In Search of the Elusive Hind Milk

If you are a breastfeeding or pregnant mom, chances are good that you have heard the terms “foremilk” and “hindmilk” in relation to breastfeeding. I hear or read these words almost daily in my life as a lactation consultant. I have pretty much reached the point where I want to rip my hair out every time I hear or see them.

I first remember hearing the words about 12 years ago while working for another lactation consultant. At the time, many moms were still being told things like “nurse baby on one breast for 10 minutes, burp baby and then nurse on the other breast for 10 minutes.” We saw moms on occasion who complained of fussy, gassy babies with green, frothy stools. I remember hearing the lactation consultant teaching moms about the “thirst quenching” foremilk that came at the beginning of a feeding, followed by the high fat “dessert” of hindmilk that came at the end of the feeding. If mom had an abundant milk supply and baby was being taken off of the first breast after 10 minutes and then moved to the other side for 10 more minutes, baby was likely not getting to the hindmilk and would be gassy and fussy. These moms were instructed to nurse baby on one breast per feeding, letting baby take as long as he needed to finish. This often corrected the problem and both mom and baby were happy.

It started innocently enough as a way to correct a fairly uncommon problem. However, the idea of “foremilk/hindmilk imbalance” is definitely a case of a little knowledge being a dangerous thing. Instead of seeing moms who are told to nurse baby for 10 minutes on each breast, I am seeing moms who are told to always nurse baby on just one breast per feeding and to make sure he stays for at least 20 minutes (or some other arbitrary time) so that he will get the hindmilk. I now see more babies with poor weight gain and moms with low milk supply than I ever saw fussy babies with green stools. I talk to moms on a daily basis who want to know, “How long does baby need to nurse before he gets the hindmilk?” I see babies who are not gaining weight and mom has been told that it is because baby is not getting enough hindmilk. In almost 10 years as a lactation consultant, I have yet to see one baby who is not gaining weight due to a foremilk/hindmilk imbalance. I have, however, seen several babies who are not gaining weight because they are not allowed to consume all of the milk available to them at each feeding. I talk to moms who report that baby fusses and cries at the end of every feeding as they are repeatedly trying to put baby back to the same breast and he refuses. I convince them to give the other breast a try and baby latches beautifully and drinks well. Mom is worried though because she has been told to only feed baby on one breast per feeding or he will never get enough hindmilk. It’s time to stop the madness!

Who is right? Feed babies on both breasts for a certain number of minutes per breast? Feed baby on only one breast per feeding and make sure he stays “long enough”? How is a mom to know what to do? You might be surprised to learn that I think they are both wrong. What is the problem here? The problem is that one-size-fits-all advice with breastfeeding fails to acknowledge that breastfeeding is a living, dynamic relationship between two individuals. While breastmilk averages 22 kcal/oz, it actually varies in calories from mom to mom and even from feeding to feeding. Moms produce milk at different rates; milk flows at different rates from mom to mom. Babies vary in how quickly they draw milk from the breast. One-size-fits-all advice just doesn’t work. So how is a mom to know how long to nurse baby or how often? One breast or two? How will she know if baby is getting the hindmilk?

The answer is two-fold – First, and most important, pay attention to the baby. Unless we disrupt the process or try to do too much directing, baby will take just what he needs. If you feed your baby when he shows hunger cues and let him stop when he is finished he will generally get what he needs. When babies are hungry, their hands are fisted and near their mouths. When they are full, their hands and arms relax. Nurse baby on one breast until he either lets go on his own or falls asleep with hands & arms relaxed. Try to burp him and then offer the other breast. If he takes it, let him nurse until he either lets go or falls asleep again. He will generally nurse for a shorter period of time on the second breast. If he doesn’t take the second breast, then offer that breast next time baby cues to nurse. Trust your baby to lead. Sometimes the waters are muddied by babies who let go because they have trouble staying attached to the breast or because they need to burp. If that is the case, they will generally try to immediately re-attach. Sometimes babies (especially newborns) will fall asleep before they are finished, especially if they are not latched well. Newborn babies will do a better job of staying awake at the breast if mom does breast compression during the feeding. Some babies will grow and gain well on one breast per nursing, some babies need the additional milk from the second side. Every baby and every mom is different. My first baby wanted/needed both breasts each feeding and was a very slow nurser, often taking 30-45 minutes per side when he was a newborn. My second baby usually only took one breast per feeding and was a very fast nurser – she was usually finished within 5-10 minutes and rarely nursed for comfort. They both grew very well, despite two totally different nursing patterns.

The second part of the answer is simply to understand what is happening in a lactating breast. Believe it or not, your breasts do not make two kinds of milk (fore milk and hind milk). Your breasts simply make breastmilk. Breastmilk is not homogenized. The fat separates from the liquid. Between feedings, the fat will begin to separate and cling to the sides of the milk ducts. As baby begins nursing and milk flows through the milk ducts, the fat will be gradually washed off the sides of the ducts. Fat content will gradually increase throughout the feeding. There is no magic point where the foremilk stops and the hindmilk starts. If baby is nursing very frequently, the fat won’t have much of a chance to separate and the fat will be more evenly dispersed throughout the feeding.

There is no need to stress. No need to watch the clock. Just nurse your baby and focus on learning to read his cues. This is how the system is designed to work.

Disclaimer: Yes, I know that there are exceptions. Some babies don’t nurse well and will struggle to draw any milk from the breast. Some moms have major problems with over-production. These problems need to be addressed individually, not by creating one rule for every situation.

56 comments on “In Search of the Elusive Hind Milk

  1. Elizabeth says:

    I can’t tell you what an important post this is…for me but others as well. Thank you so much! I’m sharing far and wide.

  2. Amanda says:

    Great post. My first baby fed so easily I didn’t think much of any of the advice I was given. He would pretty much empty a breast in less than 10 minutes and be done. I always had plenty of supply. Only hiccup – he didn’t want to breastfed after about 4 months. Nothing helped. We fought till he was 7 months then I expressed till he was 11 months and I was pregnant enough with my second that it just became too tough. Second baby. totally different! I had serious oversupply issues. He had reflux was gassy and had green frothy stools. He would take small feeds very often and genuinely never seemed to reach the hindmilk while I always seemed engorged. It took months to figure out what was going on. TG for lactation consultants and nurses and breastfeeding literature – and ultimately time. He is 9 months on Thursday and all these issues are gone! We have a brilliant breastfeeding relationship and I’m so glad we both stuck it out.

  3. Carrie Veldman says:

    Great post! Wish I knew this when I first started breast feeding. It’s been a constant struggle for us, always a new challenge to try and get through and after 11 months I am starting to lose hope. I have always had supply issues and a distracted nurser who has had a very hard time gaining weight. We are always “in trouble” at the doctor’s. I have reluctantly had to start supplementing, which has had it’s pros and cons. Pro, being I have been able to provide my daughter with extra nutrition and it actually relieved my stress level during a feeding because she relaxed when having a bottle and would continue nursing even after for comfort, which in turn helped my supply. The con, a baby who loves the bottle. Somedays she only wants a bottle and I have to really coax her into nursing and other days its the opposite. Keeps me on my toes! But a big question I always had was this whole 20 min “rule” – there is no way my baby would nurse for 20 minutes unless it was before bed time, an that was even rare. It is usually between 5-10 minutes. This in turn made me think she was only getting about half of what she needed from me and making me feel like a failure. I want nothing more to continue nursing and not having to supplement, but for us it’s so much more upkeep than I could have ever imagined with taking 9 fenugreek and 9 blessed thistle per day, atleast 60 oz of water, lots of food and a low stress level to make sure my supply is at it’s fullest. I hope this post gets to as many nursing moms as possible, because there is so much to learn about breast feeding that we don’t learn from our culture. Thank you for sharing.

    • My heart goes out to you Carrie. It is so hard when you have to struggle to maintain your milk supply. Your little one is blessed to have a mom who has persevered, despite the difficulty. Whatever supplement you need to give her does not negate all of the good things she is continuing to get from your milk. As she continues to get older and begins to rely more and more on solid foods, you may find that you are able to phase out the bottles and continue to nurse as long as you and she would like.

  4. Excellent article. So much misinformation out there, its so unfortunate when it comes from those wanting to help but end up sabotaging instead.

  5. Lina says:

    Thank you so much for this article! I’m a first timer, but I’ve been hearing how well I’m doing from my lactation consultant, the pediatrician, and even my OB. However, I’ve also been reading about this foremilk/hindmilk thing and was always concerned she wasn’t getting the right amount–despite being in the 60% percentile. After awhile, I stopped worrying about how long she was feeding and just started both feeding on demand and following her cues during feedings. She’s a quick eater and an average feeding amounts to 5-10 minutes on each side–15-20 mins total. I’m so glad I can breathe easier knowing this hindmilk thing isn’t as big of an issue as I originally thought.

  6. dearbumps says:

    When I first had my son I had my mother telling me it was only 10 minutes a side, my mother-in-law telling me just to use formula, the midwives saying to change side every time to popped off and the health visitor telling me to keep him on one side till he’d been there for 20 minutes then swap.

    Thankfully after a horrible incident where my mum told a friend of mine that I wasn’t a good mother I stopped listening to everyone except my baby and we got on brilliantly.

  7. Kenda Wathen says:

    Thank you for writing this. I am currently still bf my 17 1/2 mo. She has had slow weight gain since turning 1 and starting to walk. I was beginning to doubt myself as a mom. She does eat other foods but still desires and needs my milk. My older two were slow at weight gain as well and always on the smaller side. She is otherwise developing just fine.

    • Weight gain usually slows significantly between 12-24 months, with the average toddler gaining 3-5 lbs in that year (which averages out to just 4-6oz per month). As long as your baby is developing normally and is other wise healthy, then there may not be much cause for concern.

  8. Great Info to share! As a fellow IBCLC, I wonder where new mom’s hear this foremilk/hindmilk information. It is usually from professionals who have been in the field for a long time and are holding onto their old training. On a lighter note, I tell my kids I have white milk and chocolate milk and they love that!!

  9. Indie says:

    I’ve not been hearing the advice to only feed on one side at all from moms, but I definitely still hear the 10 minutes only thing. I had tons of difficulty with oversupply, but I don’t see it too often with the folks I work with.

  10. Rixa says:

    My first was just like yours (slow nurser, both sides every time), while my last two were like your second (faster nursers, usually just one side and they were done). I agree that paying attention to what your baby needs will solve a lot of problems!

  11. Fantastic info and so well written! Thank you!

  12. Emma says:

    So what language do you use for explaining this simply, in the face of the FM/HM terms? It drives me batty as well!

    • I usually say pretty much what I wrote here. For a short & sweet version, I simply say that there is no need to worry about FM/HM unless they have major oversupply or are trying too hard to feed according to the clock.

  13. stacy hancock says:

    I have both oversupply and overactive letdown and have to nurse on one side 2-3 times prior to switching. I think it’s great advice not to look at the clock(which I was told erroneously to do with my first). One thing not brought up that I think is contributing to a legit ‘oversupply’ seen in the first few weeks(leading to poor weight gain, fussiness, gas, ‘reflux’) is over pumping and pumping too early. We have such easy access to pumps now, many moms jump the gun and think they have to pump right away and often or they won’t make enough. Which of course signals the body to make too much. I think it prudent to encourage moms to hold off on pumping, to feed on demand, and pay attention to their baby’s cues. Also seek out a local LLL group to troubleshoot with.

    • Pumping too early and too often can definitely be a problem. It is difficult for the body to regulate if it doesn’t know how much milk baby really needs. There are some cases where pumping in the early days is necessary (i.e. baby who can’t latch or can’t nurse effectively) but for the most part, it is best to wait a bit on pumping. And mother-to-mother support is so imortant, like LLL, is so important!

      • Mary says:

        I have a question about this. I am having baby#3 in August, and with the second, I started pumping as soon as she was born, even pumping on one side while feeding her on the other. I was so concerned about having a supply of breast milk for when I returned to work. Should I only pump between feedings? How long should I wait until I begin pumping altogether? Thanks for the information!

  14. fatima says:

    my 6wk old only nurses on one side between 5-15mins… he usually pulls off or falls asleep with his arms relaxed and hands unfisted… but after he feeds, i feel like my breast still has milk in it, do i need to pump/express so my breast is fully drained? at first i was offering him both breasts but just 10 mins each time and he had green, frothy poops… now that i just feed him with one breast nd offering 2nd if he wants it, we are back to yellow poops… but he still gets gassy and fussy and spits ip quite a lot… i can hear him swallow air though especially during let down… this article is a good read for me. thanks! i am consulting with an IBCLC to work on latch and positing…

    • I’m glad to hear that you have found an IBCLC to consult with. Unless there are extenuating circumstances, it is usually not a good idea to pump after baby has nursed to satisfaction unless you want to increase your supply. Leaving that extra milk in the breast lets your body know that it is producing more than your baby needs, allowing your supply to regulate. Some gassiness and fussiness is normal at 6 weeks, but if it is excessive, it can indicate a problem. Common problems that I see with babies that are excessively gassy & fussy, swallow a lot of air and spit up a lot are oversupply, tongue and/or lip tie or food intolerances. Hopefully your IBCLC will be able to come along beside you and work with you to identify any issues and work them out.

      • fatima says:

        he had an ult that we had lasered off at 4wks… but before we had it taken care of, i got a plugged duct, so my midwife told me to pump after feeding to make sure breast is emptied… ive been pumping and doing all the stuff she adviced me to do to get rid of the plug…i then realized my supply wont b regulated f i keep pumping…so i didnt pump everytime after a feeding anymore.. just hand expressed if i still felt too engorged… i think the first plug finally went away but a second plug started feeling so sore and feels like a golf ball in my breast. i went to an obgyn and he said mastitis or abcess and prescribed me antibiotics… now m worried abt taking antibiotics because i dont want baby to get thrush… will the antibiotics help drain the lump too?

      • Without seeing you, I can’t give medical advice, but mastitis is usually accompanied by fever, chills, body aches, etc. It might be wise to ask for an ultrasound if one wasn’t already done. An abcess is serious business and should be diagnosed and treated correctly. If you are only dealing with recurrent plugged milk ducts, antibiotics won’t do anything for that. Any time you are taking antibiotics, it is good to also take a good quality probiotic to replace the good bacteria and prevent against yeast over-growth.

      • fatima says:

        sorry, i cant find a reply button from you reply box field… i dont know y the obgyn…the obgyn just looked at my breast and told me it’s an abscess…even the IBCLC touched it and examined it and agreed. she said to wait a couple days and if no improvement, to go back to obgyn and get an ultrasound and get it drained…

  15. arualcole says:

    It’s interesting that the answer is often, “Pay attention to your baby. Not the clock.”

    I have oversupply issues, or at least, I did in the beginning. Now my daughter does have to switch sides. My son, on the other hand, never did have to do that. He’d get everything he needed or wanted from one breast. I’ve never watched the clock, but sometimes I do get distracted and not realize that the reason my baby is fussing while nursing is because she’s ready to move to the other side.

  16. Amanda Olsen says:

    why do they get green frothy stools then?

    • Some moms really do have oversupply issues that need to be addressed. However, they need to be addressed for that individual mom and baby, not by telling all moms to feed on one breast each feeding or all moms to feed on both breasts each feeding. Sometimes correcting green, frothy stools is as simple as feeding baby on one breast per feeding, sometimes it is a more complicated issue. (And I will add that an occasional green frothy stool probably doesn’t need to be stressed over.)

  17. AmyJ says:

    I have a big milk supply and nursed twins the first time. I was in the habit of one breast per baby per feeding and this time with my singleton I have almost always done that. But if she seems more hungry I’ll let her nurse the second. Glad I didn’t worry too much about advice like the 10 min/side, but I was aware that I produce a lot of milk and that wouldn’t likely apply to me. Naturally breaststfeeding is going to vary a lot with each woman

  18. Jay says:

    My sister shared this post on Facebook. You are very well spoken and clear to the point. Well done!

  19. Natalie says:

    What if your LO is EBF but really small? My DS keeps dropping in his percentiles every time he sees the doctor and they make me feel horrible about it. He is almost 6 months so he will be going again soon but at his last visit he was 3% in his height and 8% in his weight. He is super happy and making his milestones so I guess I shouldn’t worry but when he keeps dropping I can’t help but worry! I saw a lactation consultant every week when he was born because he dropped a lot at first. The schedule they had me on was crazy and he even had to supplement with my sisters breast milk! Anyway it has been a struggle but I will do whatever it takes to bf for at least a year and I guess I should just not listen to the doc and trust my mothers intuition that he is just fine but on the small side!

    • That is a hard spot to be in Natalie. Sometimes I see babies that struggle to gain because of difficulty drawing milk from the breast or because of food allergies & intolerances, but sometimes they just are who they are. If he seems to be healthy otherwise (no eczema, rashes, mucus in stool, etc.), he may just be small. How does he compare with how you or his dad grew as infants? Sometimes that is a big clue.

      • Natalie says:

        In my side of the family we were all nursed and gained well. My DH was very small as a child but not sure as a baby. He was never breast fed though. He has no eczema, rashes or mucus but no longer has a poopie diaper every day which concerns me a bit. I have noticed that my sons lip and tongue have a tie and have wondered if he isn’t emptying the breast all the way. It is something I am exploring. He has been waking every 1 – 2 hours at night and chews on my nipples all the time so I’m reading all that I can on ties. I’d have to travel out of state to have it lasered so I want to be sure! He’s such a happy baby and I need to just stop putting too much thought in to all the comments he gets when in public! “He’s how old?!” “He’s 5 months, was he a preemie?” “Oh he is SO SMALL!”

      • Tongue/lip tie can definitely factor into it. I frequently see babies that gain okay (or even well) for the first 2-3 months but then start dropping off when they just can’t nurse effectively enough to sustain growth. Definitely worth exploring.

        I used to get comments like that with my youngest and it would make me so mad. She was extremely small due to her genetic condition. Random strangers would ask how old she was and then say things like “Wow! You really need to feed her!” I’m thinking “Gee, why didn’t it think of that???” I’ve come to the conclusion though that there will always be people who make unthinking comments, no matter what.

  20. Natalie says:

    And this is a great article! Thanks for writing it!

  21. [...] In Search of the Elusive Hind Milk | normal after all [...]

  22. I wish I had been able to read this article 4 months ago. I stopped breastfeeding because my daughter wasn’t gaining enough weight, and her doctor said it was because she was getting “too much foremilk and not enough hindmilk” so, going against every atom in my body, I weaned her and started her on formula. She’s six months old and I still cry sometimes because I miss breastfeeding so much. I want to relactate, and I don’t think it would be hard considering I had an abundance of milk and taking fenugreek worked for me while I was lactating, but she’s just so used to the bottle now that she isn’t interested in the boob anymore :,( No matter when I try to offer it to her, she flat out refuses. I have an SNS but she doesn’t like it and it’s really messy… *sigh/cry

    • That is heartbreaking Marissa. Don’t let anyone dismiss the grief you are feeling. It is real and it is valid. Even if you can’t entice her back to the breast, you have some options. You can re-lactate and give her your milk in a bottle or continue on the formula, but try to replicate breastfeeding as much as possible. Feed her skin-to-skin when you can; alternate arms that you hold her in when she feeds; pace her bottle feedings so that she isn’t guzzling the milk; always hold her and cuddle her when she gets her bottle; make eye contact and talk to her. She will know that you love her and cherish her, in spite of the loss of breastfeeding.

  23. Jo says:

    Would you mind if I shared this post with my childbirth ed classes and doula clients? I’d love to make copies to put in my packets – with full credit and a link back to your website, of course.

  24. fatima says:

    oh, and i am taking probiotics too… is it fine to give baby infant probiotics also?

  25. StorkStories says:

    You hit it out of the park with this one!! AWESOME! THANK YOU!!!

  26. Caleb Delana says:

    Regards for helping out, fantastic information.

  27. This is such a great post! My baby is now 7 months and we are pretty comfortable now with BF…I wish I could tell the me 7 months ago to relax and not listen to everyone to just listen to the baby because he has all answers! We listen to each other now and I never watch the clock, and boy does it make life easier, every new mom should give this a read!

  28. [...] 3 weeks, 6 week, 3 months, and 6 months.  Roughly.  Every baby is different!)  Here’s a great article about foremilk and hindmilk that should help ease your worry about “feeding too [...]

  29. Denise says:

    I keep googling foremilk/hind milk inbalance and read everything that I can find. I’ve been doing this for the last two weeks . I hadn’t came across this article until today. I’m so confused. I’ve been seeing a lactation consultant every week for the past two weeks at a suppport group and I’m even more confused … I have a 8 week old who gained 5 oz in the last week who has been having a lot of frothy poop. I nurse on one side until she doesn’t want it and if she’s still hungry I switch . The thing is that I think she only wants to nurse until my let down has slowed down . Which im assuming is all foremilk? She only wants a fast flow nursing session and doesn’t want to actually work for it. I’m also afraid she falls asleep still hungry or that it’s just that I don’t have enough milk . I was told by the location consultant that I should pump in the mornings since I leak a lot during the night my baby sleeps 6 hours through the night. she also said that I should pump in the middle of the night so that my baby wont get so much foremilk in the morning but wouldn’t that just make me produce more and throw everything off ? If I’m leaking (a lot) doesn’t that mean I have an over supply ? And if it does then why is it that by the end of the day it seems like I’m running on empty :/ sometimes I feel like formula would be less stressful . Everything can be well calculated and you can see what’s going in . I’ve exclusively breast fed this long and I really do want to continue but it’s just so stressful not knowing if I’m depriving her of fat or if I’m only giving her the “skim” milk because of my strong let down . . Sorry for the rambling . :/ also I don’t really wish to pump . But being that by the end of the day feel like I don’t produce as much when would it be best to pump or is it something that I can regulate on my own ?

  30. ABess says:

    Thank you so much. This really helped alot.

  31. Lorna says:

    Excellent, concise article, thank you so much. Like so many others I wisj I had read this the first time round. I struggled with breastfeeding for months and got lots of conflicting, wrong advice from family & healthcare workers. I was stressed for months but im proud to say I fed my boy exclusively until he was 1 & a half.

    This time round, my little girl feeds every two hours for 5-10 mins, usually just one side. She is 13 weeks and sleeps ten hours at night. Im being told to try to get her on a 3 hour feeding schedule but my instincts are telling me not to. She is gainingweight well, in the 91st centile. Any thoughts?

  32. Teena says:

    This is a really nice post. I live in Africa where we dont hav tins like lactation consultants or groups and all.. myDS is 7weeks and breastfeeding has been a real challenge(from positions to latch)though much better now. i really want to stick to Bf. DS nurses for an average of 5-8mins say every 2hours.he either sleeps off or just doesn’t want more and seems content and happy. ♍Ɣ supply is good infact most times ♍Ɣ breast is engorged. With the foremilk/hindmilk tin I’m confused if DS is getting d hindmilk at all. DS weighed 3kg(6Ibs.6oz) @ birth and 4.3kg(9Ibs.4oz) @ 6weeks. i worry he isn’t gaining much weight and isn’t getting enough milk!!!!!! .. As he feeds for just 5-8mins and ♍Ɣ breast still feels full always….!

  33. sonam says:

    my baby eats well only while sleeping.. otherwise he seems very distracted while feeding.. what should i do?

  34. twin mum says:

    I have twins so my big question is, how do I offer both breasts? Both are in constant use at each feed.

  35. Alison says:

    Seems I have found this post quite late but i am having problems where my baby never seems full and always wants another feed about 30 mins later. I was told to just feed on the one side and he seems to feed quite well – about 25 mins continuously and seems to be attached well. Quite often there is still milk on the breast when he comes off so I’m pretty sure he is getting some. He always takes himself off the breast and will sometimes want more and other times he is completely relaxed. We have got a few green stools but the main problem is the continuous hunger. We can only fill him up for more than 30 mins by using formula. Any advice gratefully received.

  36. Liz says:

    Thanks for this post! My 9wk bf baby has gained loads of weight since birth going from 6lb11oz to 12lb4oz last week. However she seems to be in a lot of discomfort, often having bouts of screaming like colic, but at any time of day or night, often during feeding, and often straining and grunting for hours at night. I read about lactose overload which has similar symptoms to colic, and the cure was suggested as less foremilk and more hind milk… How can I achieve this? Do you think this is the problem?

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