Breastfeeding mothers make standard breast milk that can be divided into two types — foremilk and hindmilk. Foremilk is the milk that your baby drinks at the beginning of a feeding, and hindmilk follows it.
Typically, foremilk is mostly water combined with other nutrients, and hindmilk is highly fatty. Both contain lactose that your baby needs to develop properly. Lactose helps good bacteria grow in the digestive system, which helps your baby fight off bad bacteria, viruses, and parasites.
Lactose contributes to brain and nerve tissue development. It also supports your baby’s growth and gives them the energy to develop new skills. A foremilk/hindmilk imbalance will prevent your baby from getting the lactose they need to grow.
Foremilk/hindmilk imbalance, also known as lactose overload, can happen when your baby has trouble digesting the lactose in your milk. It can happen due to overfeeding, feeding that is low in fat, or feeding in large volumes.
When your baby drinks a large quantity of breast milk, the foremilk that comes first can fill them up. They may get full before they’re able to drink much of the hindmilk. They don’t consume enough high-fat milk and end up taking in a lot of low-fat milk.
If your baby drinks more foremilk than hindmilk, the fat content of their feeding will be out of balance. Fatty substances are slow to digest. Because foremilk is usually lower in fat, it moves through your baby’s digestive system quickly. It passes so fast that all the lactose in the foremilk doesn’t get enough time to break down and be digested.
This out-of-balance amount of foremilk causes a lactose overload for your baby. The undigested lactose has nowhere to go but the large intestine, where it gets fermented and creates a lot of gas. This gas is the root of your baby’s foremilk/hindmilk imbalance symptoms.
Your Baby’s Symptoms
If your baby has foremilk/hindmilk imbalance, they’ll have the same symptoms as babies with a digestive disorder or lactose intolerance. They may have any combination of the following symptoms:
- More gas than usual
- Green, foamy or watery poop
- Stomach pain accompanied by crying, screaming, and general fussiness
- Trouble sleeping
- More appetite than usual
Every woman’s foremilk to hindmilk ratio is different and so is the fat content in the foremilk and hindmilk. Some babies might never have lactose overload, while some might constantly have these symptoms. You’ll know that your baby is okay if they are generally calm and have yellow or brown-colored poop.
Many sources will tell you to take all dairy products out of your diet. It is usually recommended to reduce the amount of lactose present in your breast milk. But don’t take this advice. The breast milk that your body creates is custom-made for your baby, independent of what you eat.
You can do different things to help your baby manage their feeding. You can try the following to prevent the foremilk from speeding through their digestive system:
- Research and find ways for your baby to get a better latch while breastfeeding. They’ll have more control over the flow of milk with a deeper latch.
- Lean back or lie on your side when feeding your baby. Gravity will keep the breast milk from flowing too freely.
- Don’t limit your baby’s feeding time. The longer they feed and the more hindmilk they drink, the better their digestion will be.
- Feed your baby more often. Waiting for a long time between feedings gives your body more time to develop more foremilk. The sucking comforts your baby and helps their gas move through the digestive system.
Adding more feedings to your baby's schedule can help ease their pain, but it can also worsen the problem.
A reliable way to treat foremilk/hindmilk imbalance is to separate your breast milk. Bottle feeding your baby less foremilk and more hindmilk will help them easily digest the lactose present in your milk.
Separating Breast Milk
If you’re interested in separating your foremilk from your hindmilk, you can try following these steps:
- Attach your breast pump to your breasts and start pumping.
- Watch the flow of milk and turn the pump off 2 to 3 minutes after there is a steady stream.
- Pour this first batch, or the foremilk, into a container and label it.
- Start pumping again until 2 to 3 minutes after your milk stops flowing.
- Put this second batch, or the hindmilk, into a container and label it.
Feeding your baby hindmilk or a mixture of some foremilk with mostly hindmilk will help support their growth and development.
If your baby still shows signs of lactose overload, talk to your healthcare provider.