Expert: Sally Wendkos Olds - 9/29/2009

Question
I have been successfully breastfeeding my now one-month old son and plan on continuing for at least a year. However I must return to work full time in another two weeks. I have been pumping and freezing the milk to build up a supply before I go back to work. My question is about how much milk my son will need for each bottle feeding while he's away from me. He is currently about 10 1/2 pounds and nurses about every 2-3 hours during the day and every 3-5 hours through the night. The couple times we have given him breastmilk in a bottle (to accustom him to eating from a bottle before I return to work) and I pumped instead of having him nurse, I got about 3-5 ounces - but he has only taken 2 ounces from the bottle one time and 4 ounces another time. Is there any general rule to know just how much he needs to be drinking per feeding? Thanks for your help.

Answer
Dear Angela,

First, congratulations for giving your son the best start in life by breastfeeding him! I have to commend you for accustoming him to the bottle before you go back to work so he won't have to deal with two changes at once.

As you have already discovered and will continue to learn, babies are unpredictable. They don't always get hungry at the same times and vary from feeding to feeding in what they want. He may take 3 to 4 ounces of bottled milk at one feeding (probably his typical amount at his size) and only 2 ounces at the next. In order not to waste your precious breast milk, I suggest that you freeze it in two-ounce portions and have your caregiver offer only that amount at a time. Then if he still seems hungry, the caregiver can thaw another two ounces and give that. You'll just have to work out the amounts by trial and error over the first month or two after you return to work.

Another possibility would be to take to your caregiver freshly pumped milk, which can be kept in the refrigerator for a few days, rather than frozen milk.

I'm attaching an excerpt from the new edition of my book (see below), which may be helpful. I have an entire chapter devoted to issues of pumping, storing, and feeding breast milk.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
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Storing Freshly Expressed or Pumped Breast Milk
• To be given to baby within 4 hours: Ideally, cool or refrigerate as soon as possible after expressing, but if necessary it can be kept at room temperature, even in a warm room (66° to 79°F or 19° to 26°C).
• To be given to baby within 4 to 10 hours: Pour into a clean container; cap tightly. If convenient, refrigerate the milk or put it in a cooler with frozen ice packs. This is the safest course, even though human milk kept in a capped clean container does not grow bacteria at normal room temperature (66° to 72°F or 19° to 22°C) because of its bioactivity, its ability to slow the growth of bacteria. If the room temperature is higher than 72°  (22°C), refrigerate it.
* To be given to baby within 24 hours: Immediately put milk in a clean container and cap tightly, and as soon as possible put it in a cooler with frozen ice packs; refrigerate when you arrive home.
• To be given to baby within 1 week: Pour into a clean container; cap tightly. Refrigerate at 40°F (4°C) or below. Although it should keep well for a week, ideally if you want to keep it longer than three days, it’s best to freeze it.
• To be given to baby within 3 months: Pour into a clean container; cap tightly. Quick-cool in the refrigerator for 30 minutes. Then freeze in refrigerator-freezer unit.
• To be given to baby within 6 months: Pour into a sterile container; cap tightly. Quick-cool in the refrigerator for 30 minutes. Then freeze at 0°F (-18°C) or below in the freezer of a two-door refrigerator or a deep freeze that is not opened often. Not all freezers stay cold enough for long-term storage. Check the temperature with a freezer thermometer at different places in the unit. The freezer should maintain a constant temperature of 0°F. If it keeps ice cream very solid, it’s probably cold enough.
  If your freezer does not get this cold but does keep other frozen foods hard, keep the milk in the center of the freezer and use within three to four months. Frost-free refrigerators, which have a warming element, generally do not maintain 0°F (-18°C) – see “igloo” suggestion on page tk.
  To find out whether your milk thaws and then refreezes in your freezer, check by keeping an ice cube in a little jar; if you check it a day later and find that it no longer has the shape of the cube but that it has melted and refrozen, you’ll know that this has probably happened to your milk, too. Smell the milk to see if it’s still good. If you’re in doubt, discard it.
  Use milk as soon as possible after collecting it. Ideally, you won’t keep it longer than three months. For one thing, milk collected when your baby is two months old won’t meet her needs as effectively when she’s six months old – although it’s still better than formula!
• Keeping breast milk longer than 6 months: This is not a good idea. While instructions are sometimes given for keeping frozen milk up to two years, long-term freezing alters the chemical composition of the milk. (Some of the fats break down, and the milk loses some of its ability to fight harmful organisms.) Furthermore, you run the risk of contamination if you lose electrical power during that time and the milk thaws and refreezes.
• Do not refreeze milk that has defrosted: If frozen milk has started to thaw, refrigerate it immediately and use it within 24 hours.

Storing Milk That Has Been Frozen and Thawed in Refrigerator
•   Do not refreeze, do not thaw at room temperature, and do not store in cooler.
•   To be given to baby within one hour: Keep in container in refrigerator, or cooler, or at room temperature.
•   To be given to baby within 24 hours: Keep in container in refrigerator.  

Storing Milk That Has Been Thawed and Warmed
•   Do not refreeze and do not store in cooler.
•   To be given to baby right away: feed baby.

Milk That Has Been Warmed and Left in Bottle after Feeding
•   Do not store. Throw away any milk left in a bottle because organisms from the baby’s mouth can contaminate the rest of the milk. This is why it’s best to store expressed milk in small quantities.