What is foremilk and hindmilk?
Foremilk and hindmilk refer to the different compositions of breast milk during a feeding. In the early parts of a feeding, the breast milk (foremilk) contains more water, lactose, vitamins, and proteins. As the feeding progresses, the fat content increases in the milk (hindmilk). This helps satisfy the baby’s hunger.
The foremilk quenches the baby’s thirst, while the hindmilk provides rich nutrition. Both are important components of breast milk.
What causes a foremilk/hindmilk imbalance?
A foremilk/hindmilk imbalance occurs when the baby fills up on foremilk and does not get enough of the fatty hindmilk. This may happen if feedings are cut short or if milk flow is fast. Some potential causes include:
- Switching breasts too frequently. Not allowing the baby to empty one breast before switching to the other can result in getting more foremilk than hindmilk.
- Limiting nursing time. Feedings that are shorter than 10-15 minutes may not allow enough time for the hindmilk to release.
- Using only one breast per feeding. Feeding from just one breast may not provide enough hindmilk if supply is abundant.
- Having an overactive let-down. A fast flow can cause the baby to fill up on foremilk quickly before the hindmilk releases.
- Having an oversupply. When milk is plentiful, the baby may get full on foremilk before getting the fatty hindmilk.
Paying attention to baby’s hunger cues, allowing unrestricted time at the breast, and offering both breasts can help prevent a foremilk/hindmilk imbalance.
Can too much foremilk cause colic?
Some babies do appear to be sensitive to the lactose and milk proteins found in larger amounts in the foremilk. Drinking too much foremilk and not enough fatty hindmilk may play a role in colic in some breastfed babies.
Possible reasons why foremilk may contribute to colic include:
- Lactose overload – The lactose content is higher in foremilk. Too much lactose could cause gassiness, abdominal discomfort, and crying in sensitive babies.
- Low fat intake – Without enough hindmilk, babies don’t get the satiety and calories provided by the fat. This may lead to hunger and crying.
- High protein – Foremilk is higher in whey proteins, which are harder to digest for some babies. This may irritate the gut.
However, more research is still needed to determine if foremilk/hindmilk imbalance is truly a cause of colic. While some babies do seem responsive to strategies that increase hindmilk intake, no studies have definitively proven that foremilk is a culprit.
Signs of a foremilk/hindmilk imbalance
Here are some feeding behaviors and symptoms that may indicate a baby is getting too much foremilk:
- Fussy or gassy during and after feedings
- Frequent spitting up
- Green, frothy stools
- Only sleeps briefly after feeding
- Unsatisfied and wants to feed again soon
- Difficulty gaining weight
- Colicky crying
If you notice these signs, it may point to an imbalance and insufficient hindmilk intake. However, some babies are gassy or fussy for other reasons. Contact your pediatrician if you have any concerns about your baby’s behavior, weight gain, or digestion.
How can I increase hindmilk intake?
If you suspect your baby is not getting enough hindmilk, try these tips:
Nurse longer
Allow your baby to feed for as long as they want at each breast. This allows time for the fat content to increase as the feeding progresses. Avoid limiting feeding times.
Offer one breast per feeding
Try nursing from just one side at each feeding. Switch sides at the next feed. This ensures your baby empties the breast and gets the hindmilk.
Use breast compression
Gently compress your breast with your hand a few times during letdown. This can help milk flow and increase fat content.
Pump briefly before feeding
Pumping for just 2-3 minutes before breastfeeding can help remove the foremilk so your baby gets more hindmilk.
Feed from the fuller breast first
The fuller breast tends to have a higher fat content. Nurse on that side first if you are lopsided.
Ensure good latch
A proper latch allows the baby to remove milk efficiently. See a lactation consultant if you are unsure if your latch needs adjustment.
Offer both breasts twice
Try nursing from each breast twice during one feeding. This provides two opportunities for the baby to get the hindmilk.
When to see a doctor
See your pediatrician if your baby has persistent gassiness, reflux, discomfort, or difficulty gaining weight. These can sometimes indicate an issue like:
- Food sensitivity or allergy
- Gastroesophageal reflux disease (GERD)
- Infant dyschezia (straining and infrequent stools)
- Lactose intolerance
While an imbalance of foremilk and hindmilk may play a role, other factors can also cause digestive problems. Your pediatrician can help determine if an underlying condition is responsible.
See a lactation consultant if you are having ongoing concerns about foremilk/hindmilk imbalance. They can assess a full feeding and provide tips to optimize your breast milk composition.
Conclusion
While foremilk and hindmilk are both important, getting too much of the watery foremilk can lead to fussiness in some babies. Strategies like nursing longer, feeding from one breast, and using breast compression can help ensure your baby gets enough of the rich hindmilk they need. Contact your pediatrician if your baby has ongoing gastrointestinal issues or difficulty gaining weight. With the right lactation support, most foremilk/hindmilk imbalances can be corrected. Focus on responsive feeding and providing both the thirst-quenching and filling components of your milk.