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how-much-milk-breastfed-babies-eatWhen you’re exclusively pumping for your baby – or even if you’re both nursing and bottle feeding pumped milk – it can be hard to know exactly how much your baby should be eating. How much should your baby get per feeding? How much should he or she eat in a day?

Many people feeding pumped breast milk (including me, when I was a new, confused, and sleep-deprived exclusive pumper) refer to formula feeding guidelines for an idea of how much they should be giving their babies. However, formula and breast milk aren’t the same – for example, breast milk is metabolized faster than formula. And because most breastfed babies are nursed, there is no way to tell how much they are taking in (short of weighing them before and after every feeding with a baby scale).

I recently did a survey of women that exclusively pumped for their babies, and one of the questions that I asked the respondents was how much milk their babies ate on a daily basis. I’ll go through these results first, and then go through the recommendations for formula fed babies to see how they compare.

What is the average milk intake per day for breastfed babies drinking from bottles?

The overall average intake for babies across the first year was 26.8 oz (792.5 ml); after one month of age, the minimum reported daily intake for was 16 oz (473 ml) and the maximum was 48 oz (1,420 ml). Below is a chart showing how the results were distributed:

how-much-do-breastfed-babies-eat

Here we can see that most babies eat between 24 (710 ml) and 30 oz (887 ml).

As one might expect, breast milk intake varied slightly with the baby’s age, with it averaging slightly lower in the first month of life and then increasing up to between 26 and 28 oz (770 and 828 ml) until about 10 months of age. At this point, presumably, solids are making up a more substantial part of the baby’s diet, and the average drops down to 25 oz (740ml) at 10 months and 19.5 oz (577 ml) at 11 months.

milk_baby_eats_by_age

I also looked to see if breast milk intake varied by any other factors that I had asked about in the survey, such as the age of the mother, whether the baby was a first baby or a subsequent child, and race. I didn’t find any statistically significant differences based on maternal or child characteristics, except for the age of the baby as described above.

The one relationship that I did find with regard to a baby’s intake of breast milk was the amount of milk that the mother pumped. Mothers that pumped more milk tended to feed their babies more milk.

This could be for a few different reasons. For example, mothers that switched from nursing to exclusive pumping might be closely in sync with the amount of milk that their baby needs. Additionally, women with supply on the low end of the spectrum that have babies that also don’t need as much milk might not work to bring it up as much as mothers whose babies take in more.

How does this compare to formula feeding guidelines?

I was curious whether or not the results that I got in survey would be similar to formula feeding guidelines, so I looked up the American Academy of Pediatrics guidelines. Reading them is a bit confusing, as the descriptions of appropriate intake use three ranges – the age of the baby (i.e., 1-3 months), the amount of formula (i.e., 2-3 oz), and the number of feedings (i.e., every 3-4 hours).

To simplify things, I broke the guidelines down into the below table:

baby_formula_guidelines

Here we can see that the total daily recommended intake is fairly close to the averages reported above for babies by age. The recommendation is slightly lower in the beginning, but on par with actual totals for breastfed babies by six months.

The guidelines specifically state not to feed a baby more than 32 oz (946 ml) of formula per day. I’m not sure whether or not that recommendation would also apply to breast milk, but over 10% of the respondents’ babies drank more breast milk than that on a daily basis.

(Including mine! The baby that I exclusively pumped for was a really big baby who ate 40 oz of breast milk on the regular, so hopefully it’s not an issue for breast milk.)

Note: The typical feeding schedule for breastfed babies may be very different from that of formula-fed babies. It’s more common for breastfed babies to eat more often and less on schedule than formula-fed babies, likely because (as noted above) breast milk is metabolized more quickly than formula. This discussion is only about total intake.

So, what should you do with this information?

I get frequent questions as to how many ounces should be in a baby’s bottle at given ages. My goal with this post was to be able to give mothers a ballpark as to what is “normal” for breastfed babies to eat in a given day, and if you want, you can use this as a starting point that you can tweak based on your baby’s needs. As you can see from the first chart, there is a huge variation in what breastfed babies will eat in a given day – your baby might be one that only needs 20 oz per day or one (like mine) who needs a lot more.

Ultimately, though, I would let your baby be your guide. If he finishes his bottle and still seems hungry and isn’t soothed by a pacifier or any of your other tricks, then I would go ahead and feed him more. If he’s on the other end of the spectrum and just doesn’t like to eat much, I wouldn’t push it unless there is an issue with weight gain (and then I would discuss the best approach with your pediatrician).

Note: If you’re a data geek like me and interested in more survey data, I wrote an e-book about exclusive pumping and milk supply that makes extensive use of it; you can check out here. I’ve also written this post and plan on additional ones in the future.

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lactation-consultants-exclusive-pumpingThe majority of women who exclusively pump struggled with nursing their babies before transitioning to exclusive pumping. Often, these new mothers worked with a lactation consultant shortly after their baby’s birth to try to get their baby to latch or to troubleshoot weight gain issues in their infant.

Because exclusively pumping is a bit of an outlier breastfeeding scenario, lactation consultants may not be as familiar with it as an option and how they can best support mothers who decide to do it. I asked readers of my website about their experiences, and what they wish that their lactation consultants had known about exclusively pumping. Below is what they said.

1. Exclusively pumping long term IS possible.

My experience – and that of many of the exclusive pumpers who responded – was that the lactation consultants that we spoke to were dubious that pumping exclusively would work for very long. Often, the message was that the pump is not as effective as a baby in removing milk, and that it was inevitable that our milk would dry up if we didn’t nurse.

It is true that some women don’t respond well to the pump and do struggle with producing enough milk when they are using one, but this isn’t the case for everyone. Some of us are even able to pump much more than our babies could eat; in my case, my supply was actually greater at around 50 ounces per day for the baby I exclusively pumped for than for the two babies that I nursed, where I’d estimate it closer to 30-35 ounces. There are thousands of mothers who have exclusively pumped for six months to a year, myself included.

Exclusively pumping long term is absolutely possible and is a viable option for women who for whatever reason are not able to (or do not want to) nurse. When working with a new mother who is really struggling with nursing and ready to give up, it would be beneficial for a lactation consultant to support exclusive pumping as an option rather than to continue to encourage them to try to nurse, if that is what the mother wants. As Livie Larson, a former exclusive pumper, said, “We need to know that it’s possible, and to hear success stories of those who’ve done it for however long that they could.”

2. Women who are considering exclusively pumping need information, help, and support specific to their situation.

Exclusive pumpers need different information and support than nursing mothers. In particular, some things that would be helpful include:

  • Help finding the right size breast shield. Many women use the wrong size – especially if the size they need didn’t come with the pump – and they don’t know how to determine what size they should be using. Written descriptions and pictures can be difficult to decipher. A lactation consultant can be really invaluable in watching a new mother pump and determining what size flange she needs.
  • Information about storing and using expressed milk, including how long milk can be refrigerated or frozen, and whether bottles that weren’t finished can be offered at the next feeding.
  • Information about how the pump works and about pump parts and how to clean them.
  • Information about how often and for how long to pump when exclusively pumping. A guideline to start is to pump as many times a day as the baby is taking a bottle, with the total amount of pumping time per day being about two hours.
  • Help connecting new exclusively pumping moms with veteran exclusive pumpers.

3. Rules about pumping for nursing mothers don’t always apply to exclusively pumping mothers.

Some guidelines about pumping that make sense for nursing mothers don’t work as well for mothers who do not nurse. For example, quite a few exclusive pumpers reported that they had been told to limit the amount of time that they spent pumping to 10 to 15 minutes.

Indeed, in many cases, it’s better for nursing mothers to not pump for excessive periods of time, because it can lead to oversupply, foremilk/hindmilk imbalance, and forceful ejection. However, this particular rule about the length of pumping sessions doesn’t apply to exclusive pumpers, as none of these things cause adverse issues for exclusively pumping women or their babies. For example, forceful ejection is not an issue for a baby that is drinking the milk from a bottle. Foremilk/hindmilk imbalance issues are mitigated by the fact that all of the milk is mixed together in a bottle, so it’s not necessarily the foremilk that the baby drinks and fills up on first.

Because exclusively pumping mothers may need to pump for longer periods of time in order to build their supply – for some women, sessions that are less frequent but longer can work better – not suggesting a strict 10-15 minute limit would be beneficial to women who aren’t nursing.

Additionally, it’s common advice to put a newborn to the breast every two hours when babies are very young; some exclusive pumpers reported being told to “just pump every two hours” to mimic this feeding schedule. However, pumping every two hours is much more difficult than nursing every two hours, especially through the night, given that the mother may also have to care for her baby at the same time.

Instead, it may be helpful to suggest pumping every 3-4 hours at night for slightly longer periods of time, and every two hours during the day, if possible. Additionally, lactation consultants could also provide guidance on how to get those pumping sessions in while caring for a baby. For example, using a hands-free bra to pump can enable you to hold the baby or feed the baby while pumping; putting a bouncy seat on the floor next to you while you pump is another good option.

4. Remember that exclusive pumpers are trying as hard as they can.

Many exclusive pumpers said that they felt as if their lactation consultants thought that they were “giving up” by choosing to exclusively pump. One exclusive pumper, Tracy Turtel, said that lactation consultants should “understand that not being able to breastfeed is a huge disappointment and loss to many of us. Treating us like we’re failures does not help, nor does pushing us to do something we know isn’t right for us.”

Exclusive pumping is much more work than nursing is. In many ways, it is the worst of both of the breastfeeding and formula feeding worlds. Like a nursing mother, an exclusive pumper needs to be concerned with her milk supply and how often she needs to pump, as well as her breast health and issues such as engorgement, clogged ducts and mastitis. At the same time, like a formula feeding mother, she is constantly preparing and washing bottles.

“There is so much extra work – washing the bottles and pump parts, storing the milk, and pumping every 3 hours on a different schedule than the baby. It’s as if I have twins! One that needs a milk input and one that needs a milk output,” said Jodi Rowland, another exclusively pumping mom.

Because it is so hard, very few women choose to do it over nursing, and most feel that for them it is a choice between exclusively pumping and formula feeding. Helping mothers who want to nurse so that they can avoid all of this extra effort is wonderful; however, once a mother has decided to exclusively pump, supporting her and recognizing how hard she is working is invaluable.

In summary, lactation consultants that recognize that exclusively pumping is a viable option, support them in their decision, and provide them with the information that they need will be instrumental in helping these mothers meet their (new) breastfeeding goals.

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One product that I have been wanting to try with baby #3 (that was introduced since I weaned my last baby) is the Freemie.

The Freemie is a completely different kind of milk collection system. Most pumping systems have three major parts – a breast shield that fits over your nipple, a pumping mechanism (breast shield body, membrane/valve, etc.), and then a bottle that the milk is collected in. The Freemie has the same three things, but instead of being pumped into a bottle, the milk flows into a collection cup that surrounds the breast shields and pumping mechanism. The collection cups are compatible with the Medela Pump in Style and quite a few other pumps (here is a full list).

freemie_milk_collection_system

One of the great things about the Freemie is that you don’t need a hands-free pumping bra – you can just put the collection cups in your bra and you’re all set.

However …. the Freemie manufacturer advertises that you can “pump anywhere, in front of anyone” with your shirt on using these cups. In fact, the box shows a woman chopping vegetables while pumping (well, presumably she’s pumping – I’m not sure why else there would have been a lady chopping vegetables on a box of pumping equipment).

I am not sure that it is as easy and freewheeling as they make it sound. First, in terms of pumping in front of anyone – yes, you can definitely do that. Just to be clear, though, it’s not like no one will know what you are doing/you could do this at your desk or something undetected. First, the collection cups are rather large, so it’s obvious that you’ve stuffed your bra with something. Additionally, you still have to actually be attached to the pump itself, which means that you have tubing coming out of the top of the collection cups, and you’d have to thread that back down through your bra so that it can be connected to the pump from the bottom of your shirt. And, of course, there is still the sound of the pump.

So you can pump in front of anyone, but (in my opinion) it’s the same experience that you get with a cover and hands-free bra.

I used the Freemie system for a day when I was working from home. I wanted to love them, but to be honest, I didn’t really like them, for the following reasons:

  • Normally, I refrigerate my pump parts in between pumping sessions and only wash them at the end of the day. With these, I really think you’d have to wash everything after every use because you have to remove the collection cups to get the milk out, and I ended up needing to touch the valve and the “inside stuff” of the pump when doing that.  You don’t generally need to do that with traditional pumping systems; you can just disconnect the tubing, remove the bottle, and throw it in a ziploc bag in the fridge.
  • I found these a bit painful, as if the flanges were too small. I normally use a 27mm flange, and I used the 28mm that came with the Freemie (it comes with a 25mm and a 28mm), but by the end of the day there was definitely some irritation.
  • I was pretty concerned about spilling the milk at three different points each time I’d finished pumping – when I disconnected the tubing from the collection cup, when I opened the collection cup, and when I poured the milk into a bottle. It was sort of stressful, and this isn’t an issue with traditional pumping systems.
  • It’s not compatible with the Medela Freestyle, which I prefer over the Pump in Style because I don’t have to deal with plugging the pump into an outlet.

To be fair, it may also be that I am having a hard time adjusting to the completely different way that these work after pumping “the old way” for 3 (non-consecutive) years now.

Here are some photos of my collection cups after pumping, which might help you visualize how it works:

freemie-reviews

In summary, I love the idea, and I can see how other people might really like it – not having to deal with a hands-free bra is great! However, I am not sure that I’ll be using mine again.

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