Foremilk, Hindmilk Imbalance: What Is It & How To Deal With It

In the first six months of a baby’s life, breast milk offers all the vital nutrients necessary for their development (1). However, if your baby doesn’t get enough of the proper kind of breast milk, they may develop a foremilk–hindmilk imbalance, which may lead to other issues (2).

A foremilk–hindmilk disparity could cause fussiness, gastrointestinal difficulties, and green stools in babies. Hence, given its importance, new mothers may be concerned about the composition and quantity of the breastmilk their little one consumes.

Read on to know the causes, symptoms, and treatment options for 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, gaps between feeding and how much milk the baby takes during a feed (3).

During milk production, the fat sticks 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, As fat slows down milk passage, low-fat, high-lactose milk may pass the digestive tract before the lactose is digested which can lead to gastrointestinal problems (2).

What Causes Foremilk/Hindmilk Imbalance?

Foremilk/hindmilk imbalance occurs due to the consumption of large amounts of low-fat milk. This can be caused due to the following reasons (2) (3).

• Oversupply of milk.
• Increased length of time between feeds, causing the mother’s breasts 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

Babies may suffer from gastric problems, such as bloating, intestinal cramps, stomach pain, and flatulence due to the gas produced by bacterial fermentation of undigested lactose (2) (5).

• 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 stools

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, lots of crying and excessive weight gain.

When Should You Be Concerned About An Imbalance?

Generally, an imbalance can be fixed in a matter of days by observing breastfeeds closely and 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 effectively

Breastfeeding a baby needs time and a watchful eye. Let the baby feed effectively with signs of milk transfer such as regular sucks and audible swallows during the session, and avoid detaching the baby in the middle of the feeding, unless they need a burping break.

• Allow the baby to latch on well

Ensure that the latch is deep as this can help the baby manage the milk flow better (3).

• Increase the feeding time on each breast

Frequently switching from one breast to another can create an imbalance. Instead, allow your baby to finish feeding from the first side before offering the second side. Start the next feed with the breast you ended the last feed with. This ensures the baby is transferring milk effectively 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

Gently pumping out or hand expressing 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).

Block feeding is usually not advised during the first 6-8 weeks postpartum when milk-making hormone levels are high and milk should be removed frequently from the breasts to establish an adequate milk supply and avoid blocked milk ducts/mastitis. Always check with your lactation consultant/ healthcare provider before you apply the block feeding method.

• Try different positions

Some breastfeeding positions can help you regulate the milk flow 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-1000ml 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 gets 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, certain medication and food passing too quickly through the intestine.

Green stools are also present in babies with lactose intolerance. Hence, consulting a medical professional is critical for correct diagnosis (2) (3).

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 hunger cues to help manage the issue. Once the imbalance is under control, the baby will be less cranky, and symptoms will slowly disappear.

References

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Reviewer

Dr. Regina A. HardinMD, FAAP

     

Dr. Regina Hardin is a board-certified pediatrician with over 20 years of experience in outpatient and inpatient pediatrics. She also has extensive training in diagnosing and treating Attention Deficit Hyperactivity Disorder.

Read full bio of Dr. Regina A. Hardin