Written by Jody Segrave-Daly, RN, IBCLC

Every bit a veteran NICU, nursery nurse, and lactation consultant, I take cared for and fed thousands of babies over the past 30 years. When working in the special care plant nursery, babies are fed co-ordinate to their weight and cumulative losses to make up one's mind their caloric requirements for intake amounts and optimal nourishment. For example, term babies admitted to the NICU from complications of hypoglycemia (low blood sugar) are immediately fed based on their weight, usually well-nigh sixty-fourscore ml/kg/twenty-four hour period (typically 15-thirty ml) every ii-3 hours. Newborns fed 15-xxx ml volition likely take their insufficient feeding complications stabilized and demonstrate feeding satisfaction and comfort considering the newborn stomach is at least four times larger than what is taught.

Get-go, we should review the anatomy of the newborn digestive system.

Newborn digestive system. Photo credit St. Lukes Hospital Organization, KS

Gastric emptying is a continuous motion into the small intestine which accommodates milk volume to exist more than 5-vii ml every 2-3 hours. The stomach is a muscular and very stretchable organ. Its biological role is to expand to hold nutrient and fluids while churning with digestive enzymes before entering the duodenum or small intestine. A total-term baby swallows 500-1000 ml of amniotic fluid every twenty-four hours. Ultrasound tin can confirm the tummy's size and measure when the baby swallows amniotic fluid. The newborn stomach does not magically or suddenly grow subsequently twenty-four hour period one as taught to parents. My concern every bit a long-time NICU nurse, baby feeding specialist, and IBCLC has always been why mothers are taught their exclusively breastfed newborn baby's stomach capacity is only 5-7 mL on twenty-four hour period one, which is fake.

The Myth of the Newborn Stomach Size: Where Did it Come From?

I started my research with my not-clinical lid on and turned to Google since this is where my patients typically get first. When I did a Google search for newborn stomach sizes, there were over 868 thousand links!  I was led to a plethora of visual images depicting newborn stomach size. Some of the nearly popular images were the abdomen ball models that lactation consultants clothing on their lanyards so they tin can visually brainwash new mothers how big their ' newborn's stomach size is.'

I was in absolute disbelief knowing our nigh truste d lactation co nsultants were selling, wearing and using, proudly I might say very inaccurate, dangerous and non-evidence based tools that are used in hospitals. I quickly began to sympathise that 'belly bead' models are lucrative trade to sell!

Clinical hat back on, I dug into the science behind these abdomen assurance. In the 2008 Journal of Human Lactation, I found a published article that revealed a completely different utility for belly ball models.

Marble/brawl models are oft used to represent newborn stomach capacity; however, their accuracy has not been determined:

"Measurement of infant tummy chapters has been attempted for ove r 100 years. Exact volumes cannot exist standardized, but data suggest that anatomic tum capacity and physiologic tum capacity vary widely." In addition, "Information technology is of import to note that because a wide range of feeding volumes on twenty-four hour period ane (i-twenty mL) and twenty-four hours iii (13 to 103 mL) has been reported, and the reasons for these variances are unclear, it may exist best to simply acknowledge that feeding volumes vary widely and similar tum capacity, do non lend well to the visual representation given our current knowledge."

This inquiry was published in the Journal of Human Lactation and yet, not a single lactation professional is practicing what the show says. How can this be?

Despite that qualification, new moms are inundated with images where there are a series of bottles filled with milk depicting the size of an baby's breadbasket according to each 24-hour interval later on birth, sometimes compared with fruit or unlike-sized marbles and balls. A mother sent this picture to us, which was in her infirmary room later on the birth of her babe. She also received inaccurate teaching almost the newborn stomach size and thought her formula-fed babe only needed 5 ml at each feeding.

This information is Simulated and based on enquiry from 1920.

I continued to search for more resources, and I found inquiry in 2013 from   Nils J. Bergman who published this study , which says:

"In that location is insufficient evidence on optimal neonatal feeding intervals, with a broad range of practices. The tummy capacity could make up one's mind feeding frequency. A literature search was conducted for studies reporting volumes or dimensions of stomach capacity before or afterward birth. Six manufactures were constitute, suggesting a tum capacity of 20 ml at birth."

Stomachsize1.pptx (1)

Co-ordinate to Dr. Bergman, "There is reasonable consensus on the amount of milk that man term newborn infants need per twenty-four hour period, figures given vary from 150 to 160 mL/kg/day." This means that an average iii kg or half-dozen.6 lb newborn requires 450-480 mL or 16 ounces of milk a day.  At 66 Calories/dL, this would roughly exist 100-106 Cal/kg/twenty-four hours, which is the published daily caloric requirement for a newborn.  This total volume tin be given in smaller volumes more than frequently or larger volumes less frequently, ii ounces every three hours or ane.iii ounces every ii hours.

His article poses the hypothesis that the feeding interval should be twenty mL every i hr, bold that the stomach empties only once every hour.

However, the existent-life clinical awarding of his suggested feeding interval would quickly lead to maternal and newborn exhaustion from lack of sleep and increased hazard of postnatal depression, breastfeeding cessation, and even suffocation from a mother falling asleep with her newborn during breastfeeding. In improver, his feeding interval does non have into account that the stomach actually empties during feeding and therefore the feeding capacity of a newborn is higher than 20 mL. The clinical expertise of neonatal health professionals has shown that fifty-fifty one-solar day-one-time newborns are able and exercise comfortably tolerate 15-xxx mLs per feeding.

Additional newborn stomach size research

Near popular breastfeeding pedagogy resources for new parents also refer to inaccurate information by teaching the tummy size is 5-7 ml on twenty-four hour period ane. This picture is from a mother who delivered in a Baby-Friendly Hospital this week. Imagine her confusion when her baby required additional amounts of supplementation to treat hypoglycemia.

No one could explain to her why her infant could comfortably tolerate more milk than what she was taught in this infirmary pedagogy resource booklet.

Dr. Gomez, a neonatologist, explains why hypoglycemic babies (low blood sugar) demand more than than 5 ml of milk despite being told their infant's tum can just hold 5 ml.

"Nosotros don't have any potent evidence as to the size of the stomach for each baby. Nevertheless, we practice take meaning scientific evidence that hypoglycemia and under-hydration cause damage to the brain of the infant.

We have solid evidence that feeding babies 10-20 mls when they are born is adequate to keep the blood glucose levels up in nearly babies. Some volition still need some other interventions, just 10- 20 ml feedings are enough most of the time.

There is no evidence that feeding x to xx ml of milk to a baby causes "stretching of the stomach," and we don't take ANY testify that this is detrimental to the baby."

We have bear witness that judicious supplementation helps babies and does not touch on breastfeeding rates.

So the question is, are we hurting babies by supplementing? NO. Are we hurting babies past not supplementing and allowing them to have hypoglycemia or dehydration? Yep.

According to the Academy of Breastfeeding Medicine Supplementation Protocol, they suggest exclusively breastfed babies are fed 2-10 ml per feeding, and they reference the infant stomach size co-ordinate to outdated studies (1992 and 1920) to reflect intake volume . They also say in that location is no definitive research available and the amount of supplement given should reflect the normal amounts of colostrum available, the size of the baby'due south stomach, and the age and size of the infant. The fluid and caloric intake on solar day two postal service-nativity should be higher than day one in relation to the infant'south caloric demand. Based on the limited research available, suggested breast milk intakes for healthy, term infants their feedings should exist based on satisfaction cues despite their guidelines. Unfortunately, this information contributes to additional defoliation that already exists for parents. What they do say is research is necessary to establish evidence-based guidelines on appropriate supplementation volumes for specific conditions and whether this varies for colostrum versus babe formula.

Only why don't we already know this if an infant feeding protocol has been implemented in hospitals? Protocols are supposed to be peer-reviewed for scientific accuracy.

Speaking of HUNGER cues and feeding your baby to satisfaction, hither are signs that your newborn baby needs immediate attention:

We have been talking nigh the newborn stomach size simply What about calories? How many calories do human milk, baby formula, and colostrum contain in 5-7 MLS?

What research tells us is :

  • Mature chest milk averages effectually 20 calories per ounce (~xxx mL)
  • and babe formula contains 20 calories per ounce likewise.
  • Colostrum is lower in fat and carbohydrates and comes in effectually 17 calories per ounce (~30ml) (Guthrie 1989).

How many calories do term newborns need to ensure Cell Survival?

#2 Why Fed is Best- CaloriesColostrum(1)

As you can see, exclusively breastfed newborns cannot thrive on three calories per 5 ml (one teaspoon) of colostrum at each feeding.

Why exercise some babies tolerate fasting before the onset of copious milk production and other babies practice not?

Some exclusively breastfed babies are fasting after nativity if they are not receiving enough colostrum. 1 in 5 new mothers will feel delayed onset of copious milk production from various take chances factors. This puts these babies at chance for developing complications from insufficient colostrum intake while breastfeeding.

ane in 71 exclusively breastfed babies are rehospitalized for life-threatening complications from insufficient colostrum intake. As lactation and neonatal medicine professionals it is imperative to update our educational resources and identify the babies who may need timely supplementation before the onset of copious milk production. For mothers who desire to exclusively breastfed, donor milk should be fabricated available for them to utilise if supplementation is needed. In society for babies to receive the full benefits of breastfeeding, they demand to be safely fed at every feeding.

Then how oftentimes should exclusively breastfed babies swallow?

There is no single correct respond to this question because each infant has a different weight and unique caloric requirement. By merely weight alone, a 6.6-pound baby has an average size stomach of twenty mL on day one and would require 40 mL or 1.3 oz of chest milk or formula every 2 hours to meet their basic metabolic needs or 60 mL every 3 hours. But babies should also be fed by babe cues to satisfaction. In other words, if your infant is crying and crying after breastfeeding, an firsthand medical examination is necessary to be certain the baby is non suffering from insufficient intake of colostrum while exclusively breastfeeding. If a medical evaluation is not immediately available, especially before the milk has come in, In that case, supplementation may exist urgently needed before medical evaluation is bachelor to prevent serious complications of insufficient feeding.

As yous tin can see, It's fourth dimension to ban the simulated belly bead models and update our breastfeeding pedagogy resources immediately. Our babies count on united states to keep them well-fed, meeting their metabolic needs with sufficient milk and using the all-time and most current infant feeding practices possible. This flawed product is harming besides many babies.

Every bit you can see, It's fourth dimension to ban the false abdomen bead models and update our breastfeeding education resources immediately. Our babies are counting on united states to keep them well-fed, meeting their metabolic needs with sufficient milk and using the best and most electric current infant feeding practices possible. As well many babies are being harmed by this flawed production.

Was your baby harmed by the belly bead lanyard production?

A mother writes: "Because of this stupid belly bead, my baby was discharged from the infirmary despite not eating enough breastmilk.  He had a seizure at home and was taken back to the hospital past an ambulance for dehydration."

  • To file a formal complaint most the abdomen bead lanyard company, click here.
  • If your baby was harmed from insufficient feeding related to this lanyard, click here for legal counsel.
  • To report the abdomen bead lanyard to the FDA for a faulty medical device used in a hospital, click here to MEDWATCH online voluntary reporting form

Normal Newborn Beefcake and Function | High Affect® Visual Litigation Strategies™

Additional enquiry about the newborn tum size:

The Pediatric Surgery Journaldescribes the newborn breadbasket beefcake, including the size of 30 ml at nascency:

Pediatric Anatomy Surgery Journal

Normal third-trimester fetal beefcake -ultrasound videos: the abdomen:

Guthrie, Helen Andrews. Introductory Nutrition. St. Louis : Times Mirror/Mosby College Pub., 1989

Breastfeeding confidence and measurement of milk intake

The American Academy of Pediatrics' Breastfeeding Guidelines

Helpful guide to safe infant feeding amounts from the American Academy of Pediatrics.

Helpful overview of babe feeding for the first month of life, from the American University of Pediatrics.

https://fedisbest.org/2018/ten/feeding-your-baby-when-supplementing-saves-breastfeeding-and-lives/

Normal Man Lactation; closing the gap

Legal Consultation on Breastfeeding Complications Resulting in Disability

If I Had Given Him Only One Bottle, He Would Exist Alive.

HOW YOU Tin can SUPPORT FED IS Best

There are many means yous tin can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join the Fed is Best Volunteer grouping to assistance u.s.a. reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. Join our private Wellness Care Provider Advocacy group on Facebook
  3. Make a donation to the Fed is Best Foundation. Nosotros are using funds from donations to embrace the cost of our website, our social media ads, our printing and mailing costs to reach health providers and hospitals. Nosotros do not accept donations from breast- or formula-feeding companies and 100% of your donations become toward these operational costs. All the piece of work of the Foundation is accomplished via the pro bono and volunteer work of its supporters.
  4. Share the stories and the message of the Fed is All-time Foundation through word-of-mouth, by posting on your social media folio, and past sending our resources to expectant moms that you know. Share the Fed is All-time campaign alphabetic character with everyone you know.
  5. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may accept experienced.
  6. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care, and hospitals.
  7. Write your local elected officials about what is happening to newborn babies in hospitals and ask for legal protection of newborn babies from underfeeding and of female parent'southward rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  8. Send the states your stories. Share with us your successes, your struggles, and everything in between. Every story saves another child from experiencing the aforementioned and teaches another mom how to safely feed her baby. Every voice contributes to change.
  9. Ship us messages of support. We work every single 24-hour interval to make infant feeding safe and supportive ofevery mother and kid.  Your messages of support keep us all going.

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Thanks and so much from the Founders of the Fed is Best Foundation!

Jody and Christie