Re: calculating how much EBM

[Guest guest]

I found this in one of my bookmarks, (i knew i had this somewhere) right after I

posted... thanks Diane West...

http://www.lowmilksupply.org/supplementing-howmuch.shtml

when a mom has been using lots of bottles it is tough to convince her to try

paced bottle feeding/give less than she has been.

>

> does anyone have a tried and true equation to use when the baby needs to be

EBM fed or supplemented.

>

> such as 1.5-2 oz/pound of body weight/ day...

>

> ...in other words how much do babies need/day?

>

>

> ahhh, none of the numbers i use look right

>

http://www.lowmilksupply.org/supplementing-howmuch.shtml

[Guest guest]

A great resource book to have on hand is "Pocket Guide for Lactation Management" by Karin Cadwell and -Maffei. It has charts in the Appendix for calculating weight loss percentage, how much milk a baby should have at various weights, as well as how much they should have if they need to catch up and how much they should have if they are in severe need of catchup.

Tina Carlson, PPD, CLC

(IBCLC exam hopeful 2011)

[Guest guest]

my rule is as much as the baby wants. who am I to judge? Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- From: olliemi2005

Subject: calculating how much EBMTo: Date: Saturday, February 19, 2011, 3:52 PM

does anyone have a tried and true equation to use when the baby needs to be EBM fed or supplemented.

such as 1.5-2 oz/pound of body weight/ day...

....in other words how much do babies need/day?

ahhh, none of the numbers i use look right

[Guest guest]

It depends if the baby is getting anything from the breast! The most helpful approach i've found is to calculate how much additional weight gain the baby needs to achieve above and beyond the amount the baby is already gaining, and then double that iweekly amount n terms of supplement per day. So for instance if baby is gaining 1 ounce per week, but should be gaining a minimum of 5, then that's a 4 ounce difference, baby would get about 8 ounces of supplement per day. That's of course very variable, and you gotta look at the individual baby, but that's a general target.Now, TOTAL milk need is about 2.5 ounces per pound of body weight, per 24hrs, after the first 4 to 6 days, and thereafter for the first 4 to 6 weeks, but supplementaion would rarely be that much unless mom has virtually no milk supply. Lyla-- Sent from my Palm Pixi

my rule is as much as the baby wants. who am I to judge? Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- From: olliemi2005

Subject: calculating how much EBMTo: Date: Saturday, February 19, 2011, 3:52 PM

does anyone have a tried and true equation to use when the baby needs to be EBM fed or supplemented.

such as 1.5-2 oz/pound of body weight/ day...

..in other words how much do babies need/day?

ahhh, none of the numbers i use look right

[Guest guest]

100kcal/kg/24hr

Breastmilk has @ 22 calories an ounce.

>

> does anyone have a tried and true equation to use when the baby needs to be

EBM fed or supplemented.

>

> such as 1.5-2 oz/pound of body weight/ day...

>

> ...in other words how much do babies need/day?

>

>

> ahhh, none of the numbers i use look right

>

[Guest guest]

I rely on the research which reports that the average baby does not increase his breastmilk intake between 1 - 6 months.  mom has it nicely documented at the end of her article here:  http://www.kellymom.com/bf/pumping/milkcalc.html

Start with 25 ounces and divide by the number of feeds for the starting bottle size.  Used paced bottle feeding and adjust amount accordingly (since 25 oz is the average 24 hour feed) based on baby.

I find this to work quite well and Moms are relieved to hear that intake is not dependent on baby's weight or age.EllenEllen J. Rubin, MA, IBCLC, LLLLL

-- While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby.  ~Amy SpanglerBreastfeeding questions?  1 877 4 LA LECHE

[Guest guest]

Yiu start with 25 ounces, regardless of baby's birth weight? Or do you mean if baby is over a month old? Or?-- Sent from my Palm Pixi

I rely on the research which reports that the average baby does not increase his breastmilk intake between 1 - 6 months. mom has it nicely documented at the end of her article here: http://www.kellymom.com/bf/pumping/milkcalc.html

Start with 25 ounces and divide by the number of feeds for the starting bottle size. Used paced bottle feeding and adjust amount accordingly (since 25 oz is the average 24 hour feed) based on baby.

I find this to work quite w

[Guest guest]

>

> does anyone have a tried and true equation to use when the baby needs to be

EBM fed or supplemented.

>

I find this so interesting that we don't all use the same calculation. I agree

with Lyla, " TOTAL milk need is about 2.5 ounces per pound of body weight, per

24hrs, after the first 4 to 6 days, and thereafter for the first 4 to 6

weeks " ,... so I deduct mom's volume/baby's intake from the breast from that

amount. Although sometimes I have to consider if mom has been feeding

frequently or not, and how long since her breasts were emptied.

Dalton

Louisiana

[Guest guest]

This is approximate to 100/kcal/kg/24 hrs

I just find it easier to work in metric

> >

> > does anyone have a tried and true equation to use when the baby needs to be

EBM fed or supplemented.

> >

>

> I find this so interesting that we don't all use the same calculation. I

agree with Lyla, " TOTAL milk need is about 2.5 ounces per pound of body weight,

per 24hrs, after the first 4 to 6 days, and thereafter for the first 4 to 6

weeks " ,... so I deduct mom's volume/baby's intake from the breast from that

amount. Although sometimes I have to consider if mom has been feeding

frequently or not, and how long since her breasts were emptied.

>

> Dalton

> Louisiana

>

[Guest guest]

Sorry, but any equations are using formula-feeding mentality to fix breastfeeding problems.

Let the baby show you how much he needs!! Offer the supplement in a way that does not drown him. When he is in control, he can show he is done by refusing to suck, by dropping his hands to his lap, or by just coming off the bottle (if that is the supplement method being used. Even those *very*-far-below-appropriate-weight babies who get exhausted before filling up, will drop the hands to the lap because they are sleeping, take a 15-20 catnap, then wake and want to eat again. Let them! They have plenty of catching up to do.

When babies have really been behind the mark in their intake, I warn mothers that the baby may be very cranky and demanding for 1-3 days, once they have the freedom and ability to take whatever amount they want. I explain to the mother that this is a good thing--now the baby has the *energy* to say what he needs. I tell them that baby will settle down as soon as some invisible intake threshold in him gets satisfied. One baby who had only gained 9 oz in the 9 weeks since his birth, took 2 oz from breast and then demanded **7** oz of supplement by bottle for every feeding for 36 hours. Then he settled down and took a more "normal" amount of 1.5 oz of supplement with feedings after that. This is not an unusual story.

Please stop looking for an equation. Look at what the baby is telling you.

Dee Kassing

does anyone have a tried and true equation to use when the baby needs to be EBM fed or supplemented. such as 1.5-2 oz/pound of body weight/ day......in other words how much do babies need/day?ahhh, none of the numbers i use look right

[Guest guest]

I don't see that the original poster clarified the intention for the request

however I'm fairly confident we're using these types of approaches for complex

cases that sometimes require a little more intensive approach.

Baby's who have unique needs can have feeding challenges, and in that event

there is a place for using these types of tools. I don't find it beneficial to

simplify one approach to every circumstance.

When you have experience with preterm infants and baby's with special needs we

see that it is not always the case that they show you how much they need, which

is why in some cases, used judiciously, this type of knowledge is very

beneficial.

As well, when a mother is struggling with supply, I can apply this type of

understanding to make sure we are maximizing use of her available milk and not

overfeeding infants with formula which can reduce their desire at the subsequent

feed. This can reassure a mother her baby is getting the nourishment the baby

needs, and reduce overfeeding.

Of course we are observing the infant's needs as we assess feeds.

>

> Sorry, but any equations are using formula-feeding mentality to fix

breastfeeding problems.

> Let the baby show you how much he needs!!  Offer the supplement in a way that

does not drown him.  When he is in control, he can show he is done by refusing

to suck, by dropping his hands to his lap, or by just coming off the bottle (if

that is the supplement method being used.  Even those

*very*-far-below-appropriate-weight babies who get exhausted before filling up,

will drop the hands to the lap because they are sleeping, take a 15-20 catnap,

then wake and want to eat again.  Let them!  They have plenty of catching up

to do.

>  

> When babies have really been behind the mark in their intake, I warn mothers

that the baby may be very cranky and demanding for 1-3 days,

[Guest guest]

Dee, I do the same thing. and posted it to the initial question. I think it's a good idea to have a general notion of how much a baby needs per day, but when supplementing, I teach the parents to follow the baby's lead. (we're talking healthy, full-term baby here.) I would hate for someone to tell me, "ok, you've had enough now" LOL! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- Subject: Re: calculating how much EBMTo: Date: Sunday, February 20, 2011, 7:00 PM

Sorry, but any equations are using formula-feeding mentality to fix breastfeeding problems.

Let the baby show you how much he needs!! Offer the supplement in a way that does not drown him. When he is in control, he can show he is done by refusing to suck, by dropping his hands to his lap, or by just coming off the bottle (if that is the supplement method being used. Even those *very*-far-below-appropriate-weight babies who get exhausted before filling up, will drop the hands to the lap because they are sleeping, take a 15-20 catnap, then wake and want to eat again. Let them! They have plenty of catching up to do.

When babies have really been behind the mark in their intake, I warn mothers that the baby may be very cranky and demanding for 1-3 days, once they have the freedom and ability to take whatever amount they want. I explain to the mother that this is a good thing--now the baby has the *energy* to say what he needs. I tell them that baby will settle down as soon as some invisible intake threshold in him gets satisfied. One baby who had only gained 9 oz in the 9 weeks since his birth, took 2 oz from breast and then demanded **7** oz of supplement by bottle for every feeding for 36 hours. Then he settled down and took a more "normal" amount of 1.5 oz of supplement with feedings after that. This is not an unusual story.

Please stop looking for an equation. Look at what the baby is telling you.

Dee Kassing

does anyone have a tried and true equation to use when the baby needs to be EBM fed or supplemented. such as 1.5-2 oz/pound of body weight/ day......in other words how much do babies need/day?ahhh, none of the numbers i use look right

[Guest guest]

dee, and renee, I completely agree, but moms do like to have a little bit of a target/guideline, or at least how much to start with. especially if they are using an SNS or lactaid, it’s nice to know what they *might* expect baby to take...

lyla

[Guest guest]

oh yes! I always give them a ball park based on what the baby takes after breastfeeding during my consult.... Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- Subject: Re: calculating how much EBMTo: Date: Sunday, February 20, 2011, 9:03 PM

dee, and renee, I completely agree, but moms do like to have a little bit of a target/guideline, or at least how much to start with. especially if they are using an SNS or lactaid, it’s nice to know what they *might* expect baby to take...

lyla

[Guest guest]

I think the focus of this discussion was intended to be > 1 month. However if

supplementation in the immediate postpartum period were to become necessary, for

whatever reason, either colostrum or formula, I am certainly providing some

guidance re: volumes otherwise parents would be feeding 45+ml thanks to the

lovely 60ml bottles!

As usual, like any tool or resource, there are appropriate and beneficial uses

for this information, and other times when it is unnecessary. The key is

distinguishing between the two.

>

> dee, and renee, I completely agree, but moms do like to have a little bit of a

target/guideline, or at least how much to start with. especially if they are

using an SNS or lactaid, it’s nice to know what they *might* expect baby to

take...

>

> lyla

>

[Guest guest]

But, I still always say...as much as he wants! because mom can get stuck on numbers and then not pay attention to baby. Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- Subject: Re: calculating how much EBMTo: Date: Sunday, February 20, 2011, 9:03 PM

dee, and renee, I completely agree, but moms do like to have a little bit of a target/guideline, or at least how much to start with. especially if they are using an SNS or lactaid, it’s nice to know what they *might* expect baby to take...

lyla

[Guest guest]

Yes - I start with 25 ounces regardless of baby's birth weight for all babies between the age of 1 month - 6 months.  However, I'm talking here about healthy babies whose Moms are returning to work.  

For example, if a Mom is going to be separated from her 6 week old, I ask how many feeds he will typically have in a 24 hour period.  Say the answer is 8 - then the average feed using the 25 ounce number is basically 3 ounces.  I suggest preparing 3 ounce bottles for all missed feeds plus several 1 ounce bottles as back-up.  I REALLY encourage paced bottle feeding, pauses during feeding, following baby's cues, never encouraging a baby to finish a bottle if he indicates he is done.  If he seems fussy after that 3 ounce bottle - try a couple of things - burp, cuddle, walking, etc.  Still think he's hungry?  Crack open the one ounce bottle and back to paced bottle feeding.  Use this method to work towards determining what individual baby needs.

Since 25 ounces is an average - some babies will take more and others less - this is just a good ballpark figure to begin with.  mom explains this all quite nicely, so I refer Moms to the article there.  http://www.kellymom.com/bf/pumping/milkcalc.html  She has lots of links to research demonstrating the 25 ounce average as well.

I also tell returning to work Moms to try to get in two feeds at the breast before work and to nurse upon immediately picking up the baby.  This is also where those 1 ounce bottles also come in handy.  I suggest that Mom call caregiver on the way home so baby is not offered a large bottle shortly before she arrives.  If baby needs to eat anyway, the 1 ounce bottle may be enough with Mom arriving soon thereafter.

Moms returning to work do need a figure to start with when storing ebm and resources / expectations to share with their caregivers on bottle feeding a breastfed baby.  They have great fears that as baby grows he needs significantly more - the research that I have read does not support this.

Sadly, I have worked with Moms who decide to give up on breastfeeding and providing ebm because of caregivers overfeeding and fears that Mom can't keep her supply up.  I once spoke with a Mom whose caregiver (Grandparents) were giving a 2 week old 4-6 ounces every 2 hours!  I also speak with Moms who do not want to pump when they work and I share that breastfeeding does not have to be an all or none type of thing.

That about sums up my back to work and ebm speech!

Ellen

Ellen J. Rubin, MA, IBCLC, LLLL

-- While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby.  ~Amy SpanglerBreastfeeding questions?  1 877 4 LA LECHE

[Guest guest]

I use the 2.5 x body weight as a guideline. And I use this

depending on the situation. If I have a baby who is so sleepy they will not

rouse on their own, then I ask parents to work towards getting a specific

amount into baby. As baby begins to have energy and is waking on their own I

teach parents to watch the baby. If the ‘formula’ say baby needs

23 ounces in 24 hours but baby asks for more – I tell them, give him

more! If he asks for a bit less – I say watch the baby…feed him a

bit less as he may want a bit more the next 24 hours.

I agree with who says we can’t just use one

tool – it is important that we have a variety of tools to use with the

variety of babies out there. Not all babies respond the same way. I have seen

babies who were content to sleep themselves to death and others who were

perfectly capable of letting everyone know what they need. There is a fine

balance here and it is my job to teach the parents how to know the difference…

Warmly,

Jaye

Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net