Is Too Much Milk Bad For A New Born? by Michelle Roth, IBCLC
Too Much Milk Part 3: Foremilk / Hindmilk Imbalance
A 1988 study by Woolridge and Fisher first described what came to be called “foremilk-hindmilk imbalance.” These researchers looked at babies who were irritable and gassy, and often had green, watery bowel movements. These babies weren’t gaining well despite nursing often. What they found in common was that the babies seemed to be getting too much of the milk at the beginning of a feeding, and not enough of the fat-rich milk later in the feed. While their study has not been replicated, what lactation professionals and later researchers have found is that sometimes babies have a series of symptoms consistent with an overload of lactose that the intestines cannot absorb.
Very rarely do babies have primary lactose intolerance, since lactose is the main sugar found in human milk and is necessary for infant growth and development. Lactose is broken down into glucose and galactose in the baby’s digestive tract by an enzyme called lactase. When the baby’s body has too much lactose and not enough enzyme to process it, the intestines ferment it, causing excess gas. The excess lactose also causes water retention in the large intestines, and quicker gastric emptying. This is seen by caregivers as watery, possibly mucousy, stools.
This condition is often referred to as secondary lactose intolerance or lactose overload. It stems either from an insult to baby’s gut (such as from certain medications or from a condition like celiac disease or other allergies) or from inadequate fat intake (such as could happen in the case of oversupply, when the baby is overwhelmed by the milk and fills up quickly on the milk at the beginning of a feeding).
Milk early in a breastfeeding session is low in fat, and as nursing continues the fat concentration increases. The hindmilk is about twice as fatty as the foremilk. This fat slows down digestion, giving baby’s body enough time to break down lactose into more usable parts.
Babies with secondary lactose intolerance often are diagnosed with colic. They exhibit inconsolable crying, seem gassy, and are generally uncomfortable. Most often they have green, watery stools that may have mucous or blood in them. Sometimes they have a burning diaper rash. Occasionally their condition is thought to be a food sensitivity or allergy.
The good news is that secondary lactose intolerance is treatable with some simple steps.
- Manage feedings more appropriately: Mothers might limit feedings because they have been told to only nurse for a specific number of minutes before switching sides, or they may have sore nipples that make nursing painful.
- Follow the baby not the clock: Watch for baby’s hunger signs, and don’t try to hold him off longer between feedings. When nursing sessions are more closely spaced, the milk is higher in fat. When a longer period of time elapses between feedings, the fat content diminishes. Even if it’s only been an hour, put the baby to the breast again if he shows hunger cues.
- Finish the first breast first: If a baby’s feedings are being scheduled, the baby may not be nursing long enough to get enough fat. Instead of limiting the number of minutes the baby nurses on each side, let the baby nurse as long as he wants on the first side. If he falls asleep or comes off on his own after a good feeding, switch sides. If he’s still hungry, he will eat again. If not, start on that breast at the next feeding.
- Assess baby’s positioning and latch to maximize milk intake and limit nipple soreness: Have the baby checked to be sure he doesn’t have a physical cause for weak suck or poor milk transfer.
- Take measures to manage the oversupply: If a mom has oversupply issues or an overactive milk ejection reflex, it may be that the baby is overwhelmed with milk early in a feeding and isn’t hungry enough to continue at the breast to get the more fat-rich milk later in a feed. Take measures to manage the oversupply, such as feeding on one breast only for several consecutive feedings, and use positioning and latch to help with a let-down that overwhelms the baby.
- Assess mom’s diet:
- According to Noble and Bovey (1998), “an inadequate fat intake in the maternal diet appears to make a direct contribution to the intensity of lactose overload symptoms, resulting in lower fat and higher lactose levels in their breast milk.”
- During lactation, moms should get a little more than half of their calories from complex carbohydrates, about 15 percent from protein, and less than 30 percent from fat, of which only 10 percent should be saturated fats. Limiting the amount of simple sugars and increasing the necessary macronutrients will decrease the amount of lactose in breastmilk as well as increase the proportion of fat.
- The types of fats mom eats matter. Mothers who eat more fish, nuts and seeds tend to have higher levels of unsaturated fats in their breastmilk than moms who eat a diet with more animal-based fats.
- Food sensitivity does occur in some babies. Proteins are the biggest culprit leading to intestinal changes in baby that may cause problems with lactose breakdown. Cow’s milk protein is a common offender, in addition to soy, eggs, wheat and more. If you suspect a food sensitivity may be causing your baby’s distress, you might consider an elimination diet.
- Work on better breastfeeding without weaning.
- Because of the high level of lactose in human milk compared to other milks, your baby’s healthcare provider may suggest weaning to formula. Most formulas are cow’s milk or soy based. While hypoallergenic formula’s can be used, the risks of formula feeding may outweigh the risks of continued breastfeeding. Since changes in feeding patterns and maternal diet have the potential to heal baby’s gut and alleviate the symptoms of lactose intolerance, they should be tried first before weaning from the breast.
- Mohrbacher, N. Breastfeeding answers made simple. Amarillo, TX: Hale Publishing, 2010.
- Noble, R & Bovey, A. Resolution of Lactose Intolerance and “Colic” in Breastfed Babies, 1998. Paper presented at the ALCA Vic (Melbourne) Conference, November, 1997.
- Riordan, J & Wambach, K. Breastfeeding and human lactation. Boston: Jones & Bartlett, 2010.