How Much Milk does My Baby Need & Is My Baby Getting Enough Milk?

 

Day	24hr volume produced	Infant intake	Stomach capacity
1	37ml (7 - 123ml)	few drops - 5ml/feed	7ml
2	84ml (44 - 335ml)	5 - 15ml/feed	13ml
3	408ml (98 - 775ml)	15 - 30ml/feed	27ml
5	705ml (452 - 876ml)	45 - 60 ml/feed	57ml
1 - 6 months	800ml (478 - 1300ml)	30 - 135ml/feed	not available

How often to feed?

In a study of 71 thriving, exclusively breastfed infants ranging in age from 1 to 6 months, it was observed that the infants:

• averaged 11 feeds (range 6 - 18) per 24 hrs
• 10 of the babies always fed from both breasts each feed
• 19 babies always fed from one breast each feed
• 42 infants sometimes fed from both breasts and sometimes fed from only one
• 2/3 of babies fed at night, and had their biggest feed at this time, consuming 20% of their total daily intake.

These researchers concluded that mothers should respond to their babies' cues rather than striving to be average.

So what are feeding cues?

Responding to early feeding cues is the most effective way to meet the infant's needs.
Mothers need to know they can learn their infant’s feeding cues, and by responding to the early cues their infant need not become distressed before feeds:

• Early cues
  • wiggling, moving arms or legs
  • rooting, fingers to mouth
• Mid cues
  • fussing, squeaky noises
  • restless, crying intermittently
• Late cues
• full cry, aversive screaming pitch, color turns red

So is my baby getting enough milk?

• After most feeds, baby will appear calm 
• Baby's mucous membranes (etc lips) is moist
• Urine output & change in stool colour (If it's coming out, it must have gone in!) Important for parents to understand!
• Baby's growth (according to weight on growth chart)

Day	Urine Output	Stool Output
1	one or more wet nappy/diaper	one or more meconium stools
2	two or more wet nappies/diapers	one or more meconium/transitional stools
3	three or more wet nappies/diapers	transitional stool
4+	6 to 8 thoroughly wet nappies/diapers, with clear urine	soft, yellow, curdy (at least daily until about 6 weeks)

Meconium Stool

Transitional Stool

Yellow, seedy Stool

What about my baby's growth?

Evidence shows that formula-fed infants deviate substantially from healthy breastfed infants. In 2006, WHO released the WHO Child Growth Standards which were developed over nine years of collected data from a Multicentre Growth Reference Study (MGRS) of 8440 healthy breastfed infants from a wide international sample of six countries.

These growth curves provide a single international standard that represents the best description of physiological growth for all children from birth to five years of age and establish the breastfed infant as the normative model for growth and development. 

Please ensure that your paediatrician uses the WHO growth chart and not the previously used growth charts (National Center for Health Statistics/World Health Organisation) which were based predominantly on artificially-fed infants and early introduction of solids,and are now considered outdated and should no longer be used. 

Here are some RED FLAG signs of when you should be worried:

1. Output is LESS than expected.

Output is a direct indicator of intake.
You should be concerned if your baby's urine is concentrated or smelly, and lack of daily bowel motions or green, scant starvation stools, and encouraged to make an urgent appointment with your health care provider.

2. Breastfeeding is painful.
Breastfeeding should not be painful!
Nipple damage is always the result of an abnormality in breastfeeding. Poor milk transfer to the infant is frequently associated with nipple pain or damage.
Painful breasts may be a symptom of severe engorgement, or mastitis.
Please seek immediate help from an expert in breastfeeding management.

3. Increasing jaundice.
Jaundice is a normal physiological state for the majority of breastfed infants. It peaks at Day 3 then gradually fades.
Increasing jaundice causes sleepiness and poor feeding; and conversely, poor feeding causes increasing jaundice. Jaundice should not be seen below the level of the umbilicus or extremities. If you suspect your infant has increasing jaundice,consult your infant's health professional. 

With all these information given, we still cannot conclude a "one size fit all" method of ensuring baby is getting enough milk and growing well, because there are various individual cases which cannot be fitted into the normal variant like for example:

• Child was born large, but is genetically determined to be slighter - or vice versa.
• Child has had a temporary illness, losing weight which will be quickly regained when healthy again.
• Inadequate nutritional sustenance to support growth; or excessive, or poor quality foods causing obesity.
• Chronic illness that prevents normal growth.

 So it is best to consult a paediatrian which has ample knowledge on breastfeeding with regards to this.

Correct Pumping Method & Choosing a Breastpump

Expressing breastmilk is a learned skill so give yourself enough time and patience to master that skill. Do not feel disappointed if you will gain only little or no milk when you use the breastpump for the first time. Consider your first pumping sessions as practice sessions.

What kind of breastpumps to choose? Well, there are certainly many to choose from in the market nowadays. Neverthless, choose a breastpump that:

1. Suits your need.

    -If you are a working mother on the go, choose a breastpump which has double pumping function (cuts pumping time in half), handsfree (with a pumping bustier), and has options of electrical and battery use (easy during travelling).

     -If you spend most of the time direct feeding your baby and close to the baby, you can also opt for other simpler function pumps.

2. Affordable

    -Choose a pump which suits your budget and invest in one that can last for a reasonable period of time.

3. Portable

    -A breastpump should be portable to ensure you can carry it along with you wherever, whenever. Should be your BFF from now on :-)

4. Efficient suction & comfortable.

   -Try to find a breastpump which mimics your baby's suction to maintain your milk supply. A breastpump with a comfortable yet efficient suction level might help prevent nipple injuries.

You might want to try this. *wink* *wink*

Available at www.evelove.com.my

How to use a Breastpump??

·         Before using a breastpump for the first time, read and follow the instruction for use.

·         Whether you hand express or use a breastpump, wash your hands before you start expressing your milk.

·         Find a comfortable place to express your milk.

·         Select a breastshield that fits your breast. The breastshield should closely surround your nipple but leave enough space so that your nipple is not rubbing against the wall of the shield and can move freely back and forth. Your nipple should be at the centre of the breastshield.

·         Pump at a level which is sufficient to express milk but not painful or uncomfortable.

·         Massage your breasts before and occasionally during pumping to encourage your let-down and milk flow.

·         Double pumping does cut your pumping time in half and your prolactin levels are higher when you use a double pump, so you may produce more milk in less time. When you pump one breast at the time, switch from one side to the other several times.

·         Pump at consistent intervals (try not to go more than 4 hours) for at least 20 minutes each breast to maintain a good supply.

Hand Expression (Marmet) Technique

There are circumstances when a mother needs to express breastmilk such as:
1. Being away from baby
2. Over active let-down (causing baby to gag)
    In this case, expressing a bit of milk before feeding might help to regulate flow
3. Oversupply of milk (expressing might help prevent engorgement)

4. Building up milk supply (the more you express/feed directly, more milk will come!)

You can express breastmilk in two ways. Either using God's given natural gift (your hands) or using a breastpump.

The video below shows some helpful tips in expressing breastmilk using hands.

Benefits of Breastfeeding

 
      BENEFITS FOR MOTHER

-Reduces the risk of breast cancer. Women who breastfeed reduce their risk of developing breast cancer by as much as 25 percent.. The more months or years a mother breastfeeds, the lower her risk of breast cancer.

 

-Reduces the risk of uterine and ovarian cancer. Estrogen levels are lower during lactation, hence the less estrogen available to stimulate the lining of the uterus and perhaps breast tissue also, the less the risk of these tissues becoming cancerous.

      -Lessens osteoporosis.Non-breastfeeding women have a four times greater chance of  developing osteoporosis than breastfeeding women and are more likely to suffer from hip fractures in the post-menopausal years.

       -Benefits child spacing. Since breastfeeding delays ovulation, the longer a mother breastfeeds the more she is able to practice natural childspacing, if she desires

        -Promotes emotional health. Studies show that breastfeeding mothers show less postpartum anxiety and depression than do formula-feeding mothers.

-Promotes postpartum weight loss.Breastfeeding mothers showed significantly larger reductions in hip circumference and more fat loss by one month postpartum when compared with formula-feeding moms. Breastfeeding mothers tend to have an earlier return to their pre-pregnant weight.

 -Costs less to breastfeed.

BENEFITS FOR BABY

Adapted from Chapter 18 of THE WOMANLY ART OF BREASTFEEDING, 7th Revised Edition: 

"Human Milk for Human Babies " documents the benefits of breastfeeding such as the antibodies in it to protect the baby from illness. For example, a study in the Philippines showed that, "Deaths from respiratory infections and diarrhea were eight to ten times higher in babies who were artificially fed than in those who were even partially breastfed for six months "

 (THE WOMANLY ART OF BREASTFEEDING,7th Revised Edition, page 350). “Breastfed babies have a decreased likelihood for allergies and dental caries. They also benefit from appropriate jaw, teeth and speech development as well as overall facial development. This means that people who were artificially fed may experience more trips to doctors and dentists “

The benefits of breastfeeding is an endless list which cannot be summarized in just one blog post. This post is just intended to ensure parents get the introduction of benefits of breastfeeding. There are too many short term benefits, long term benefits both for mother and babies. So...keep on breastfeeding! :-)

Comparison of Breastmilk & Infant Formula

Comparison of Human Milk and Formula

NUTRIENT FACTOR	BREAST MILK	FORMULA	COMMENT
Fats	-Rich in brain-building omega 3s (DHA and AA) -Automatically adjusts to infant's needs; levels decline as baby gets older -Rich in cholesterol -Nearly completely absorbed -Contains fat-digesting enzyme, lipase	-No DHA -Doesn't adjust to infant's needs -No cholesterol -Not completely absorbed -No lipase	Fat is the most important nutrient in breastmilk; the absence of cholesterol and DHA, may predispose a child to adult heart and central nervous system diseases.  Leftover, unabsorbed fat accounts for unpleasant smelling stools in formula-fed babies.
Protein	-Soft, easily-digestible whey -More completely absorbed; higher in the milk of mothers who deliver preterm -Lactoferrin for intestinal health -Lysozyme, an antimicrobial -Rich in brain-and-body- building protein components -Rich in growth factors -Contains sleep-inducing proteins	-Harder-to-digest casein curds -Not completely absorbed, more waste, harder on kidneys -No lactoferrin, or only a trace -No lysozyme -Deficient or low in some brain-and body-building proteins -Deficient in growth factors -Does not contain as many sleep-inducing proteins.	Infants aren't allergic to human milk protein.
Carbohdrates	-Rich in lactose -Rich in oligosaccharides, which promote intestinal health	-No lactose in some formulas -Deficient in oligosaccharides	Lactose is considered an important carbohydrate for brain development. Studies show the level of lactose in the milk of a species correlates with the size of the brain of that species.
Immune Boosters	-Rich in living white blood cells, millions per feeding -Rich in immunoglobulins	-No live white blood cells-or any other cells. Dead food has less immunological benefit. -Few immunoglobulins and most are the wrong kind	When mother is exposed to a germ, she makes antibodies to that germ and gives these antibodies to her infant via her milk.
Vitamins and Minerals	-Better absorbed, especially iron, zinc, and calcium -Iron is 50 to 75 percent absorbed. -Contains more selenium (an antioxidant)	-Not absorbed as well -Iron is 5 to 10 percent absorbed -Contains less selenium (an antioxidant)	Vitamins and minerals in breast milk enjoy a higher bioavailability-that is, a greater percentage is absorbed. To compensate, more is added to formula, which makes it harder to digest.
Enzymes and Hormones	-Rich in digestive enzymes, such as lipase and amylase -Rich in many hormones: thyroid, prolactin, oxytocin, and more than fifteen others -Varies with mother's diet	-Processing kills digestive enzymes -Processing kills hormones, which are not human to begin with -Always tastes the same	Digestive enzymes promote intestinal health. Hormones contribute to the overall biochemical balance and well- being of baby. By taking on the flavor of mother's diet, breastmilk shapes the tastes of the child to family foods.