The fact that your breast milk changes throughout a feeding to give your baby exactly what he needs is pretty amazing. But it can also be a source of anxiety if you're worried that the milk's nutritional composition somehow isn't right.
Indeed, a suspected foremilk and hindmilk imbalance is a common concern among nursing moms. But there's a lot of misunderstanding around what foremilk and hindmilk actually are and what it means for your milk to be "imbalanced." And once you get the facts, you might find that there's a lot less to be concerned about than you previously thought.
What is foremilk and hindmilk?
Foremilk is the first milk that your baby gets at the beginning of a nursing session, and hindmilk is the milk that he gets towards the end of a nursing session.
Some people mistakenly think of foremilk and hindmilk as two distinct types of breast milk, with foremilk being lower in fat and higher in the milk sugar lactose, and hindmilk being creamier and more calorie-rich.
But while the two are slightly different, your breasts aren't switching from making one type of breast milk to another midway through a feeding. In fact, your milk's fat content has more to do with how much time has passed between feedings.
When cells in your breasts make milk, the fatty part of the milk clings to the cells while the watery part of the milk travels closer to your nipples. And since this milk is closer to your nipples, it's the first sips that your baby will get.
As more milk is continuously being produced, the longer you go in between feedings, the more of that watery foremilk builds up. Going several hours in between nursing sessions means your baby might get more of that foremilk. On the other hand, nursing more frequently means there's less time for lots of foremilk to build up.
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The bottom line? The foremilk that your baby gets at the start of a feeding tends to be the most watery, and he'll get more of the higher fat hindmilk as the feeding progresses. But the transition is a gradual one, and the overall lactose, fat and water content of the milk your baby drinks at any given feeding will be determined by how long it's been since he last nursed.
What's more, the milk your baby gets at the start of a feeding isn't lower quality than what he gets later on. Both types of milk are equally important and are designed to nourish your baby with exactly what he needs.
What is a foremilk and hindmilk imbalance?
A foremilk and hindmilk imbalance is where the breasts make too much of one type of milk and not enough of the other. But lactation consultants and doctors rarely use the term today because it is considered misleading.
What used to be called a foremilk and hindmilk imbalance is now referred to as lactose overload. Lactose overload is different from lactose intolerance — a digestive disorder where lactose can't be broken down, which typically doesn't occur in children under 3 who were born full term.
Lactose overload happens when a baby regularly gets more of the watery, higher-lactose milk and less of the higher-fat milk that contains less lactose. Most often, this occurs when a baby takes in a lot of milk at once, which can happen if he's going a long time in between feedings or if a mom has an oversupply issue.
Lactose is a sugar in milk that the body must break down properly in order to fully absorb it. While your baby can break down some lactose, getting too much lactose-rich milk and not enough fat can overwhelm his digestive system. More fat in the milk helps slow down digestion, which helps keep things in balance. That can lead to lactose overload, a condition marked by digestive discomfort and changes to your baby's stool.
As for how often it actually occurs? Despite how common it is for breastfeeding moms to worry about having a foremilk and hindmilk imbalance, lactose overload doesn't occur that often. In fact, official statistics are fairly hard to come by, and many lactation consultants say they don't see the problem very often.
What are the symptoms of lactose overload?
While lactose overload isn't all that common, when it does occur, it's fairly easy to spot.
Start by looking at your baby's poop. Typically, the poop of breastfed babies has a seedy consistency. But undigested lactose will make stools explosive and frothy. Lactose overload also makes babies excessively gassy and very, very uncomfortable — so they tend to scream and cry a lot more than average.
Can lactose overload affect a baby's weight? Theoretically, getting significantly more lower fat milk and not enough of the creamy stuff could cause a baby to have trouble gaining weight. But in practice, most experts agree that poor weight gain isn't a typical sign of lactose overload. Instead, it's a sign that a baby is having an issue with getting enough milk overall.
How do you fix lactose overload?
First things first: Unless your baby is showing symptoms of lactose overload, the amount of foremilk versus hindmilk that he's getting is probably fine. If your baby seems content and comfortable and his poops are normal, your breast milk is delivering exactly what he needs.
If you suspect that your little one is dealing with lactose overload, start by seeing your pediatrician.
If your pediatrician determines that lactose overload is definitely the problem, you should see a lactation consultant too. The issue is usually easy to resolve with the right guidance, and she may recommend taking steps like:
- Offer more frequent feedings. Nursing more often prevents milk with a higher water and lactose content from building up in your breasts, so your baby takes in less lactose while she drinks. A gentle breast massage before a feed may also maximize the fat content of the milk if you're dealing with an oversupply issue.
- Make sure one breast is drained before offering the other. Cutting off one breast before it's totally drained means your baby will get less of the high fat milk towards the end.
- Change your position. If oversupply is causing your baby to take in too much milk at once, nursing from a laid-back position can slow your flow.
- Let your baby lead the way. Instead of timing the feed, have your little one nurse on one breast until she naturally stops. That ensures she gets all the benefits of your milk that she needs.
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