Breast milk provides all the essential nutrients needed for a baby’s development during the first six months (1). Given its importance, new mothers might wonder if their baby is getting the proper composition and amount of milk.
If your baby does not receive the right composition and quantity of breast milk, it can lead to a foremilk-hindmilk imbalance in the baby and subsequently cause more problems (2).
If the baby is fussy, has gastrointestinal issues, and passes green stools, the cause could be foremilk-hindmilk imbalance.
Read this post to learn about the causes, symptoms, and management of foremilk-hindmilk imbalance.
What Are Foremilk And Hindmilk?
Foremilk is the milk that comes out at the start of a breastfeeding session, while hindmilk is the milk available toward the end (3). Contrary to popular belief, foremilk and hindmilk are not two distinct types of milk. They are terms to describe the differences in the composition of breast milk during the course of a feed.
The consistency and composition of foremilk and hindmilk may be slightly different. Foremilk might be thinner with lower fat content compared to hindmilk. The degree of difference in the fat content of foremilk and hindmilk depends on the amount of time the milk remains in the milk ducts and gaps between feeding (3).
During milk production, the fat stick to the milk-producing cells called alveoli, and the watery part of the milk moves toward the nipple. A long gap between feedings can cause the breasts to fill up, making foremilk more watery. This watery milk is low-fat with high lactose content. However, if the baby feeds often, less difference in foremilk and hindmilk fat content is observed (3) (4).
What Is Foremilk/Hindmilk Imbalance?
Foremilk/hindmilk imbalance is an older term for lactose overload (3). It is a condition in which the baby receives more low-fat, high-lactose, and more watery foremilk than high-fat hindmilk, failing to meet their daily dietary requirements. As a baby’s digestive system cannot process excess amounts of lactose, this imbalance can lead to gastrointestinal problems (2).
What Causes Foremilk/Hindmilk Imbalance?
- Oversupply of milk.
- Increased length of time between feeds, causing the mother’s breast to overfill.
- Switching breasts without draining one properly during nursing sessions.
What Are Some Common Symptoms Of Foremilk/Hindmilk Imbalance?
Improper digestion of lactose causes gastrointestinal problems. Here are some common symptoms of foremilk-hindmilk imbalance in babies.
- Gas problems
- Frequent nursing
The thin watery foremilk doesn’t satisfy babies, and also, the gastric pain makes them feel uncomfortable, so they may seek comfort by nursing and might act hungry. Feeding might provide temporary relief by releasing the gas and poop, but it can build up more lactose, causing more gas and discomfort (5).
- Increased spit ups
Babies might spit up or throw up milk as a result of overfeeding (2).
- Green poop
The color of your baby’s poop might change. It may become frothy and green, resembling the stool of babies with lactose intolerance (5).
- Rashes on the bottom
The stools of the infant may become acidic and cause burns and nappy rashes (5).
- Frequent urination
An infant with foremilk-hindmilk imbalance generally urinates more than ten times a day due to the consumption of excess watery milk that may pass through the stomach too quickly (5).
- Instantly defecating post the feeding session
The baby might poop immediately after breastfeeding. This is caused by the large volume of low-fat milk moving rapidly through the intestinal tract without proper digestion (2).
Besides these symptoms, your baby might also show other signs, including sleeplessness or wakefulness, fussing during the feed, excessive grunting in the early hours of the morning, and excessive weight gain.
When Should You Be Concerned About An Imbalance?
Generally, an imbalance can be fixed in a matter of days by changing feeding behavior. However, if the baby continues to be unsettled and symptoms become more severe, it is good to consult a pediatrician.
How To Deal With Foremilk And Hindmilk Imbalance?
The following are a few ways that you could implement to manage foremilk-hindmilk imbalance.
- Allow the baby to feed properly
Breastfeeding a baby needs time and a watchful eye. Let the baby feed properly during the session, and avoid detaching the baby in the middle of the feeding.
- Allow the baby to latch on well
Ensure that the latch is deep to allow adequate flow of milk (3).
- Increase the feeding time on each breast
Frequently switching from one breast to another can create an imbalance. Instead, increase the feeding time on each breast during every nursing session. Continue feeding on the same side until the baby seems content, and switch only if the baby becomes unsettled. This allows the baby to drain more milk from each breast and enables a balanced supply of foremilk and hindmilk (2).
You can also stop for a few moments before moving the baby to another breast. Taking a break might help the baby feed for a longer duration. Burp the baby, relax for a few moments, and wipe off any excess milk from the baby’s mouth. Resume after some time on the other side.
- Express some milk before the feeding session
Pumping out about an ounce of milk before breastfeeding can reduce the amount of watery foremilk. This can also regulate the milk flow if the breast is overfilled or in the case of an overactive letdown (6).
- Feed the baby immediately when hungry
A hungry baby will suck more vigorously. This might cause forceful milk flow and consumption of a higher amount of foremilk. To avoid this, feed the baby immediately when they are hungry.
- Use the block-feeding method
You could employ block-feeding to regulate milk production in case of an oversupply. Feed using one breast for a certain duration (3-4 hours depending on the milk supply), and when the breast is sufficiently drained of milk, switch over to the other breast.
This will ensure the baby gets the required amount of high-fat milk by feeding on both breasts. The high-fat milk will also move slowly through the baby’s intestinal tract, allowing proper digestion of lactose (2) (5).
You can follow this pattern for a few days until the problem is resolved. However, you need to check if the baby is sufficiently satisfied after feeding on one side. If one breast seems too soft and the baby is distressed, switch to the other breast (2) (5).
- Try different positions
Some breastfeeding positions can help you regulate the milk supply for the baby. Try feeding the baby by laying on your side, chest to chest with the baby (3). It is a comfortable position for both you and the baby.
Lying back is another position that can be used (3). Recline on a bed or chair and place the baby on your chest. Their head should be near your breasts, allowing eye contact. The position gives the baby more control and freedom to move.
- Feed more often
Maintaining a schedule and feeding the baby regularly allows the breasts to drain well and fill up with balanced proportions of foremilk and hindmilk. This also helps the baby get both foremilk and hindmilk instead of just foremilk that can collect due to the longer duration between feedings (3).
Myths Regarding Foremilk And Hindmilk Imbalance
Misconceptions regarding the terms foremilk and hindmilk and the imbalance are aplenty. We have debunked a few of them below.
Myth 1: If the baby doesn’t get hindmilk, they will not gain adequate weight
Truth: Weight gain in babies is linked to overall milk consumption, not just hindmilk. If they feed well during the day and consume enough milk as per their dietary requirement (an average of about 750ml per day), the weight gain will not be impacted (4).
Myth 2: If babies feed often, they receive a higher amount of foremilk than hindmilk, causing a foremilk-hindmilk imbalance
Truth: The fat concentration in the milk gradually increases as the baby starts feeding. When babies feed often, they manage to drain the breasts. Hence a frequent feeder might start by consuming low-fat milk but eventually get high-fat milk (4).
Myth 3: If your baby passes green poop, it means they have a foremilk-hindmilk imbalance
Truth: Green poop alone does not indicate foremilk-hindmilk imbalance (lactose overload). Several factors can result in green stools, such as illness, allergies, poor diet, mother’s diet rich in leafy vegetables, iron supplements, and food passing too quickly through the intestine.
Myth 4: Foremilk is always low-fat
Truth: The fat proportion in foremilk and hindmilk differs depending on the feeding pattern. There is a more significant variation in the fat content of foremilk and hindmilk when there is a big gap between the feeds. When the duration between feeds is short, the foremilk of that particular session might have higher fat content than the hindmilk of a different feeding session (4).
Proper management of feeding can be an effective solution for treating foremilk-hindmilk imbalance (2). Try to understand and interpret your baby’s needs hunger cues to help manage the issue. Once the imbalance is under control, the baby will be less cranky, and the symptoms will slowly disappear.
2. Lactose overload; Iowa Department of Public Health
3. Foremilk and Hindmilk; La Leche League International
4. Worries About Foremilk and Hindmilk; Breastfeeding USA
5. Lactose overload in babies; Australian Breastfeeding Association
6. Breastfeeding Today; La Leche League International