Welcome to the lactation page of the Mother & Child website. This information is provided for quick reference and not to be used instead of a medical consult or to replace the recommendations of your medical doctor or your lactation consultant.  We hope that you will find this page a helpful resource for your lactation questions.

How can I keep track of feedings and etc? answer

How many calories are in breastmilk? answer

What affects the amount of fat and calories in a mother's milk? answer

What is APNO ointment? answer

How can I keep track of feedings and etc?

Below is an example of a chart that we use.  Time of day, which breast is used to start the feeding, how long nursed, if you refer to the clock, if a bottle was used what was the volume of feed, was it expressed breastmilk or formula, was the diaper changed, comments is a great spot for burp, hiccups, spit up information..etc. 

To print this blank chart click here

						Mother & Child
						(508) 769-8521
	NAME:	Hannah							DATE:	1/2/2010
	TIME	R/L	MINS	AMT	B/F	WET	BM	COMMENTS
1	6A	Left/right	20/15	0	0	large	o	Wet burp -
2	9A	Right/left	15/15	2 oz	breast	large	Sm. yel	Comf.
3
4
5

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How many calories are in breastmilk?

Average calorie & fat content of human milk

The average calorie content of human milk is 22 kcal/oz. Caloric content varies widely throughout each feeding and the day, however, due to changing fat content. The amount of fat in human milk changes dramatically during each feeding and throughout the day, since fat content depends on the degree of emptyness of the breast (empty breast = high fat, full breast = low fat). The average fat content of human milk is 1.2 grams/oz.

Calorie & Fat Content of Human Milk
	Average	Range
Energy	22 kcal/oz	13 - 35 kcal/oz
	75 kcal/100 mL	45 - 119 kcal/100 mL
Fat (total lipids)	1.2 g/oz	0.6 - 1.5 g/oz
	4.2 g/100 mL	2 - 5 g/100 mL
	3-5%	1-10%
References: Hamosh 1991, p. 118; Jelliffe & Jelliffe 1978; Lawrence 1999, p. 108, 305, 738.

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What affects the amount of fat and calories in a mother's milk?

• Mom's diet? The research tells us that mom's diet doesnotaffect the average amount of fat or calories in her milk. However, mom can change the types of fat in her milk by altering the types of fats that she eats (Lawrence 1999, p. 106-113, 300-305; Hamosh 1996, Hamosh 1991, p. 123-124). An increase of one fatty acid could generally be expected to occur concurrently with a decrease in another. For example, one study has shown that black mothers in South Africa who eat a traditional maize diet have less monunsaturated fatty acid in their milk than urban mothers who consumed more animal proteins and fats (van der Westhuyzen 1988).

• The degree of emptiness of the breast is what research has shown to drive breastmilk fat content, and thus calorie content. The fuller the breast, the lower the fat content of the milk; The emptier the breast, the higher the fat content of the milk (Daly 1993). For more information see I'm confused about foremilk and hindmilk - how does this work? and How does milk production work?

FULL Breast  =  LOWER Fat Content & SLOWER Milk Production

EMPTY Breast  =  HIGHER Fat Content & FASTER Milk Production

• Breast compression has been shown to increase fat content of milk (Stutte 1988). 

The above information tells us that milk fat may be more effectively increased through 'mechanical'means (i.e. longer & more frequent feeding, massage, breast compression, expressing foremilk before nursing) than by changing mom's diet.

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What is APNO ointment?

1. “All purpose nipple ointment” (APNO)
This combination of 3 ingredients seems to help for many causes of sore nipples, including poor latch, Candida (yeast), dermatologic conditions, infections of the nipple with bacteria and possibly other causes as well. It is always good, however, to try to assure the best latch possible, because improving the latch helps with any cause of pain.
mupirocin 2% ointment (not cream): 15 grams
betamethasone 0.1% ointment (not cream): 15 grams. If betamethasone ointment is unavailable, mometasone ointment (15 grams) can be used instead. It is better not to mix creams and ointments.
To which is added miconazole powder so that the final concentration is 2% miconazole. Sometimes it is helpful to add ibuprofen powder as well, so that the final concentration of ibuprofen is 2%.
This combination gives a total volume of approximately 30 grams. Clotrimazole powder to a final concentration of 2% may be substituted if miconazole powder is unavailable, but both exist (the pharmacist may have to order it in). I believe clotrimazole is not as good as miconazole, but I have no proof of that. Using powder gives a better concentration of antifungal agent (miconazole or clotrimazole) and the concentrations of the mupirocin and betamethasone remain higher.
The combination is applied sparingly after each feeding (except the feeding when the mother uses gentian violet). Do not wash or wipe it off, even if the pharmacist asks you to. In Canada, Kenacomb (easier to find) or Viaderm KC (less expensive) ointments (not cream) can be substituted for the above combination, but are distinctly inferior. I used to use nystatin ointment or miconazole cream (15 grams) as part of the mixture, and these work well, but I believe the use of powdered miconazole (or clotrimazole powder) gives better results.
Any pharmacist should be able to make up this ointment, but not all want to. Not all pharmacies carry all the ingredients. If you are having difficulties, ask the pharmacist for the nearest compounding pharmacy.
Dr. Jack Newman

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