Too much discussion about foremilk vs hindmilk has led to worries for breastfeeding moms. Some have even stopped nursing, believing they weren’t able to meet their baby’s needs.
However, foremilk and hindmilk imbalance (now referred to as lactose overload) is a very rare and treatable condition. We’ll explain this concept and answer any questions you may have.
If you’re worried about a foremilk hindmilk imbalance, we hope this article will set your mind at ease.
Foremilk and Hindmilk Imbalance aka Lactose Overload
If your baby regularly has green, frothy poops combined with stomach pain and inadequate weight gain, they may be suffering from lactose overload. Try nursing in a reclined position, allowing your baby to breastfeed as often and as long as they wish, and empty one breast before offering the other. Expressing a little milk before breastfeeding may also help.
Foremilk vs Hindmilk
A woman can only make one kind of milk — breast milk. However, breast milk is released from the breast in two consistencies: foremilk and hindmilk.
It’s important to note that all breast milk is good milk! Babies need a good balance of foremilk and hindmilk for optimum satisfaction and nutrition.
What Is Foremilk?
Foremilk is the first milk released during a feed or pumping session. It is higher in lactose and lower in fat than hindmilk. It has a watery texture and is more clear than white. It is hydrating and nourishing for your baby, but it may not keep them feeling satisfied for long.
What is Hindmilk?
Hindmilk is released after foremilk during a feed or pumping session. It is higher in fat and lower in lactose than foremilk. It has a creamier consistency and is whiter than foremilk.
Like foremilk, hindmilk is also nourishing for your baby, but this denser milk may keep your baby feeling satisfied for longer.
What Is Foremilk and Hindmilk Imbalance?
You may have heard a narrative that suggests that hindmilk is the better milk and is more important than foremilk. However, all babies require a good balance of both to meet their nutritional needs.
When milk is released into the breasts, the thinner foremilk makes its way to the nipple, while the fattier content tends to cling to the cells. When your baby nurses, or when you begin pumping, the foremilk is generally the first milk released.
As your baby continues to nurse, or as you continue to pump, the hindmilk will eventually be drawn from the breast as well. There is no specific timeframe in which this takes place. It will depend on several factors such as the length of time since your last feed, how strong your baby’s suckle is, or how often your milk lets down during a feed.
A lactose overload, or foremilk and hindmilk imbalance, happens when a baby is regularly ingesting too much high-lactose foremilk and not enough high-fat hindmilk. Without the fat content, the milk may move through the baby’s body too quickly, preventing the lactose from being properly digested (1).
This can happen for several reasons.
- Too much time passes between feeds: If your baby is very hungry at each breastfeeding session, they will suck more aggressively, which can signal your body to create more milk than necessary.
- Oversupply issues: If your body seems to produce enough milk to satisfy triplets (like mine seemed to do with my first child), your baby may get plenty of foremilk at the start of a feed. This can make it difficult for them to keep up with the flow of milk and cause them to pull off the breast before they are fully satisfied or have received enough hindmilk to balance the foremilk.
- Switching sides before emptying the breast: If you switch breasts too frequently while nursing, your baby may not receive enough hindmilk.
Lactose overload was once thought to be very common. However, we are now learning it is actually quite rare.
Symptoms of Foremilk and Hindmilk Imbalance
There are a few key symptoms of a foremilk and hindmilk imbalance.
- Green poop: If your breastfed baby is regularly plagued by bowel movements that are lime green and foamy or explosive, there’s a chance they are dealing with a lactose overload.
- Gas and stomach pain: If your baby is also regularly very fussy during breastfeeding and seems to suffer from gas or tummy troubles, they may have a foremilk hindmilk imbalance.
- Insufficient weight gain: If your breastfed baby is not gaining enough weight you should consult with your pediatrician or a lactation consultant. These experts can confirm if they’re suffering from lactose overload.
Note, though, that if your child is experiencing one of these symptoms on its own, it’s unlikely to be due to an imbalance (2).
The Baby Poop Spectrum
If your baby occasionally has green poop, but the rest of their bowel movements are normal in color and texture, it’s probably not something to be concerned about. There are many reasons for changes in stool color or consistency. However, if you regularly find colorful surprises in your baby’s diaper, there may be something else going on. Visit your pediatrician if you have any concerns.
How Do I Fix Foremilk Hindmilk Imbalance?
If your baby is showing signs of foremilk hindmilk imbalance, contact your pediatrician to rule out any other causes of these symptoms. If an imbalance is confirmed, there’s no need to stop breastfeeding. There are several things you can try that may help.
If your baby is struggling to keep up with the flow of milk, work against gravity by breastfeeding in a more reclined position (3).
Your baby will have to work harder to draw milk from the breast, instead of feeling like they’re drinking from a firehose.
Feed Often and Fully
Trust your baby to know when they are hungry, and feed often if they desire. Allow your little one to nurse on one side until they stop on their own.
Then offer the other side and do the same. At their next feed, begin on the side you previously ended on (4).
Ensure a Good Latch
Correct any latching issues to ensure your child is adequately drawing milk from the breast. For a good latch, make sure the baby is taking more than just your nipple into their mouth. Here’s how to do it:
- Start by holding your baby straight against you, ensuring their whole body is in a line and their head is not turned or tilted.
- Stroke the area between their nose and mouth with your nipple until their mouth opens wide.
- Aim your baby’s chin toward the bottom of your breast and your nipple toward the roof of their mouth.
- Bring your baby to your breast so their mouth closes over much of the areola.
If you have a forceful milk letdown or an oversupply issue, you can also try expressing a little milk before nursing. Simply massage the breast or use a Haakaa silicone pump to release some of the foremilk prior to breastfeeding.
Can Too Much Foremilk Be Bad For Babies?
There is no specific amount of foremilk a baby can safely digest. What is most important is that your baby receives an adequate balance of both foremilk and hindmilk.
Should I Worry About Foremilk and Hindmilk?
Unless your baby is regularly having lime green poops, seems to be suffering from tummy troubles, or is not gaining enough weight, you have no reason to worry about foremilk and hindmilk.
How Long Does It Take for a Baby To Get Hindmilk?
There is no set time at which your baby will start to receive hindmilk. If some milk remains in the breast after the previous feed and only a short amount of time has passed, they may start receiving hindmilk immediately upon latching.
What’s most important is that you allow your baby to nurse until they have signaled their completion before switching to the other side.
How Long Should I Pump To Get Hindmilk?
Hindmilk may be expressed at any point during a pumping session. You may be able to see this transition as the collected milk will appear thicker and more white. For the best balance of foremilk and hindmilk, pump on each side until you are no longer receiving milk. The longer you pump, the more hindmilk will be collected.
How Do You Separate Foremilk From Hindmilk?
If your baby was born prematurely, their doctor may suggest that you feed them more hindmilk so they can gain weight quickly. You can separate the foremilk from the hindmilk when pumping.
For the first few minutes of a pumping session, you will likely collect more foremilk than hindmilk. This will appear thinner and more watery. Stop pumping when the milk starts to appear thicker and more white. At this point, you can either feed your baby or use a separate container to collect the hindmilk (5).
Trust Your Baby and Your Body
If your baby is showing signs of a lactose overload (green foamy poop, gas and stomach pain, inadequate weight gain), don’t worry too much. You can try feeding for longer periods in a reclined position, switching sides less often, or expressing a little milk before nursing.
If your baby seems content after feeding and their bowel movements are normal, there’s no need to worry about foremilk vs hindmilk. Trust your child to know when they are hungry and when they are full. Allow them to feed for as long and as often as they wish. And trust your body to produce exactly what your baby needs.