Nutrition: Foundations for Life

Mrs. Jones comes to your practice with her 4-day old son Sammy.  Pregnancy, labor and delivery were uncomplicated.   Delivery was spontaneous and vaginal;  Sammye weighed 3750 grams at birth.  He was discharged from the nursery breastfeeding exclusively and weighing 3450 grams.  Mrs. Jones now says that she is going to being supplementing with formula because she is not making enough milk. Sammy is nursing 10-12 times a day, or about every two hours. Sometimes he will nurse at one breast for 20 minutes and fall asleep. She thinks he is satisfied, but in 20-30 minutes he is hungry again and wants to take the other breast. She is certain that he must not be getting enough milk.   As you talk to her further, you learn that he has 8 wet diapers per day and has yellow seedy bowel movements every time he nurses.   Today he weighs 3550 grams.

How should you advise Ms. Jones about Sammy's eating pattern?

   1.  She is correct.  He is eating too often.  She should breastfeed for 20 minutes and then "top off" by offering formula.  She should expect that he will sleep for 4 hours between feeds.

   2.  She should pump her breasts and see how much milk she is making.  If she is not making at least 4 ounces from both breasts, this confirms that her milk production is inadequate to meet Sammy's needs.

  3.  Sammy is failing to thrive because he is below birth weight and clearly needs additional calories.

  4.  She’s doing great! Breastmilk is very easily absorbed and has a fast transit time through the GI tract.  It is normal for breastfeed babies to eat every two hours, 8-12 times a day. Many breastfed babies will “take a break” between breasts. Just like most of us need some time between dinner and dessert, so do breastfed babies.

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