Marie Davis RN IBCLC

Oversupply Syndrome and Colic


Foremilk - Hindmilk Imbalance

With or without an

Over Active Let-Down

Too much milk?


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

See also Two Kinds of Milk? (Not really)

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. 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.

Why Lactose?

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

a) The infant gut makes a given amount of an enzyme called "lactase" that is responsible for digesting lactose.

b) If the infant gut becomes overloaded with lactose, it is in unable to process all the lactose.

c) The remaining "free" lactose ferments, producing gas pains

d) The lactose also "pulls" water from the infant's system, causing stool changes similar to osmotic diarrhea.

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.

If you think this may be your baby's problem please fill out the evaluation form and send it to me. I do not give "advice" for treatment without a full history.


Baby’s Symptoms:

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

Maternal symptoms:

  1. Persistent sore nipples, often with a linear crack across the nipple face.
  2. Nipple may come out of baby’s mouth pinched, not round, occasionally has a ridge along nipple face.
  3. Mother feels that she has too much milk or complains of constant leaking
  4. Mother feels that she doesn’t have enough milk because the baby appears to be “always hungry” or “not satisfied”.
  5. Mother complains of pain deep in the breast between feedings, which may be from nerve irritation due to persistent nipple pinching. (The resulting neuritis symptoms may need to be treated with an anti-inflammatory medication for 2-3 days).
  6. Mother complains of painful letdowns that sting or burn; [approximately 50% say they cannot feel letdown.] First letdown tends to be very painful if breast is overfull
  7. History of repeated engorgement, plugged ducts and/or mastitis.
  8. Mother may have questions regarding her dietary intake as related to infant fussiness and gas; or nay have begun elimination diet
  9. Mother may express that baby does not like her or her milk
  10. Positive family history for “colic”
    1. Had a similar history with a previous child.
    2. Sisters who nursed report colicky babies.
    3. Maternal grandmother reports problems with breastfed children and colic.



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