A Work in Progress
Not proof read--not spell checked!
Oversupply Syndrome and Colic
Foremilk - Hindmilk Imbalance
With or without an
Over Active Let-Down
Too much milk?
|Marie Davis RN IBCLC||
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
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. 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.
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 believes that what mothers eats and/or drinks will cause colic in the baby. 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.
Initial oversupply with the onset of mature milk production causes some babies to be fussy during the first week.
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.
Lactose or milk sugar, is present all milks. Lactose is the primary source of energy for the baby. The baby needs lactose for proper growth and development. Foremilk is high in lactose, providing quick energy to the infant. The belief is if a baby has "too much foremilk" intake, it can produce intestinal discomfort in the baby.
Foremilk has a higher concentration of lactose than hindmilk
This is not lactose intolerance but lactose overload. Congenital (meaning "born with it") lactose intolerance is very rare, because it would be incompatible with life, prior to the availability of substitute "milks."
However, not all the symptoms are related to lactose overload. Some professionals believe that the problem is simply a matter of mother and baby not being "in sync," but the symptoms cannot be "blamed" on feed mismanagement alone. We have found that the syndrome tends to run in families, and tends to worsen with each subsequent baby. It is most commonly reported with second and third babies by experienced breastfeeding women. The answer to the difficulty may be more complex than we realize.
Fundamentally, the symptoms are related to multiple causes such as: the baby may be getting too much milk too fast, air swallowing, a high overall volume of milk intake, in addition to a high volume of foremilk intake and/or lack of an adequate intake of hindmilk.
Gains weight quickly (1-2 pounds/week)
Often is 1 pound or more over birth weight at 2 weeks of age.
Appears colicky, fussy, gassy.
Burps “like an adult” or burps poorly.
Passes large amounts of flatus.
Spits up frequently, often appears to be large amounts.
May have tentative diagnosis of gastric reflux
Gulps with feedings or appears to choke with letdown.
Pulls off the breast frequently or chews at the breast.
Grunts frequently between feedings
Abdomen appears full and distended especially after feedings. May have hyperactive bowel sounds.
Will latch on only to the nipple or pinches nipple during feedings.
Wants to nurse very frequently.
Has short feedings (5-7 minutes).
Nurses minimally on the second breast or refuses to take the second breast after nursing well on the first breast.
Has a stuffy nose after feedings.
Early or frequent ear and/or sinus infections.
10-15 wet diapers per day.
Has unusual stooling patterns:
Wants to suck hands or pacifier frequently.
If nursed lying down, may leave a “puddle of milk in the bed,” choke or gulp less frequently.
In later phases
Last Reviewed: Thursday, May 10, 2012 11:05 PM