Sample FAQ: Hindmilk worries

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Do I need to ensure my baby gets “hindmilk”?

The milk that babies get toward the end of a feed, sometimes called “hindmilk,” has more fat than the milk at the beginning of a feed. For this reason, some mothers are told they should offer only one breast at each feed or force the baby to stay on the breast longer than necessary, supposedly so the baby can empty it and get the hindmilk. This is bad advice and can create problems for mother and baby. Babies are good at controlling their intake. They know when they are hungry and how much milk they need. Mothers don’t need to worry about what kind of breast milk the baby is getting, only that the baby is getting enough. Mothers should pay attention to their baby’s hunger signs and to know how often to feed and whether to offer one breast or two.

A) Describing fore- and hindmilk

Breast milk fat is the most variable component of milk. For example, milk fat amounts vary between day and night and between mothers.

The fat content of breast milk also increases as the baby feeds. The lower-fat milk that a baby gets early in the feed is called foremilk and the richer milk from later in the feed is called hindmilk. The terms foremilk and hindmilk simply acknowledge the normal change in milk fat; they are not different types of milk. Babies take in both fore- and hindmilk when breastfeeding well. 

The baby’s growth does not depend on the exact amount of fat they take in at each feed as this is variable (Mitoulas 2002). Rather it is the overall amount of milk that is more important. Breastfeeding babies are good at managing their intake and they will give hunger signs and breastfeed according to their needs. Indeed, one study (de Fluiter 2020) showed that babies end the feed sooner if the milk is richer in fat. 

B) “Getting the hindmilk”

If your baby is healthy, just follow the baby’s hunger signs to guide you on how often to breastfeed and whether to offer one or both breasts at each feed (Kent 2006). 

Some mothers are unfortunately advised to give the baby only one breast at each feed or force the baby to stay on the breast after the baby is done feeding, supposedly to ensure the baby empties the breast of the richer hindmilk. This is a case of good science being used to issue bad advice. It can create problems for both mother and baby. 

Forcing babies to empty the breast in order to take more “hindmilk” is not appropriate as normal babies generally do not empty the breast. They take only about 70% of the available milk in a feed (Kent 2006). Mothers need not worry about the kind of milk the baby is getting, just that the baby is getting enough milk. If a baby is not growing well, keeping the baby on one breast at each feed or forcing the baby to “empty” the breast is unlikely to fix the problem and can result in not dealing with the real cause. 

Sometimes mothers are told that green stools indicate the baby is not getting enough hindmilk. This is not true. Green stools have no relation to milk fat. They are often a sign of a large milk supply and are a normal occurrence. 

They might also be told that the lack of curds (stool seeds) in the babies stool indicates a lack of hindmilk. This is also not true. Some babies have curds and some don’t.

References

de Fluiter KS, Kerkhof GF, van Beijsterveldt IALP, et al. Longitudinal human milk macronutrients, body composition and infant appetite during early life. Clin Nutr. 2020 Nov 24:S0261-5614(20)30644-0

Kent JC, Mitoulas LR, Cregan MD, et al. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006 Mar;117(3):e387-95 
 
Mitoulas LR, Kent JC, Cox DB, et al. Variation in fat, lactose and protein in human milk over 24 h and throughout the first year of lactation. Br J Nutr. 2002 Jul;88(1):29-37

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