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Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day

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Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day ARTICLE Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day Jacqueline C. Kent, PhDa, Leon R. Mitoulas, PhDa, Mark D. Cregan, PhDa, Donna T. Ramsay, PhDa, Dorota A. Doherty, PhDb,c, Peter E. Hartmann, PhDa aDepartment of Biochemistry and Molecular Biology, Faculty of Life and Physical Sciences, and bSchool of Women’s and Infants’ Health, The University of Western Australia, Crawley, Western Australia, Australia; cWomen and Infants Research Foundation, Crawley, Western Australia, Australia The authors have indicated they have no financial relationships relevant to this article to disclose. ABSTRACT OBJECTIVE. We aimed to provide information that can be used as a guide to clinicians when advising breastfeeding mothers on normal lactation with regard to the frequency and volume of breastfeedings and the fat content of breast milk. www.pediatrics.org/cgi/doi/10.1542/ peds.2005-1417 METHODS. Mothers (71) of infants who were 1 to 6 months of age and exclusively doi:10.1542/peds.2005-1417 breastfeeding on demand test-weighed their infants before and after every breast- Key Words breastfeeding, feeding behavior, feeding feeding from each breast for 24 to 26 hours and collected small milk samples from volumes, infant feeding, breast milk each breast each time the infant was weighed. Abbreviation IQR—interquartile range RESULTS. Infants breastfed 11 Ϯ 3 times in 24 hours (range: 6–18), and a breastfeed- Accepted for publication Sep 19, 2005 ing was 76.0 Ϯ 12.6 g (range: 0–240 g), which was 67.3 Ϯ 7.8% (range: 0–100%) Address correspondence to Jacqueline C. of the volume of milk that was available in the breast at the beginning of the Kent, PhD, The University of Western Australia, breastfeeding. Left and right breasts rarely produced the same volume of milk. The Biochemistry and Molecular Biology, M310, 35 Stirling Hwy, Crawley, Western Australia 6009, volume of milk consumed by the infant at each breastfeeding depended on Australia. E-mail: [email protected] whether the breast that was being suckled was the more or less productive breast, PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2006 by the whether the breastfeeding was unpaired, or whether it was the first or second American Academy of Pediatrics breast of paired breastfeedings; the time of day; and whether the infant breastfed during the night or not. Night breastfeedings were common and made an impor- tant contribution to the total milk intake. The fat content of the milk was 41.1 Ϯ 7.8 g/L (range: 22.3–61.6 g/L) and was independent of breastfeeding frequency. There was no relationship between the number of breastfeedings per day and the 24-hour milk production of the mothers. CONCLUSIONS. Breastfed infants should be encouraged to feed on demand, day and night, rather than conform to an average that may not be appropriate for the mother-infant dyad. PEDIATRICS Volume 117, Number 3, March 2006 e387 Downloaded from www.aappublications.org/news by guest on September 23, 2021 REASTFEEDING MOTHERS SHOULD be made aware of not possible to assess how the infant feeds to appetite in Bthe variability of milk volumes per breastfeeding, relation to the volume of milk available in the mother’s the frequencies of breastfeedings, and the distribution of breasts. Furthermore, the literature on the frequency of milk intake by day and by night of healthy breastfed breastfeeding generally fails to define what constitutes a infants.1 breastfeeding. Although Ho¨rnell et al11 defined “one Mothers among the !Kung hunter-gatherers have breastfeeding episode” as the “duration of suckling 2 been observed to breastfeed 4 times every hour during minutes or longer and separated from previous breast- the day and at least once at night.2 In contrast, Cadogan,3 feed by at least 30 minutes,” this does not consider in his essay to the Governors of the Foundling Hospital whether the infant fed from 1 breast or both during that (London, United Kingdom) in 1748 recommended that episode. infants be suckled only 4 times a day and not at night, In this article, we investigate the volume and the because he considered the night feeding to result in pattern of milk intake in a cross-sectional study of 1- to breastfed infants’ becoming “over fat and bloated.” Re- 6-month-old infants who were being exclusively breast- laxation of the concept of scheduled breastfeeding was fed on demand, and we examine the contribution of first strongly promoted by Wickes4 in 1953 and subse- each breast. This is the first article to describe the vari- quently advocated by community support groups such ation in the volume of milk consumed from each breast as La Leche League and the Australian Breastfeeding at each breastfeeding, the degree of fullness of each Association that were at the vanguard of the movement breast before and after each breastfeeding, and the fat back to breastfeeding in the early 1970s in Western content of the milk consumed from each breast through- societies. As a result, infants were breastfed more fre- out the day and night. This will provide a normal refer- quently both by day and by night. It now is recognized ence range to enhance clinicians’ support for breastfeed- that breast milk provides the optimal nutrition for in- ing mothers. fants, and current recommendations to mothers are that infants be breastfed “on demand” (according to their METHODS appetite) exclusively for the first 6 months of life.5,6 Data were collected from 71 mothers who were exclu- Bangladeshi infants have been found to consume half sively breastfeeding on demand healthy, term infants their daily milk intake between 6 AM and 6 PM.7 Matheny who were aged between 1 and 6 months. These mothers and Picciano8 in the United States investigated whether were participants in studies that were conducted in this measurement of milk production over a 12-hour period laboratory from 2000 to 2004.15–17 These studies were could be doubled to determine the 24-milk production. approved by the Human Research Ethics Committee of Studying 4-week-old infants, they found that more milk The University of Western Australia. was consumed between 6 AM and 6 PM and less was The mothers test-weighed their infants before and consumed between 2 PM and 2 AM. Doubling of either of after each breastfeeding from each breast on a Medela these 12-hour intakes resulted in significant inaccuracies electronic Baby Weigh Scale (Medela AG, Baar, Switzer- in estimation of 24-hour milk consumption. The product land) for a period of 24 hours plus 1 breastfeeding. A of the volume of 1 or 2 consecutive breastfeedings and corrected 24-hour production for each breast then was the number of breastfeedings in the period also has been determined using these data, but no correction for infant found to be inaccurate.9 The data of Cregan et al10 show- insensible water loss was made; therefore, milk produc- ing variation in the volume and the frequency of breast- tion may be underestimated by 3% to 10%.18–20 All feedings over 24 hours for Australian infants also suggest measurements of breastfeed amounts, storage capacity, that these calculations would be inaccurate. However, and milk production are expressed in grams that can be for accurate assessment of milk production, the necessity considered to be nearly equivalent to mL because the of a full 24-hour period of measurement of milk intake density of milk is 1.03 g mLϪ1.21 For each mother, the in our society for infants between 4 and 26 weeks has breast that had the higher 24-hour production was not been determined. termed “more productive” and the breast that had the A wide variation in the frequency of breastfeeding has lower 24-hour production was termed “less productive.” been recorded in the United States and Sweden in ex- In addition, milk samples (Յ1 mL) were collected by clusively breastfed infants.11,12 These authors collected hand expression into 5-mL polypropylene plastic vials longitudinal records of the number, time of day, and (Disposable Products, Adelaide, Australia), immediately duration of breastfeedings of infants between 2 and 26 before and after each breastfeeding from each breast. weeks of age, but no information was provided on the Samples were frozen as soon as possible and kept at volume of milk consumed at each breastfeeding by these Ϫ15°C for analysis. The cream content of the milk sam- infants. Previously, interest has focused on the nutrient ples was measured by the creamatocrit method,22 and intake of the infant, and the total consumption has been the fat content of each sample, in grams per liter, was quoted with no information provided on the volume of calculated as 5.37 ϫ creamatocrit ϩ 5.28.15 milk consumed from each breast.13,14 Therefore, it was The original estimation of fat content as a function of e388 KENT, et al Downloaded from www.aappublications.org/news by guest on September 23, 2021 degree of breast emptying was introduced by Daly et al,23 and all individual breastfeedings recorded over 24 hours whereby fat content was best predicted using a quadratic (n ϭ 775). Analyses of individual breastfeedings were function with degree of emptying as a predictor. Al- weighted according to the number of breastfeedings re- though time since last breastfeeding and individual corded per woman. Paired and unpaired univariate com- breast had a small effect, the best predictor of fat content parisons of summary data were performed using t tests was degree of emptying. This accounted for 68% of or their nonparametric equivalents depending on data variation, which was deemed satisfactory given the normality.
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