The reader is strongly encouraged to get the assistance of a Qualified Lactation Consultant  (IBCLC) or their baby's physician in the treatment of Oversupply Syndrome.

For professionals see: Lactation Clinic Protocol

General Information:
What is over supply syndrome?
Oversupply Syndrome has also been called Foremilk - Hindmilk imbalance. I think that terminology gives a false impression of how the breast works. There is never a point where the milk is all fore milk or all hindmilk--it is always mixed together. I have chosen to call it Oversupply *Syndrome* because the condition manifests in a definite group of characteristic symptoms that effect both mother and baby.

Kittie Frantz once called me "The Queen of Oversupply." I don't really know if that is true ;-) but we have been researching this phenomenon in my medical center's lactation clinic since 1989. We have collected data on several thousand moms and babies. I also collect data from my private practice and Internet contacts.

Colic?
Most medical providers and parenting books simply believe that colic is something that babies get and parents have to put up with until it goes away. However in our studies we have found that approximately 95% of the colic cases we see are caused by oversupply syndrome. Approximately 2 percent are dietary allergies, 1 percent can be traced to gastro esophageal reflux (GER). True colic; defined as colic that occurs without a known cause, is only about 2 percent of our colic cases.

Very few medical providers recognize that colic could be caused from an oversupply of mother's milk. I believe that this is because our culture generally believes that women don't make enough milk. In the past, when feedings were strictly controlled and done by the clock, women did have low milk supply problems. Now that mothers are better educated about breastfeeding, oversupply colic is more common yet remains unrecognized. Another problem is that our culture also strongly believes that what mothers eats and/or drinks causes colic in the baby. Often women are needlessly put on restricting elimination diets before other causes have been explored.

Oversupply Syndrome was first described as Overactive Letdown by Andurusiak and Kuzenko in 1987. As previously stated, our work suggests that Oversupply Syndrome is the most common cause of colic - like symptoms in breastfed infants. Breastmilk synthesis research by Hartman, et al, seems to support this theory. Hartman found that some women produce very large amounts of foremilk every hour. This may be why some women and infants are highly affected by this syndrome especially if they are switching breasts frequently, not allowing baby to set the pace of the feeding, not "finishing the first breast first" or by imposing set times for the frequency and duration of feedings. The symptoms may be related to multiple causes other than just the high concentration of lactose in foremilk: the baby may be getting too much milk too fast, swallowing air, may have an high volume intake of milk overall or have high volume of foremilk intake and/or lack of an adequate intake of hindmilk at feedings.

Initial oversupply with onset of mature milk production causes some babies to be fussy during the first week. One study talked about complete drainage of the breasts as a treatment for too much milk, In van Veldhuizen-Staas's report, of the 4 cases presented, only one (case 4) was not during the first 2 weeks post-partum when I expect oversupply a a normal part of Lactogenesis stage II

Case 1 nine days old
Case 2 eight days old
Case 3 four days's old
Case 4 two months old

With severe engorgement present and flowing milk a complete pump-out is something many of us began recommending to prevent a feedback response, (which could severely hamper a mother's milk supply further down the line) during the period when her breasts are laying down prolactin receptors,. But to accept this as a general recommendation for treatment is not acceptable.

We have a blanket policy in out clinic not to "treat" prior to 3 weeks of age. Mother's milk supply is in a state of constant flux in the first weeks. How feedings  (breast emptying) is handled or mis-handled will have physiological consequences which affect milk production later on.

Good breast pumps are now available for purchase

Colic symptoms normally appear at 3 to 4 weeks of age.

Once the cycle is broken, colic symptoms lessen significantly or disappear within 72 hours in the majority of our patients. A select few require further intervention.

Fore-milk hind-milk imbalance

A high level of foremilk produces intestinal discomfort. The infant gut becomes so overloaded with foremilk that the lactose ferments producing gas pains. Baby responds to any intestinal upset by wanting to nurse. The more baby nurses without receiving hindmilk, the more discomfort baby has. It becomes a vicious cycle of crying, nursing and crying and nursing.

Early treatment of Oversupply Syndrome can prevent months of living with colic - like behavior, possible early weaning and/or lack of weight gain after 4 months of age.

Mothers, health care providers, and child care books often report that colic goes away on its own at 4 or 5 months of age. We believe that this is because pregnancy hormones are no longer driving milk production. After about 4 months, nursing and/or pumping keeps the milk supply going. This is called autocrine or local control of milk production. Under autocrine control the breast now makes milk for the next feeding based on how *empty* it is after the previous feeding.

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Copyright Marie Davis, RN, IBCLC 1999  
Last Reviewed: Sat, Sep 12, 2009