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Belly Models as Teaching Tools: What Is Their Utility?

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Journal of Human Lactation http://jhl.sagepub.com/

Belly Models as Teaching Tools: What Is Their Utility?

Amy K. Spangler, Andrea L. Randenberg, Michelle G. Brenner and Maeve Howett
J Hum Lact 2008 24: 199
DOI: 10.1177/0890334408316079

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 Reviews

Belly Models as Teaching Tools: What Is Their Utility?

Amy K. Spangler, MN, IBCLC, Andrea L. Randenberg, BSN, IBCLC, Michelle G. Brenner, MD, IBCLC,
and Maeve Howett, PhD, IBCLC

Abstract
Marble/ball models are often used to represent newborn stomach capacity; however, their accu-
racy has not been determined. The objective of this review was to analyze data on newborn
stomach capacity and determine whether marble/ball models serve as accurate representations.
A literature search yielded limited data, most emanating from the early 1900s. Data suggest that
anatomic capacity of the newborn stomach varies with the birth weight of the infant. Physiologic
capacity bears no relation to anatomic capacity of the newborn stomach but is a measure of the
ability of the mother to produce milk and the newborn to ingest milk. Given the wide range of
feeding volumes on days 1 and 3 and the reported 8-fold increase in average feeding volume
during the same time period, it is best to acknowledge that feeding volumes like anatomic stom-
ach capacity vary widely and do not lend well to visual representation by marble/ball models.
J Hum Lact. 24(2):199-205.
Keywords: newborn stomach capacity; marble/ball models; physiologic capacity;
anatomic capacity

Introduction removal.1,2 However, it is not unusual in the early puer-

Healthy, full-term, breastfed, newborn infants typically
have no need for supplements to their mothers’ milk
assuming early, frequent feeds, and adequate milk
Received for review April 23, 2007; revised manuscript accepted for publi-
cation December 28, 2007.
Amy K. Spangler is a registered nurse as well as an international board certi-
fied lactation consultant. She has served as president of the International
Lactation Consultant Association and chair of the United States Breastfeeding
Committee. She is a member of the affiliate faculty at Emory University School
of Nursing and a perinatal instructor at Northside Hospital. Andrea L.
Randenberg is a registered nurse certified in neonatal intensive care nursing as
well as an international board certified lactation consultant. Michelle G.
Brenner is an international board certified lactation consultant. She has been in
private practice pediatrics and is currently in academic pediatric practice at
Children’s Hospital of The King’s Daughters in Norfolk, Virginia. She is
a member of the American Academy of Pediatrics Section on Breastfeeding, the
International Lactation Consultant Association, and the Academy of Breastfeed-
ing Medicine. Maeve Howett is a pediatric nurse practitioner and lactation con-
sultant in Atlanta, Georgia. She is presently a clinical assistant professor in
family and community nursing at Emory University. Her research interests are
interdisciplinary, focusing on women’s experiences of infant feeding in breast-
feeding and nonbreastfeeding mothers and early childhood nutrition.
Address correspondence to Amy K. Spangler, MN, IBCLC, 12 Ball Creek
Way, Atlanta, GA 30350; e-mail: amy@amysbabies.com.
J Hum Lact 24(2), 2008
DOI: 10.1177/0890334408316079
© Copyright 2008 International Lactation Consultant Association
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perium for parents to express a concern that there appears
to be very little “milk” or colostrum in the mother’s
breasts. In an effort to allay their concerns, it is a popular
practice among breastfeeding educators to use a set of
balls, beads, nuts, marbles, or similar objects as a teach-
ing tool to illustrate the small size of a newborn infant’s
stomach. Use of belly models is a way of demonstrating
to new parents that the small amount of colostrum pro-
duced by the breast may match the amount the newborn
infant’s stomach can hold. The belly models also reinforce
the need for the infant and mother to remain close together
for frequent and uninterrupted feedings.3 A 2006 La Leche
League International publication4 about colostrum intake
reports that
A one day old baby’s stomach capacity is about 5-
7 ml or about the size of a marble. By day three the
newborn’s stomach capacity has grown to about
0.75-1 ounce (22-29 ml) or about the size of a
“shooter” marble. Around day seven the newborn’s
stomach capacity is now about 1.5-2 ounces (44-59
ml) or about the size of a ping-pong ball.
Comparable teaching tools assign similar but slightly
different capacities to the small marble (5-7 mL),
199
200
shooter marble (22-27 mL), and ping pong ball (60-81
mL).5 The popularity of these tools suggests that a
visual representation of a newborn’s stomach capacity
is clinically useful to practitioners as an adjunct to par-
ent education. This review is an effort to understand if
the belly models are expressing accurate information
about infant stomach capacity and feeding volumes in
the newborn period, as the initial data to support the
use of the models was published nearly a century ago.
First Days and Small Volumes
Before birth, the fetus is housed in a sterile environ-
ment and the stomach is exposed only to amniotic fluid.
Soon after birth, the newborn is exposed to an open
environment and the stomach must process nutrient-
dense colostrum or infant formula. Although mechanisms
responsible for the rapid growth and functional matura-
tion of the stomach remain unclear, there is evidence that
both endogenous hormones and ingested nutrients play
an important role.6
During the period immediately after birth, the gas-
trointestinal tract undergoes profound growth, structural
change, and functional maturation.6 Mechanisms respon-
sible for the changes remain to be elucidated, but there is
evidence that ingested colostrum and immunoglobulins
contained therein may play an important role.6 The most
common explanation for small feeding volumes ingested
by breastfeeding infants in the hours following birth is
the limited availability of colostrum in the maternal
breast; however, the normal delay of the breast in sup-
plying copious amounts of milk may instead represent
one part of a complex physiologic process of assimilat-
ing the newborn into the outside world.
An editorial7 published in The Lancet in 1965
described the first feed,
In the general physiological upheaval after birth,
the first feed has excited less interest than the first
breath. If a healthy, mature baby is put to the
breast or is offered a bottle soon after birth, so lit-
tle is taken in volume and calories those three
days of self-imposed starvation can be regarded
as physiological.
The reasons for this relative fast for the first 2 or 3 days
are unclear. It is likely multifactorial and may represent
an important mechanism of adaptation to extrauterine life
that requires the infant and mother be close together for
frequent feedings. Whether the small feeding volume
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Spangler et al J Hum Lact 24(2), 2008
taken by newborns is a consequence of colostrum avail-
ability, or the delay in lactogenesis II is an adaptation for
infant protection, it is important to note that although
healthy, full-term infants possess sufficient nutrient stores
to maintain homeostasis, these stores may be insufficient
or depleted in preterm, ill, or at-risk infants (an infant of
a diabetic mother, those born with meconium-stained
fluid, or birth asphyxia).8
One potential explanation for small feeding volumes in
the hours immediately after birth was suggested by
Zangen et al9 as an immature gastric relaxation response
in accommodating the entry of a meal. In an effort to gain
insight into the mechanisms for early satiety in the first
days of life, a latex balloon attached to an 8-French feed-
ing tube was inserted into the stomach of live newborns.
The researchers evaluated pressure and volume changes
in the stomach using a computer-driven air pump to
inflate the balloon and measure volume. Receptive relax-
ation and compliance increased in response to distention
over the first 80 hours after birth and the volume of air
required to fill the stomach to a maximum pressure (30
mm Hg) more than doubled during this period. Gastric
volumes at the maximum pressure ranged from 38 to 76
mL. Increasing age and the number of feedings accounted
for more than half the measured changes in volume but
explaining how a few hours and a few meals alter gas-
tric neuromuscular function can only be speculative,
given the many physiologic changes during the first
days after birth. Suggesting that infants have “imma-
ture” relaxation is inadequate to explain why small
volumes are physiologic; however, the findings by
Zangen et al9 add further support to the importance of
not overfeeding in the first days.
The Transition to Higher Volumes
Apart from the findings of Zangen et al, little is known
about infant stomach capacity in the first days of life. The
first reports of infant stomach capacity were published
in the late 1800s using postmortem examination—
obviously a poor substitute to measurement in a live
model.10,11 In 1894, Zuccarelli attempted to measure the
capacity for stomach distention by removing the stomach
from the body of newborn infants and distending it with
water. The stomach contents after distention were approx-
imately 4.5 times the original volumes (33 mL as com-
pared with 7 mL).6,12
The first reports in live infants were done by Scammon
and Doyle13 in 1920 and focused on changes in gastric
capacity during the first 10 days of life. Scammon and
J Hum Lact 24(2), 2008
Table 1. Physiologic and Anatomic Stomach Capacity
Author Method Measure Day 1 Day 2
Scammon Prefeed and Physiologic 7 (3-60) 13 (4-60) 27 (3-110) 36 (5-130) 57 (8-140) 64 (2-155) 68 (10-145) 71 (10-160) 76 (5-148) 81 (10-210)
and Doyle postfeed capacity, mL
(1920)13 weighing (range)
Scammon Postmortem Anatomic 30-35
and Doyle exam capacity, mL
(1920)13
Doyle referred to anatomic stomach capacity as the
term given to the stomach volume measured by post-
mortem examination. Approximate feeding volume
obtained by prefeed and postfeed weighing in live
infants was termed physiologic capacity of the stom-
ach.14 Scammon and Doyle13,14 clarified their use of
the term by emphasizing that
Physiologic capacity shows little relation to the
anatomic (actual) capacity of the organ (stomach)
but is rather a measure of the ability of the aver-
age mother to furnish nourishment in this period
and the ability of the average child to receive it.
Despite being the accepted standard mechanism for
assessing breast milk intake, test weighing is actually
a measure of milk transfer (a reflection of the volume
of the milk that is provided and ingested) (see Table 1)
and not a measure of anatomic capacity.
Unlike our current understanding of the need to
breastfeed an infant 8 to 12 times in a 24-hour period,
infants in Scammon’s study were breastfed no more than
5 times a day, with many infants fed less than 5 times a
day; infants on day 1 received on average 1 to 2 feedings.
The infants are described as “breastfed” and no mention
is made of supplemental feedings. No indication is given
as to why the number of feedings was limited but is prob-
ably reflective of the encroachment of a cultural shift in
infant care that was well intentioned but based upon arti-
ficial feeding schedules. It is also important to note that
the average feeding volumes listed in the study (and
termed physiologic stomach capacities) represented a
wide range of values among mother-infant pairs with 3
mL being the smallest amount and 60 mL being the
largest amount consumed at a feeding on day 1. Infor-
mation on parity and prior breastfeeding experience was
not provided.13 However, based on this and other data
published at the time, Scammon calculated the average
newborn anatomic capacity to be 30 to 35 mL at birth
and 100 mL by 4 weeks of age, representing a 3-fold
increase.14
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Belly Balls as Teaching Tools 201
Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10
In 1987, sonogram was first used to measure stom-
ach size and was found to positively correlate with ges-
tational age from 9 to 40 weeks gestation.12 However,
the reliability of sonographic assessment of stomach
capacity based on stomach dimensions has not yet
been documented. Children of the same weight and
age might be expected to have similar stomach capac-
ities; however, varied metabolic rates, caloric needs,
and feeding frequencies may affect feeding volumes.
Milk intake or transfer during a breastfeeding is
affected by a number of variables, including, but not
limited to, the amount of milk available in the breast
(affected by the timing of lactogenesis II), infant suck-
ling skills, breastfeeding techniques, and the length of
time between feedings.
Saint et al,15 using an integrating electronic balance to
measure milk intake, reported that the average amount
of milk yield during the first 24 hours after birth in a
sample of 9 women was 37.1 mL, with a range of 7 to
122 mL. On day 3 postpartum, an average milk yield of
408 mL was reported, with a range of 98 to 775 mL.
A significant correlation was found between milk
intake, determined by weighing the infant, and milk
yield (milk volume extracted from the mother), deter-
mined by weighing the mother, but neither provide evi-
dence of stomach capacity. Milk yield was not related to
parity. Infants in the study by Saint et al15 breastfed an
average of 6 times in the first 24 hours with a range of 3
to 8 feedings. On day 2, infants fed an average of 7.5
times a day with a range of 5 to 10 feedings. There was
no significant correlation between milk yield and feeding
frequency for the first 5 postpartum days. However, by
day 14 and day 28 there was a significant positive corre-
lation between milk yield and feeding frequency.
Neville8 described a pattern of milk intake in which
mean milk transfer is low during the first 2 days post-
partum, rises rapidly on days 3 and 4, correlating with
the timing of lactogenesis II, and then increases more
slowly to reach maximum levels of approximately 800
mL per day at 6 months postpartum in exclusively
breastfeeding women.
202
Table 2. Anatomic Stomach Capacity Measured by Naveed
et al16 at Autopsy
Birth Weight, g Stomach Capacity, mL
500-1000 (n = 21) 6-10
1001-1500 (n = 18) 10-12
1501-2000 (n = 22) 12-15
2001-2500 (n = 19) 15-18
> 2500 (n = 20) 18-21
The Correlation Between Stomach Capacity
and Birth Weight
Not unlike the 19th-century colleagues discussed earlier,
Naveed et al16 examined 100 perinatal autopsy speci-
mens from 63 fresh stillbirths and 37 deaths occurring in
the first week after birth in an effort to determine stom-
ach capacity as it relates to birth weight. The stomach
was decompressed and tied at the cardiac and pyloric
end. They then loosened the cardiac end and filled the
stomach with water using a 10-mL syringe until the fun-
dus of the stomach ballooned out with obliteration of the
gastric curvatures. The water was then retrieved and the
volume recorded. Naveed et al calculated the mean of 2
consecutive measurements differing by less than 5%.
Care was taken to minimize stretch artifacts and mea-
surement errors. They found that the larger the infant, the
greater the stomach capacity, suggesting a positive cor-
relation between measured stomach capacity and birth
weight.
Table 2 shows the estimated stomach capacity for
infants of different birth weights, as derived from a lin-
ear regression equation. There was no significant dif-
ference between live born and stillborn infants in any
of the weight groups except in the 1501 to 2000 g
weight range (anatomic). Stomach capacity reportedly
had no relation to the total number of feeds in the live
born group. This finding contradicts that of Zangen
et al who reported that volume was affected by both
increasing age and the number of feedings. Zangen
et al,9 however, studied healthy, live newborns, whereas
the data in the study by Naveed et al16 were derived from
autopsy examinations.
Prefeed and Postfeed Weights
Numerous studies have examined the reliability of test
weighing. Accuracy is defined as the degree of confor-
mity of a measured or calculated quantity to its actual
(true) value, that is, the ability of a measurement tech-
nique to measure the true value of the property. Precision,
also referred to as reproducibility or repeatability, is the
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Spangler et al J Hum Lact 24(2), 2008
degree to which repeated measurements or calculations
will show the same or similar results. If a procedure is
imprecise, its clinical usefulness is hampered consider-
ably. The results of calculations of a measurement can be
accurate but not precise; precise but not accurate; neither
or both. A result is valid if it is both accurate and precise.
Neville17 reported that test weighing is an accurate
indicator of breast milk intake. Meier et al18,19 reported
that test weighing for this purpose is slightly inaccu-
rate because of evaporative water loss but that this
inaccuracy is too small to be clinically relevant.
Savenije and Brand20 concluded that test weighing
is an accurate but imprecise method for assessing milk
intake in young infants and should therefore not be
used in clinical practice. Their conclusions were based
on a single set of prefeeding and postfeeding weight
measurements for each study infant in an attempt to
reflect practice in actual clinical situations in which
test weighing is used, rather than repeated samples, as
occurs in most research studies.
It is important for clinicians to understand the benefits
of test weighing as well as the limitations, especially
when small incremental changes are being measured.
Data show that when following strict research protocols,
test weighing provides an accurate estimate of intake
across a range of infant weights and intake volumes.19
Before clinical interventions are entertained, multiple
measurements as well as clinical indices should be ascer-
tained. In a research setting, where repeated measure-
ments are obtained and then averaged, test weighing
with suitable scales can be both accurate and precise.
However, in a clinical setting, it is also important for the
clinician to take several weights and compute the aver-
age, as no single measurement can be considered reli-
able. The accuracy of a single test weight can vary from
+15 to −15 mL, therefore the usefulness of a single test
weight in assessing intake, particularly when very small
amounts of milk are consumed, is limited.
Although prefeeding and postfeeding weights are
considered reliable research tools for measuring milk
transfer and average feeding volumes, these data cannot
be extrapolated to estimate either the size of the stomach,
the physiologic capacity of the stomach, or the volume of
fluid the organ is capable of containing, thus it is not
appropriate to use measurements of prefeeding and post-
feeding weights to describe stomach capacity.
Are the Marble/Ball Models Accurate?
After reviewing the literature, it appears that the avail-
able research does not provide any evidence to support
J Hum Lact 24(2), 2008 Belly Balls as Teaching Tools 203

Table 3. Volume of Hollister Belly Ball Modelsa

Age of Infant, d Object Stated Volume, mL Mathematical Formula, mL Displacement Method, mL

Original tool
1 Small marble 5-7 1.77 2.0
3 Shooter marble 22-27 8.2 9.0
10 Ping pong ball 60-81 27.6 30
Revised tool
1 Shooter marble 5-7 8.2 9.0
3 Ping pong ball 22-27 27.6 30
10 Extra-large chicken egg 60-81 Nonspherical, volume not calculated 60
a
The “Belly Balls Lactation Tool” by Hollister, Inc has recently been modified. The revised tool contains a shooter marble, ping pong ball, and extra-large
chicken egg represented by a plastic egg.

the use of marble/ball models to represent newborn

stomach capacity or stomach size. Based on available
data (see Tables 1 and 2), these models may be useful
only as a representation of average breast milk intake
during the early newborn period.
Given their popularity, we decided to explore the fea-
sibility of using the models as a visual representation of
average feeding volume. Using data from Saint et al,15 the
average amounts of colostrum produced on days 1 and 3
were 37 mL and 408 mL, respectively. By day 14 average
milk yield was 1156 mL. Study infants reportedly breast-
fed an average of 6 times on day 1 and 7.5 times on day
3.15 To determine average feeding volume, we divided the
average amount of colostrum produced on days 1 and 3
by the average number of feeds. The average feeding vol-
ume was 6.1 mL on day 1 and 54.4 mL on day 3.
In an effort to determine the accuracy of the marble/
ball models to represent average feeding volumes during
Figure 1. Original Hollister Belly Ball models. The illustrated cir-
the first 10 days of life, we calculated the volume (capac- cles above are not meant to be accurate representations of
ity) of the small marble, shooter marble, and ping pong the actual Belly Ball models by Hollister (2006).
ball obtained from the “Belly Balls Lactation Tool” by
Hollister, Inc (see Figure 1) using the following methods:
the small marble and shooter marble are now assigned
(1) pouring a measured amount of water into a container
to the shooter marble and ping pong ball. The small
with milliliter markings (volufeed bottle), then measuring
marble has been removed and an extra-large chicken
the amount of water displaced when the object is inserted
egg has been added. The results in Table 3 show that
into the container, and (2) applying a mathematical
the revised marble/ball models more accurately reflect
formula for determining volume (capacity), that is, mul-
stated volumes. However, it appears that neither the
tiplying the diameter (d) cubed by π (3.14), then dividing
original nor the revised models could be useful in
the product by 6, noting that 1 cm3 = 1 mL (see Table 3).
accurately representing average breast milk intake on
A 6-inch (152 mm) Dial Caliper (General Tools Manu-
days 1, 3, or 10.
facturing Company, New York; No. 142, UPC 44145)
was used to measure the diameter of each object. The
The Implications of Exceeding Stomach Capacity
small marble measured 1.5 cm in diameter, the shooter by Overfeeding the Newborn
marble measured 2.5 cm in diameter; and the ping pong
ball measured 3.75 cm in diameter. At birth, gastroesophageal sphincter tone is poor,
The “Belly Ball Lactation Tool” has recently been offering little resistance to regurgitation of food. In
revised (see Figure 2). Values previously assigned to addition, the emptying time of the newborn stomach is

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204
Figure 2. Revised Hollister Belly Ball models. The illustrated cir-
cles above are not meant to be accurate representations of
the actual belly ball models by Hollister (2007). Scammon
R, Doyle L. Observations on the capacity of the stomach
in the first ten days of postnatal life. Am J Dis Child.
1920;20:516-538. Naveed M, Manjunath C, Sreenivas V.
An autopsy study of relationship between perinatal stom-
ach capacity and birth weight. Indian J Gastroenterol.
1992;11:156-158. http://www.ameda.com/breastfeeding/
started/stomach.aspx. Retrieved November 14, 2007.
slow; barium studies during the first week of life show
failure of complete emptying even after 24 hours.21
Gastroesophageal reflux, the retrograde movement of
food and acid from the stomach into the esophagus and
sometimes the oropharynx, occurs often in infants. It is
described by parents as “spitting up” and causes little
concern unless it interferes with feeding and nutrition,
causes poor weight gain, discomfort, damages the esoph-
agus, leads to breathing difficulties, or continues beyond
infancy into childhood. Harris et al22 reported that aspira-
tion of gastric contents is responsible for 3 out of every
100 000 deaths among infants less than 1 year of age.22
Premature and sick infants have an even greater risk for
aspiration due to small stomach size, poor cough reflex,
and inability to coordinate suckling, swallowing, and
breathing.23 It has been suggested that the volume of
liquid that can be safely administered to a neonate is
determined by the capacity of the stomach. Researchers
acknowledge that there is much to be learned about
appropriate feeding volumes during the first days after
birth, and report high variability in the intake of
colostrum by exclusively breastfed infants during that
time period.15,24 Yamauchi and Yamanouchi24 reported
intake of 168.2 to 406.6 mL of breast milk in 24 hours on
day 3, whereas Saint et al15 reported milk yield of 98.3 to
775 on day 3. Were accurate data on stomach capacity
available, they could be used to guide the clinician in
determining the volume of a feed for ill or premature
infants, and the volume of supplement for infants unable
to breastfeed for one or more feedings.
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Spangler et al J Hum Lact 24(2), 2008
Discussion
The benefits of breastfeeding are compelling and a
growing body of evidence shows that exclusive breast-
feeding for the first 6 months of life is optimal.25 With
greater emphasis on exclusive breastfeeding and growing
concern over obesity and its health problems, health care
professionals are rightly concerned about the amount of
milk a mother produces and the amount of milk a baby
consumes in the first days after birth.
Measurement of infant stomach capacity has been
attempted for over 100 years. Exact volumes cannot be
standardized, but data suggest that anatomic stomach
capacity16 and physiologic stomach capacity vary widely.15
During the first 3 days after birth, the newborn stomach
becomes more compliant and develops greater receptive
relaxation, associated with a larger volume capacity.9 These
changes in the newborn stomach, combined with the con-
comitant increase in milk production associated with lacto-
genesis II, help to explain the progression of feeding
volumes over the first 10 days of life.
Recognizing the usefulness of visual aids in com-
municating educational concepts such as feeding vol-
ume, is there an alternative to the marble/ball models?
Saint et al reported average feeding volume on day 1
of 6.1 mL, therefore one possible model could be a tea-
spoon (1 teaspoon = 5 mL). As a familiar household
object, a teaspoon would reinforce to families that the
small amount of colostrum ingested per feeding on day
1 is normal and adequate for their infant.
Additionally, a teaspoon could be used to supplement
those infants who fail to latch on and breastfeed effectively
for one or more feedings. However, it is important to note
that because a wide range of feeding volumes on day 1
(1.1-20.4 mL) and day 3 (13.1-103.3 mL) has been
reported, and the reasons for these variances are unclear, it
may be best to simply acknowledge that feeding volumes
vary widely and like stomach capacity, do not lend well to
visual representation given our current knowledge.
Suggestions for Future Research
Factors that potentially impact feeding volumes (and
changes in feeding volumes) during the first week of
life include availability of milk, infant suckling skills,
physiologic mechanisms (caloric needs, gastric empty-
ing time, intestinal motility, gastric relaxation and
compliance), length of feeding, and frequency of feed-
ings. The relationship of these factors and their affect
 J Hum Lact 24(2), 2008 Belly Balls as Teaching Tools
on milk transfer need to be explored further to deter-
mine their contribution to the small feeding volumes
during the first few days after birth and the increase in
feeding volumes thereafter. The work in Australia
using high-resonance sonography to study suckling
suggests further possibilities for understanding stom-
ach capacity.26 A large-scale research study would be
helpful in determining average volumes that can be
consistently validated, whether physiologic capacity
differs between breastfed and formula-fed infants, and
clinical indicators of overfeeding.
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breastfeeding in the maternity ward. Positive long-term effects. Acta
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2. Kramer MS, Kakuma R. The optimal duration of exclusive breast-
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3. Smith L. Coach’s Notebook: Games and Strategies for Lactation
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4. La Leche League International. What is Colostrum? How Does It Benefit
My Baby? Schaumburg, IL: La Leche League International; 2006.
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6. Xu R. Development of the newborn GI tract and its relation to colostrum/
milk intake: a review. Reprod Fertil Dev. 1996;8:35-48.
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9. Zangen S, Di Lorenzo C, Zangen T, Mertz H, Schwankovsky L,
Hyman P. Rapid maturation of gastric relaxation in newborn infants.
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10. Guillot N. De la nourrice et du nourrisson. Union Med. 1852:61.
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Resumen
Los modelos Bolas/Canicas (Marble/balls) se usan con
frecuencia para representar la capacidad estomacal del
recién nacido, pero su precisión no se ha determinado. El
objetivo de esta revisión fue de analizar datos sobre la
capacidad estomacal del recién nacido y determinar si los
modelos marble/ball son representaciones precisas. Una
revisión de la literatura mostró datos muy limitados, la
mayoría de principios de los 1900s. Los datos sugieren
que la capacidad anatómica del estomago del recién
nacido varia con el peso al nacer del bebe. La capacidad
fisiológica no tiene relación con la capacidad anatómica
del estomago del recién nacido, pero es la medida
de la habilidad de la madre de producir leche y la
ingesta del recién nacido. Dado el gran margen de los
volúmenes de alimentación en el día 1 y 3 y el aumento
de 8 veces reportado en el promedio del volumen de ali-
mentación durante el mismo periodo, es mejor reconocer
los volúmenes de alimentación como la capacidad
anatómica que varía en un gran margen y no confiarse a
la representación visual de los modelos marble/ball.