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Thread: Does this look like foremilk/hindmilk imbalance?

  1. #1

    Default Does this look like foremilk/hindmilk imbalance?

    Hi I'm new here and woul love some help/advice. My 2 month old son just recently had green poop with traces of blood he has been gassy with acid reflux for awhile, with very very frequent explosive poops. He cries the most at night as if he is in pain. I started Googling and now i am convinced I might have the foremilk/hindmilk imbalance. I have been examining my bottles like crazy and they seem more watery with less fat. I Mainly breast feed with 2-3 pumping sessions 30 min each per day. The most I pump from one breast per session is 4oz.

    Also when he breast feeds he will eat anywhere between 10-15min total but only to spit up what seems to be a almost have of the milk he just ate. Then he will act hungry again. I just want to make sure he is getting the right milk, I am trying to ebf hopefully until 6-12months.

    Any thoughts? see photos that show how the watery layer really separates a ton from the rest of the milk-- Also a little tmi I am adding a picture of his stool as well
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  2. #2
    Join Date
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    Default Re: Does this look like foremilk/hindmilk imbalance?

    Hi mamasb2. I can see you are worried about your baby. I hope I can help set your mind at ease.

    First we have to consider if there actually is any such thing as foremilk-hindmilk "imbalance"? This implies there is something knowable that would be considered balanced, and I assure you, no one could define for you what amounts of each type of milk would be considered "balanced" nor can anyone even define exactly what milk would be considered hindmilk and what foremilk, except as those terms relate to when the milk comes out of the breast. The idea that there is an actual confirmed "thing" called foremilk hindmilk "imbalance" is based on the echo chamber of the internet taking some very limited information about expressed milk and making many totally unproven and in fact irrational assumptions based on that limited info. Unfortuinately many moms are misled by this to think there is a right and wrong kind of milk! There isn't. All 'types' of human milk is healthy and good for baby.

    So, here is what is actually known. It is known that when a mother pumps her milk and pumps to the point her breast significantly softens and the milk flow becomes slower, the milk nearer the start of the pump session is less fatty and higher in milk sugar (lactose) than the milk that comes out closer to the end of the pump session, and that this is a gradual change throughout the pump session. So foremilk refers to the milk that comes at the beginning of a pump session and hindmilk refers to that which comes at the end. No one says this, but I suppose that makes what is expressed in between "in between milk." We know this happens when a mom pumps because lactating women have pumped their milk this way, the milk taken at various points of the pump session was tested, and that is what was found.

    So, many assume that milk also comes from the breasts in the same way when a baby nurses. In fact, it is possible this is not true, because when a baby nurses, milk is extracted very differently than it would be by a pump, and in fact is extracted in a way that is more likely that more fat comes out early on. However, it is generally accepted that to at least some degree, milk comes from the breasts in a similar fashion when baby nurses.

    So in other words, there being foremilk first and foremost is entirely normal and desirable. It is thought that foremilk is more thirst quenching and also gives baby more energy. Baby needs this to grow and thrive and to nurse with vigor. So perhaps this is why nature designed things this way- because foremilk is so important it has to come first! Also, foremilk does have fat in it, and as long as baby is getting enough milk to gain ok, all is well, even if most of the milk baby gets is so called foremilk.

    How do we know this? Because the babies who get the most foremilk compared to other babies are babies whose moms make more than enough milk, a situation called overproduction. These babies usually gain more rapidly than average. So they are obviously getting plenty of fat.

    Now when people say foremilk has more lactose, some moms think that the issue is caused by their baby being lactose intolerant. I assure this is impossible. Lactose and lots of it is vitally needed by rapidly growing babies who require enormous amounts of energy. Very rarely some babies truly are unable to digest lactose due to a serious and again, rare disorder, and these poor babies shortly after birth are identified as being very ill.

    Ok. So why do people say foremilk hind milk imbalance is a problem? Well, in fact if a baby is getting lots of foremilk all at once, it sometimes indeed causes some minor gastrointestinal issues. These manifest in a variety of ways that may include baby unusually fussy, unusually gassy, green poops and sometimes a little bit of blood in the poop in the form of streaks or flecks. Also, babies who get lots of milk all at once tend to spit up more (this does not hurt them but of course is a mess.)

    Also some babies react when nursing to a fast flow- sputtering, coughing, gagging etc.

    Since most of the time bottles are gently shaken before giving them to baby, the 'foremilk' and 'hindmilk' is mixed. However, bottle fed babies may display similar problems if baby is overfed or fed too quickly with bottles.

    So what causes "too much foremilk all at once?" Two things. Mom makes more milk than baby needs, (overproduction) and/or baby is not nursing frequently enough. A contributing factor in some cases is when a baby is overly encouraged to nurse both sides every time baby nurses even if they seem to prefer not to. Timing baby at each breast or not letting baby fall asleep nursing could also cause baby to be taken of the breast after only getting lots of foremilk.

    So what helps reduce these minor gastrointestinal issues un that case is 1) not doing things that increase milk production to more or at least not much more than baby needs, 2) Encouraging baby to nurse frequently and letting baby nurse one side at a time if baby prefers and 3) nursing uphill (mom leaning back, baby more on top.)

    So, I am curious how many times in 24 hours baby nurses, if baby usually nurses one of both sides at a time, also why you are pumping three times a day, and if baby is getting any bottles and how much etc. Also how is baby gaining?

    Also, It is normal for human breastmilk in a jar or bottle to look watery and for the fat to separate because it is not homogenized like cow milk in the store is. Your milk in the bottles as pictured looks completely normal to me. Your baby's poop also looks like normal breastfed baby poop.
    Last edited by @llli*maddieb; June 17th, 2017 at 09:24 PM.

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