Nutrient intake by breast-fed infants during the first five days after birth.

The intakes of milk and specific nutrients during the first 120 hours after birth were measured in 11 full-term, breast-fed infants. Infants were test weighed at all feeds using an electronic balance, and milk samples were obtained from both breasts one to three times daily. Milk was analyzed for levels of fat, protein, lactose, calcium, sodium, and potassium; energy content was calculated using the Atwater factors. The average (+/- SD) intake of milk in the first 24 hours after birth was 13 +/- 16 g/kg (range, 3 to 32 g/kg), increasing to 98 +/- 47 g/kg (50 to 163 g/kg) and 155 +/- 29 g/kg (110 to 196 g/kg) on days 3 and 5, respectively. Mean daily intakes of energy, lactose, calcium, and potassium were less than 12% of the mean day 5 intake on day 1 and less than 25% of the day 5 intake on day 2. In the first few days after birth, the nutrient intake of the solely breast-fed infant is highly variable and is frequently low.

Medical management of successful breast-feeding.

Despite the present climate of professional and lay enthusiasm for breast-feeding, many women experience problems in the initiation of lactation, either because of misinformation, secondary lactation difficulties, or primary failure of lactation. This article provides pediatricians with practical guidelines for the successful initiation of breast-feeding and the prevention and early detection of problems. Recommendations are made for optimal prenatal preparation for breast-feeding, intrapartum routines that facilitate lactation, appropriate early follow-up of nursing infants, and the management of the full normal course of breast-feeding.

Lactation failure due to insufficient glandular development of the breast.

With the present increased incidence of breast-feeding, clinicians need to be prepared to identify and manage problems in lactation. Most problems are related to insufficient knowledge, inappropriate routines, and lack of confidence and are easily managed or prevented by prenatal education, anticipatory guidance, and adequate support. Increasing evidence exists that primary causes of lactation failure also occur and can preclude successful lactation, even among highly motivated women. Three cases are presented in which lactation failure is believed to stem from insufficient glandular tissue within the breasts. Supportive history for this entity include absence of typical breast changes with pregnancy and failure of postpartum breast engorgement to occur. Associated physical findings included a unilateral underdeveloped breast in each woman and palpable patchy areas of glandular tissue in one case. Breast diaphanography, or transillumination, substantiated clinical findings in the two cases in which it was performed. Both multiparous women had a previous unsuccessful breast-feeding experience, whereas the primiparous woman had immediate family members with a history of lactation failure. All three women benefited psychologically from the interpretation that lactation failure was not due to their breast-feeding performance, and each elected to continue nursing long-term despite the need for formula supplement. These cases are presented to emphasize that primary causes of lactation failure do exist and to alert clinicians to the historical and physical findings suggestive of inadequate glandular tissue as an etiology of previously unexplained lactation failure. Preserving the "every woman can nurse" myth contributes to perpetuating a simplistic view of lactation and does a disservice to the small percentage of women with primary causes of unsuccessful lactation.

Insensible weight loss in children under one year of age.

A selected group of 12 breast-fed infants were studied for insensible weight loss over the first year life. The method used to determine the insensible weight loss was non-invasive and based on a computerized weighing system. Findings indicate that the insensible weight loss in a one-year-old child reaches 36% of the average insensible weight loss reached in adulthood (360 g/day). Furthermore, the insensible weight loss (g/h/kg) was constant at about 1.9 g per kilogram per hour over the first year of life. Insensible weight loss contains two components, insensible water loss (92%) and metabolic losses (8%).

Contemporary breast-feeding management.

This article updates clinicians in the successful initiation and practical management of nursing couples. Routine breast-feeding anticipatory guidance is provided, and specific problem-solving techniques offered for commonly encountered lactation problems. The physiologic basis of normal lactation is emphasized and related to specific problems. Issues addressed include the management of lactation in the presence of maternal employment, infant failure-to-thrive, maternal drug therapy, and infant prematurity.