Foremilk/hindmilk imbalance

From BirthWiki

According to La Leche League International: "As baby begins nursing, the first thing he receives is this lower-fat Foremilk, which quenches his thirst. Baby's nursing triggers the mother's milk ejection reflex, which squeezes milk and the sticking fat cells from the milk-making cells into the ducts. This higher-fat Hindmilk mixes with the high-lactose foremilk and baby receives the perfect food, with fat calories for growth and lactose for energy and brain development. However, when milk production is too high, baby may fill up on the foremilk and then have difficulty digesting all the lactose that is not balanced by fat. This is known as foremilk/hindmilk imbalance or Oversupply."

Below is a picture of both hindmilk and foremilk expressed from one woman. Notice the difference in color and apparent thickness.

The following symptoms were obtained from Marie Davis, R.N., I.B.C.L.C.

Baby's Symptoms:

1. Appears colicky, fussy, gassy.
   
2. Burps "like an adult" or burps poorly.
   
3. Passes large amounts of flatus.
   
4. Spits up frequently, often appears to be large amounts.
   
5. May have tentative diagnosis of gastric reflux.
   
6. Gains weight quickly (1-2 pounds/week).
   
7. Often is 1 pound or more over birth weight at 2 weeks of age.
   
8. Gulps with feedings or appears to choke with let-downs.
   
9. Pulls off the breast frequently or chews at the breast.
   
10. Grunts frequently between feedings.
    
11. Abdomen appears full and distended especially after feedings.  May have hyperactive bowel sounds.
    
12. Will latch on only to the nipple or pinches nipple during feedings.
    
13. Wants to nurse very frequently.
    
14. Has short feedings (5-7 minutes).
    
15. Nurses minimally on the second breast or refuses to take the second breast after nursing well on the first breast.
    
16. Has a stuffy nose after feedings.
    
17. Early or frequent ear and/or sinus infections.
    
18. Has many (10-15) wet diapers per day.
    
19. Has unusual stooling patterns:
    
    1. semi thick stools often described as "yellow cottage cheese", or "Peanut butter".
       
    2. Infrequent, large stools that remain liquid to soft in consistency.
       
    3. Frequent diarrhea like stools that may appear slimy and have and acrid smell due to fermentation of lactose in the infant gut.
       
20. Wants to suck hands or pacifier frequently.
    
21. If nursed lying down, may leave a "puddle of milk in the bed," choke or gulp less frequently.

Maternal symptoms:

1. Persistent sore nipples, often with a linear crack across the nipple face.
   
2. Nipple may come out of baby's mouth pinched, not round.
   
3. Mother feels that she has too much milk or complains of constant leaking.
   
4. Mother feels that she doesn't have enough milk because the baby appears to be "always hungry" or "not satisfied".
   
5. Mother complains of pain deep in the breast between feedings which may be from nerve irritation due to persistent nipple pinching.  (The resulting neuritis symptoms may need to be treated with Ibuprofen 400 mg. every 4-6 hours as an anti-inflammatory for 2-3 days).
   
6. Mother complains of painful let-downs that sting or burn.
   
7. History of repeated engorgement, plugged ducts and/or mastitis
   
8. Mother may have questions regarding her dietary intake as related to infant fussiness and gas.
   
9. Positive family history for "colic".
   
   1. Had a similar history with a previous child.
      
   2. Sisters who nursed report colicky babies.
      
10. Maternal grandmother reports problems with breastfed children and colic.

Correcting hindmilk/foremilk imbalance

It has been suggested that finishing the first breast first will help reduce hindmilk/foremilk imbalance.  The idea is that if the baby nurses of the breast that was nursed from the previous nursing, then the breast will be drained and the hindmilk will be consumed rather than beginning with the next breast and having the baby consume only foremilk once again. It's also been suggested that pumping a few ounces before beginning a feed will reduce the amount of foremilk and make it easier for the baby to finish the breast, therefore cosuming the hindmilk in the same feeding.

Marie Davis, R.N., I.B.C.L.C. says:

"Goal of treatment is to reduce milk flow to a level that the infant can tolerate by reducing breast stimulation. Note: The treatment for Oversupply Syndrome is deliberately left off my web site because in our clinic we've seen the treatment backfire and babies loose weight. It is important that the diagnosis is accurate before any treatment steps are taken. If a lactation consultant is not available to you, you may contact me via email regarding your situation. I prefer to evaluate your situation first and then send personalized treatment information."

If you suspect hindmilk/foremilk imbalance, it may be best to contact a lactation consultant for help.

To find a lactation consultant in your area go HERE and also below: International Lactation Consultant Association International Board of Lactation Consultant Examiners

This entry was added to the original BirthWiki by amyncarter on 26 July 2009.