Nutrition: Foundations for Life

1.  INCORRECT.  He is eating too often. She should breastfeed for 20 minutes and then give formula.  She should expect that he will sleep for 4 hours between feeds.

The practice of giving formula after nursing at the breast is called topping off. Topping off is not a good idea because it sets up the vicious cycle illustrated in the previous question Here are a few reasons why:

            a) Giving formula after the baby is satisfied will cause the baby to become over-full. This increases the amount of time before it wants to feed again interrupting the feed back loop that tells the breast to make more milk.

            b) Babies thrive exclusively on breastmilk until they are 6 months old. A formula feed baby will go from consuming about 24 oz of formula a day to 32+oz of formula a day. When breastfeed babies go through growth spurts they signal mom’s body to make more milk by nursing more frequently and for longer periods of time. If moms misinterpret this as “not enough milk” and give formula their bodies have no way of knowing that the babies milk demand is increasing, and they quickly do not have enough milk to satisfy their baby.

            c) Breastfeeding is a skill that both mom and baby have to learn. The mechanics of drinking from a bottle different than from a breast. Each time you put a bottle in a breastfeed baby’s mouth you re-enforce those mechanics increasing the likely hood that the next time they try to latch on to the breast they may have problems which leads to frustrations which leads to more bottles.

2.  INCORRECT.  She should pump her breasts to see how much milk she has. If she can’t pump out four ounces then she is not making enough and make up the rest with formula.

Babies are much more efficient at emptying a breast than a breast pump. Although breast pumps are occasionally used to assess the adequacy of milk transfer this would not be appropriate in this case. In addition, because breast feed babies may eat more often than formula fed babies it stands to reason that the amount they eat at each feed may not be the same as a formula feed baby.

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

Sammy is gaining weight well, has normal number of wet diapers and bowel movements he is not starving.

4.  CORRECT.
Also, don’t forget that breast milk production is regulated by a feed back loop. Prolactin is  secreted from the anterior  pituitary. It is responsible for ductal and alveolar development of the breast during pregnancy. During lactation it works on the alveolar tissue to produce milk. Oxytocin is released by the posterior pituitary. It is responsible for contraction of the myoepithelial cells surrounding the alveoli  and causes milk ejection reflex or "let down". There is also autocrine regulation of  breast milk production. Local mechanisms within the mammary gland that depend on the amount of milk removed by the infant are responsible for the day to day regulation of milk volume.
 

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