Foremilk Hindmilk Imbalance

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Article updated: 20 February 2019

If you've ever left your milk in the fridge for a while, you might have noticed that the milk separates, with a fatty layer on top. This is a normal occurrence and absolutely nothing to worry about. Some mothers may question whether they are producing enough milk fat for their babies. Here is how to know if you have a fore milk hind milk irregularity and how to correct it. 

Foremilk hindmilk imbalance


Foremilk vs Hindmilk


What is Foremilk? 

Foremilk meaning: Foremilk is the milk that lies in the front of your breast's milk-producing cells (alveoli); this is the first milk that your little one drinks during a breastfeeding session.

"My breast milk looks watery!"

This milk is watery when compared to hindmilk and is usually bluish. Don't underestimate the importance of foremilk though. Fore milk consists of high lactose and low fat, it, therefore, is excellent at quenching a baby's thirst. 


What is Hindmilk?

Hindmilk meaning: Hindmilk is the milk further back in your breast's milk-producing cells (alveoli). It is calorie loaded and has a much higher fat percentage. It also looks thicker and darker in color. Hindmilk promotes weight gain. 

Hindmilk contains between 23 and 35 more calories per 100ml compared to foremilk.


So, Why this Difference in Milk?

When the milk is produced, it passes the alveoli (milk-producing cells). Most of the fat in breast milk sticks to the back and sides of the alveoli (the fatty hindmilk), while the rest of the milk collects in the front of the alveoli (less fatty foremilk).

So, the fat gets stuck further back in the breast's alveoli, and this is what causes the significant difference between the milk at the beginning of a feed and the milk at the end. The fat content in milk gradually changes during a feeding, there is no precise time when foremilk switches to hindmilk. 

The longer a mother waits between feedings, the more foremilk is allowed to collect and the longer it will take before her baby receives the hindmilk.

Mothers only really produce one type of milk, although the fat content of the milk changes throughout a feeding session. The fat content depends on how full the breast is and how long the breast milk has been in the milk ducts.


How do I Know if I have an Imbalance?

Usually, when the watery milk moves towards the nipple, it will combine with any milk that was left in the breasts previously; this resulting mixture of foremilk and hindmilk is the perfect food for any baby. 

BUT

If you struggle with hyperlactation or also known as oversupply, things could get a little tricky. In this case, your baby will receive too much foremilk before the hindmilk can reach the nipple; this causes a foremilk-hindmilk imbalance. The result is that your baby will be ingesting too much lactose. 

Babies produce a substance called lactase, and this is what breaks down the lactose in breast milk. When there is too much lactose to break down, your baby will experience excessive flatulence (gassiness), pain (colic symptoms), and green, foamy, explosive stools. 

A foremilk-hindmilk imbalance is often mistaken for allergies or lactose intolerance. Lactose intolerance, though, is exceptionally rare. Only one in every thirty thousand babies are diagnosed with galactosemia (true lactose intolerance). 


How to Judge if You Have an Oversupply


Foremilk-hindmilk Imbalance Symptoms

stinky baby, nappy change, stinky nappy, stinky diaper

What does hindmilk foremilk imbalance poop look like?

  • You will notice green frothy explosive stools. Lactose rich and fat deficient milk will cause osmotic diarrhea. 
  • Blood in stools. You may also notice tiny amounts of blood in your baby's stool, and this is due to the gut irritation caused by high amounts of unabsorbed lactose. 
  • Green foremilk poop. A green stool cannot be the only indicator of foremilk-hindmilk imbalance. Green stools can be the result of many other things such as the foods you eat (transferred via the milk), it can also occur during the introduction of solids, during teething and with a tummy bug. As long as everything else is normal, such as the consistency of the stool, and your baby doesn't show any signs of fussiness, you don't need to worry about green stools. BUT, If your baby's stool is green, slimy or foamy, and your baby seems fussier than usual, there are a few things you can do to rectify it, these are mentioned below. 

Other Symptoms

  • Gassiness. All babies struggle with gas pain, some just struggle with this more than others. It is essential that you don't change your feeding patterns unnecessarily. You might think you have a hindmilk-foremilk imbalance when in fact it could just be normal gastric development causing the fussiness. 
  • Diaper rash due to acidic stools.
  • The baby spits up a lot.
  • Colic symptoms. Fussing during and after feeds. 
  • Increased frequency of wanting to feed with very short feeding sessions. (5 - 10 Minutes); not becoming satisfied. Many mothers with Foremilk-hindmilk imbalances may think that they have a low milk supply even though their breasts are always full; this is because their babies are continually needing to feed. 
  • Slow weight gain.
  • Choking at feeds and excessive milk spray. Mostly due to an accompanying fast flow of milk.
  • The mother may be engorged, may struggle with plugged ducts and mastitis
  • Cracked and painful nipples.


How to Fix a Foremilk- hindmilk Imbalance

"How do you increase fat in breast milk and produce more hindmilk?"

  • Ensure a good latch
  • Try to change breastfeeding positions. The reclined breastfeeding position is recommended as well as the side-lying position
  • Express a full ounce of milk before feeding. 
  • Block Feeding. Do not time your feedings. Breastfeed from only one breast per feeding. Empty the other breasts just a little for pain relief. This encourages the release of serotonin in the breast, which is an inhibitor of lactation. The longer the breast goes unemptied, the more inhibitor is released, and this will lower the amount of milk produced. Usually, only a week of block feeding is necessary to rectify an oversupply issue. Sometimes a mother may need to do this a few extra days. Alternatively, the same breast can be emptied for two consecutive feedings instead of one. By only partially emptying both breasts, the problem is perpetuated. (1)
  • Sometimes, an oversupply is accompanied by a forceful letdown (A fast flow of milk). More information about overactive and underactive milk let down here.
  • The full guide on how to get more hindmilk than foremilk.


Other ways of reducing milk supply include:

  • Pseudoephedrine.
  • Sage or Thyme tea.


Exclusive Pumping with a Foremilk hindmilk Imbalance

  • When you express your milk, and you know you have an oversupply, it would be best to mix all milk expressed in one sitting to ensure that you are not feeding your baby a bottle filled with too much lactose. 
  • Pump until your breasts seem soft and thoroughly drained. The emptier the breasts, the fattier your milk will be. 
  • Express milk less frequently throughout the day. Instead of pumping 8 times, for example, you could pump 6 times. 
  • Use breast compression to remove milk more efficiently while pumping. 
  • Dump some milk if you have to. If you feel you have a severe oversupply, you can dump the first ounce or more and then keep the rest. 

When does milk come in?



In Conclusion 

Mothers with oversupply issues should encourage their babies to nurse long enough on one side to receive the fattier hind milk before switching breasts. Expressing your milk before a feeding session will ensure that your baby receives enough calories and less lactose while taking in less milk, therefore, keeping your baby full for more extended periods. 

After trying the above methods, you should notice that your baby's stools start to normalize. Your baby should also seem much less fussy at the breast and after breastfeeding. 

For those mothers who do not have oversupply, the timed release of the various components of breast milk (foremilk and hindmilk) leads to a feed that assists in minimizing gastrointestinal issues. With that being said, if you do not have an oversupply, you do not need to concern yourself about the fat content of your milk. 

What you need to do before you change any feeding patterns. 

  • Keep an eye on your baby's weight.
  • Look for ways to keep colic symptoms at bay. 
  • Get help. Contact your local La Leche League. Their services are free. They can evaluate the situation and advise accordingly. 


1. Management of hyperlactation syndrome by full drainage and block feeding methods 

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Lucca Jisha M Lucca1, Arathi Santhosh2


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