It’s common for breastfeeding mothers to worry if their baby is getting enough milk, and it’s also common to wonder if their baby is getting the right mix of breastmilk during feeds.
To add to a mother's worries, sometimes well-meaning friends or family members may suggest a foremilk hindmilk imbalance as the cause of a breastfed baby's upset tummy.
However there are myths and misunderstandings as to what foremilk hindmilk imbalance really is all about.
Foremilk is term used to describe the breastmilk a baby typically gets at the start of a feed that is lower in fat and calories.
Hindmilk is the term used to describe the breastmilk a baby typically gets increasing amounts of as the breast drains and is higher in fat and calories.
Foremilk Hindmilk Imbalance Myths
Here are 3 myths and corresponding truths about foremilk hindmilk imbalance:
Myth #1: “Your Baby Is Getting Too Much Foremilk Because He's Feeding Too Often.”
Truth: When a baby feeds from a full breast, the milk he gets at the start of the feed is relatively lower in fat and calories (the foremilk). As the feed goes on and he drains the breast, the concentration of fat and calories increases (hindmilk).
However, if a baby feeds often, chances are he is keeping his mother’s breasts relatively well drained. When a baby feeds from a breast that is well drained to begin with, he gets a larger concentration of higher fat/calories milk from the very start of the feed, compared to if he’d stared feeding from a full breast.
There’s also no distinct point during a breastfeed when the milk suddenly changes from foremilk to hindmilk.
Myth #2: “Your Baby Isn’t Putting On Enough Weight Because He’s Getting Too Much Foremilk And Not Enough Hindmilk.”
Truth: A baby who is not getting enough breastmilk overall won’t put on enough weight. If a baby is feeding well and is fed as often and for as long as he wants to, he’ll likely get what he needs, including the right balance of foremilk and hindmilk.
Myth #3: ‘Your Baby Is Unsettled, Windy And Has Green Poos Because He’s Getting Too Much Foremilk.’
Truth: The lactose concentration from the start to the end of a breastfeed is about the same. In other words, there’s about the same concentration of lactose in foremilk as there is in hindmilk. Here are 4 facts about lactose intolerance in babies.
If a mother has an oversupply, then her baby may be getting too much volume of breastmilk (including a lot of lactose) and her baby may show signs of lactose overload (e.g. unsettled behaviour, loads of green frothy poos and loads of wees).
The theory of lactose overload has been that if a baby drinks large volumes of breastmilk, there may be too much lactose overall for her to digest. The remaining lactose gets used by normal gut bacteria, and gas is released that causes wind, pain and loads of very runny green frothy poos may result.
It has also been theorised that fat slows down the movement of milk through a baby’s gut, giving his digestive system longer to break down the lactose. Hence, it's often advised to get a baby to drain the first breast well before offering the second side.
Interestingly, research into stomach emptying rates in premature babies questions this theory of lactose overload. This is because this research found that the components (e.g. fat, lactose, protein) of breastmilk don't influence the rate of stomach emptying.
It also found that stomach emptying rates were about the same regardless of the volume of the feed. This research was on premature babies, so it may or may not apply to full term babies. Nonetheless, it does pose some doubt as to the mechanisms behind lactose overload.
The take home message with all this is to feed your baby according to your baby’s individual needs, by watching out for feeding cues. This way, you’ll help ensure she gets what she needs.