL. Human milk intake and growth in exclusively breast-fed infants. J Pediatr. 1984;104:187-195
Kent JC, Mitoulas LR, Cox DB, Owens RA, Hartmann PE. Breast volume and milk production during extended lactation in women. Exp Physiol. 1999;84:435-447
Aksit S, Ozkayin N, Caglayan S. Effect of sucking characteristics on breast milk creamatocrit. Paediatr Perinat Epidemiol. 2002;16:355-360
Butte NF, Wong WW, Hopkinson JM, Smith EO, Ellis KJ. Infant feeding mode affects early growth and body composition. Paediatrics. 2000;106:1355-1366
Dewey KG, Peerson JM, Brown KH, et al. Growth of breast-fed infants deviates from current reference data: a pooled analysis of US, Canadian, and European data sets. World Health Organization Working Group on Infant Growth. Paediatrics. 1995;96:495-503
Mattheny RJ, Picciano MF. Assessment of abbreviated techniques for determination of milk volume intake in the human milk-fed infant. J Pediatr Gastroenterol Nutr. 1985;4:808-812
Mitoulas L, Kent JC, Cox DB, Owens RA, Sheriff JL, Hartmann PE. Variation in fat, lactose and protein in human milk over 24h and throughout the first year of lactation. Br J Nutr. 2002;88:29-37
Cox DB, Owens RA, Hartmann PE. Blood and milk prolactin and the rate of milk synthesis in women. Exp Physiol. 1996;81:1007-1020
Dewey KG, Heinig MJ, Nommsen LA, Lönnerdal B. Maternal versus infant factors related to breast milk intake and residual milk volume: the DARLING study. Pediatrics. 1991;87:829-837
Woodward DR, Rees B, Boon JA. Human milk fat content: within-feed variation. Early Hum Dev. 1989;19:39-46
KEEPING UP-TO-DATE WITH BREASTFEEDING MEDICINE
Droplets of Knowledge: Helping practitioners stay up to date with the latest information on breastfeeding, as well as a look at some classic studies.
Prepared by Constance Pond
Email lll.denaduran@gmail.com or lllleader.constance@gmail.com with comments, questions, or suggestions for future Droplets.