Every time breast/bottle feeding is debated on the internet, a domo-kun kills a kitten

[nanila]

With the subject line in view, I'm going to talk about a decision that has caused my internal guilt monitor to spike off the charts.

Since I started work again and Keiki began going to nursery two and a half months ago, the nursery staff have been attempting to bottle-feed him twice a day. It has been a mostly unsuccessful endeavour. He vigorously rejected bottles with teats. He relented toward sippy cups for a while, though he was still not enthusiastic about taking breast milk or formula from either. When I started overnighting once a week in London (my usual full-time routine) in September, he would occasionally drink 100 mL (3.5 ounces) on the second day I was away. But he seems to have figured out that I return on the evening of the second day, and he's quite happy to go on milk strike until the warm fleshy milk-production unit comes back.

He rejected his two daily nursery bottle feeds for two weeks in a row, so this week we chose to stop asking the nursery to give them to him. The reason for the guilt? He's ten months old, and according to The Literature, he's still supposed to be getting 500 mL of milk (breast or formula) a day until he's one. I estimate, from when I'm away and have to pump to keep the boobs from 'sploding, that he gets at most 100 mL per feed from me. Even with one feed in the morning, one at bedtime and one or two at night, that's still not 500 mL, and obviously he doesn't get anywhere near that when I'm away for a day and a half.

He eats all the solid food that's offered to him, and even some that's not. Yesterday he stole his sister's half-eaten cupcake. Last week, Keiki's key worker was highly amused when they set out biscuits for the babies to decorate with icing and chocolate buttons. They turned their backs for a few seconds. When they turned round again, four babies were sitting nicely with two undecorated biscuits apiece in front of them. One baby had half a biscuit clutched in his hand and a lot of crumbs around his mouth. (You get one guess which baby that was.) This was right after lunch. So I don't think there's anything wrong with his appetite, and he certainly seems to be getting enough to eat. I really shouldn't be worried, but what with all the unconsciously absorbed socially imposed guilt surrounding being a working mother and being away from my little ones and that annoying mystically calculated 500 mL amount that we're not achieving, I have to expend a considerable amount of emotional energy talking myself into remaining calm.

He's fine. He's fine! He's a happy, healthy baby. He just prefers boob or food to anything that comes out of a bottle. I should stop stressing, y/y?

Comments

further on this

[fred_mouse]

have gone and talked to co-worker, and discovered that there is no published study that compares the amount of available milk taken by baby with the amount of available milk that is typically expressed, within individuals. There are studies that look at amount taken by the baby (average 67%, sorry, no SDs or measures of within/between participant variation), and pumping under various conditions (between 60 and 65%, again, no useful information there).

[it has gone on the list of things that we might get around to doing, one of these days. I'll put it on my list of possible work place projects....]

Re: further on this

[nanila]

Milk production, particularly the ratio of at the breast to in the pump, would be an excellent thing to understand better. I know a lot of breastfeeding mums who stressed a good deal over how much milk their babies were getting, especially in the early days, because obviously you can't measure it when it's going directly from the source into baby's mouth. When you're using bottles, you know exactly how much has been made and drunk, and I think that eases people's minds.

Re: further on this

[fred_mouse]

so, the way to measure the milk intake (and indirectly, the parent's milk production) is called test weighing. It requires scales that can reliably give a weight of the baby to a fine scale (ours are closest 2g for infants up to ~5kg, and closest 5 g up to something like 10kg). Baby is weighed before a feed, and then at the end of a feed, with no changes to clothing.

One thing though - we've been looking at perceptions of inadequate production, and what we've seen in our most recent cohort is that people who reported concerns about production, and test weighed for every feed over 24 hours (+ 1 feed) - something like a 1/3 of these have really good milk productions (I'll have to look up the study, and send you the link, if you are interested).

And yes - we would love to know more about what works and what doesn't for milk supply. There are not enough researchers in the field, and bugger all funding. Which is frustrating for something that has long term health ramifications, and as a result is really expensive at the aggregate level.