After your breast milk has been in the refrigerator for awhile, you may have noticed that it separates, with the fattier milk rising to the top. This breast milk fat separation is totally normal and nothing to be concerned about. However, some women worry that they aren’t making enough of the fatty milk, and that they have something called a foremilk/hindmilk imbalance that is hurting their baby. Here’s how to know if this might be an issue for you, and how to fix it if you’re pumping.
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What is foremilk and what is hindmilk?
Foremilk is the milk that flows out of your breasts at the beginning of a pumping session, while hindmilk is the milk from the end of a session.
What is the difference between the two? Because the fatty parts of breast milk stick together, and to the sides of your milk ducts, the milk that is released from your breasts first contains less fat and is more watery. Later, when the breast is more empty, more and more fat begins move out of the ducts and flow out of the breast.
Therefore, foremilk tends to have less fat than hindmilk, as the amount of fat in breast milk will gradually increase during a pumping session.
What is foremilk/hindmilk imbalance?
Foremilk/hindmilk imbalance can occur when a baby fills up pretty much exclusively on foremilk and doesn’t get much of the fatty hindmilk when he eats. This can result in the baby taking in too much lactose and not enough fat.
What are the causes of foremilk/hindmilk imbalance?
In babies that nurse, this can happen if the mother has an oversupply or if the baby is frequently switching breasts during a nursing session. When this happens, baby becomes full from the foremilk and stops eating, so she doesn’t get hindmilk from either breast.
This happens less frequently with exclusive pumpers, because you are feeding your baby a bottle with all of the foremilk and hindmilk mixed together, rather than foremilk first followed by hindmilk. However, some exclusive pumpers may also struggle with this if they have an oversupply or if their pumping sessions are on the shorter side.
What are some common foremilk/hindmilk imbalance symptoms?
Your baby getting too much foremilk and not enough hindmilk may result in the following symptoms:
- Becoming more fussy than normal
- Having colic symptoms
- Becoming gassy
- Having green poop
When should you be concerned about an imbalance?
First, I wanted to note that many lactation consultants agree that foremilk/hindmilk imbalance is not very common. (This is a great piece on the subject.)
Parents often worry when they see that their baby has a green stool. However, foremilk/hindmilk imbalance isn’t the only cause of green stools: green poop can be the result of something you ate (green vegetables or something with food coloring), teething, a virus, or starting solids, for example.
My suggestion is to not be too anxious about green poop unless your baby’s poop is consistently green and he is very fussy. However, if this is the case – most dirty diapers are green over a day or two (and possibly “frothy“) and your baby is not a happy camper, there are some things you can do to try to fix it. (Note: You should call your pediatrician regarding any health concerns that you have for your baby.)
Because there has been some confusion in the past, please note that this is NOT necessarily an example of foremilk/hindmilk imbalance; it’s just showing the breast milk fat separation. You can’t tell if there is “enough” hindmilk from looking at a photo, unfortunately.
What should you do if you’re exclusively pumping and think foremilk/hindmilk imbalance may be an issue?
There are a few things that you can try.
- Pump for longer. If you are concerned that the milk you’re pumping doesn’t have enough hindmilk, one way to increase it is to pump for longer so that you’re pumping when your breasts are emptier. (Remember, the emptier the breast, the fattier the breast milk.) So, you could try adding a few minutes to each session, or you could drop a session so that that you’re pumping less time but for longer. For example, if you’re doing 8 pumping sessions that are 15 minutes long, you could change your schedule so that you’re pumping 7 times per day for 20 minutes, and see if that helps. Also, you can try some strategies to empty your breasts faster.
- Separate out the first ounce. If you have an extreme oversupply (say, you’re pumping over 50-60 ounces per day), and you think you are pumping too much watery milk, you can bring a separate container with you when you sit down to pump. After you pump the first ounce, disconnect your bottles and pour the milk into the separate container. Then, reattach and keep pumping.
- Keep milk from pumping sessions together. If you are not an oversupplier, you might want to try keeping the milk that you pump from one session into one single bottle (and make sure that session is long enough that you’re getting hindmilk). This way, if you pump until you’re fairly empty, you know that you’re combined the foremilk and hindmilk from one session into the one feeding, and it should hopefully have the right amounts. It’s sort of like block feeding for pumping.
- Mix all your milk together. Yes, this is the opposite of what I just said! Different things will work for different people, and some oversuppliers find that using the pitcher method (where you put all of the milk you pump into a pitcher and then prep bottles from that) helps them manage issues with foremilk/hindmilk imbalance. This can be especially helpful if you pump into more than one bottle on a side at some pumping sessions.
Common Foremilk/Hindmilk Imbalance Questions
Here are a few additional common questions.
Should you throw away extra foremilk?
If you decide to separate out of the first ounce or so that you pump as described in the second option above, should you throw it away?
No! Just because it’s watery doesn’t mean it’s any less liquid gold. Some things you can do with it include:
- Mix it your baby’s solid food (if she hasn’t started solids yet, you can freeze it until then)
- Use it in a milk bath
- Make breastmilk jewelry from it
- Make breastmilk lotion or breastmilk soap, etc.
I feel like there is not a big enough layer of fat at the top of my refrigerated bottles. How big should it be?
There is no “correct” amount of separation. The only way to see if there is an imbalance issue is to look at your baby, not your breastmilk.
Is she gaining weight appropriately? Is she mostly happy? Are her poops mostly not green? If these are true, then don’t worry about what the breast milk fat separation looks like the in the fridge.
How can I tell if my issue is foremilk/hindmilk imbalance or dairy allergy?
Because the symptoms are very similar, it can be hard to know which is causing your baby to be unhappy.
I would try fixing one of the two issues at a time. You can try cutting out dairy and see if that helps. Or, you can try to correct the possible foremilk/hindmilk issue (by using one of the four options listed above, if you’re an exclusive pumper, or by block feeding, if you’re nursing).
The reason I wouldn’t do both at once is that if and when things improve, you won’t know which change did it and what the underlying issue was, and you might be stuck on a dairy free diet when it’s not necessary. (However, if you’re desperate for things to improve, then do what you have to do!)
Have you dealt with foremilk/hindmilk imbalance? Or been worried about green poop? Tell us about it!
References- Bonyata, Kelly, IBCLC. “Foremilk and hindmilk – what does this mean?” https://kellymom.com/bf/got-milk/basics/foremilk-hindmilk/
- Breastfeeding Problems. “Foremilk Hindmilk Imbalance.” https://www.breastfeeding-problems.com/foremilk-hindmilk-imbalance.html
- Kellymom. “Mother-2-Mother Concerns: Green Stools.” https://kellymom.com/mother2mother/m2m-green-stools/
- Madden, Katie, RN, IBCLC. “‘The Good Milk’ Foremilk/Hindmilk.” https://balancedbreastfeeding.com/the-good-milk-foremilkhindmilk/
My daughter is 7 months and I have an extreme oversupply 50+ oz a day and she is gaining weight but in the lower end of percentile (16%) I have such a thin layer of fat on stop of my milk and I’m not sure how to go about changing that or if I should start supplementing with Bobbie formula? When she was younger she definitely had very loose stools and had “colicky” symptoms very gassy. She is on solids now so it’s gone away now but I’m just trying to get advice on what you think I should do?? Is it possible to not get enough because I’m a vegetarian?
Hi Leah! I would talk to your pediatrician if you’re concerned, but nothing in what you said worries me. Being a vegetarian won’t affect your milk composition (women in famine conditions make perfect breast milk). It could just be that baby is genetically on the small side? Is she happy and thriving overall?
Hi, thank you for this article very informative. I’m an exclusive pumper and my son is 8 weeks now. My issue is that my son seems to be reacting to my breast milk by way of a very aggressive diaper rash since he came home. He also struggled with colic but that’s gone away. The rash has me worried because it bleeds occassionally. His pediatrician prescribed an ointment which is keeping it from worsening. I’ve tried all the rash creams, have cut out dairy, going on 2+ weeks and stopped drinking caffeine but still no success I switch to strictly formula to see if that helps and his rash cleared up. My milk seems healthy mix of fore & hind milk but I’m not sure what I’m doing wrong. I thought it was lactose overload but now I’m not sure. I pump 30-40 minutes 4 to 5 times a day and average 24oz a day. Would you have any idea what this could be?
Hi Alaida! I’m not sure, but maybe it is an allergy? I know you cut out dairy, but my understanding is that it can take a few weeks for it to be completely gone? Have you asked your pediatrician about maybe doing an elimination diet or something?So sorry you’re dealing with this!
My first born had the same issue with diaper tastes, they were SO bad it broke my heart. have you tried changing diaper or wipe brands? That’s what worked for us. I found that certain brands of diapers gave him such a bad reaction as well as wipes. Not I just use unsented wipes and I’m picky about what diapers I use. Hope this helps!
Hi my baby is having difficulty sleeping when she usually can sleep well. And I’ve noticed she’s been having green poop. But she’s not fussy tho. I usually combine both sides of my pump milk but I feel that it’s imbalance milk intake. How do I avoid this? Since I’ve mixed it into one bottle to store.
Hi Syikah! You could maybe try the pitcher method?
Hi FTM here, my son is 9 weeks and was breast fed but changed to exclusively pumping for about three/ four weeks. He has been having green mucus poos basically since I switched to pumping. I have stated to pump for longer as I now know about the for milk hind milk imbalance and some poos had improved but not massively. I pump 5/6 times daily and get roughly 12oz each time, he is not fussy or upset in any way so I’m not sure what to do?
Hi! I would talk to your pediatrician and see if they are concerned. If he’s not fussy/upset, it might not be an issue as long as he’s comfortable and growing well. 🙂
Hello! I have a 6 month old that I am fully breastfeeding. I pump during the workday and nurse when baby is home with me. He has had green, watery/mucusy stools for almost two months. He’s a happy baby and doesn’t seem uncomfortable at all. Also gaining weight…but his stools do not seem normal and it’s been such a long time. Any thoughts on whether this is a dairy issue or foremilk/hindmilk issue? We have an appointment with a GI specialist in a couple weeks but would love to have something to try in the meantime!
Hi Tricia! If baby is finishing at least one breast when you nurse and a full bottle when you’re at work, and if he’s happy and growing well, I think it’s unlikely that it’s a foremilk/hindmilk issue. Do you have oversupply at all?
Hi
I have 2 me months old kid, initially during the beginning of feeding I use to get hind milk which is very thick white but for past 2 days suddenly I am getting foremilk at beginning and I feel my milk is watery.
My babies stools are mucusy. Is there any remedies to increase hind milk or to reduce fore milk? Please do let me know
My almost 4 weeks old (on Thursday) is having trouble with breastfeeding due to her tongue tie. We had it released a week ago yesterday. I had mastitis prior to the surgery likely because she is not emptying me. She struggles to get any more than an ounce in 30 min of nursing. Within the last 4-5 days, she began making noises during the night like she’s uncomfortable, pulling her legs up to chest, increase in fussiness where we really can’t calm her, crying after eating, mucousy/watery poop possibly some black specks, spitting up more, and difficulty sleeping. She no longer will let us hold her while sleeping and really doesn’t want us to hold her in general. I’ve been pumping 5-6 times a day anywhere from 15-25min. I looked at the bottles and there is a thin layer of fat at the top. I have never been able to feel my let down. Does it sound like more of an imbalance issue or allergy? I called the doctor today and they suggested I eliminate dairy from my diet, have her upright for 20-30min after eating, and have her in a more upright position when sleeping (swing or bouncer). She really won’t sleep in an upright position.
Hi Ellen, I’m not 100% sure, but with the length of your sessions, I think it is more likely to be reflux or an allergy than foremilk/hindmilk? I wish I could give you a clear answer!
Thanks! I should’ve added I get anywhere from 1.5-2.5 oz on each side when I pump. I don’t think I have an oversupply. What do you think?
Currently dealing with a 6 week old baby with green mucousy stools that occasionally have blood. Baby isn’t overly fussy and is gaining weight just fine. Doctor recommended cutting dairy. One week in and have yet to see improvement but I understand it can take 2-3 weeks. I am an EPer and have oversupply. I produce 65oz/day and pump 5x per day for 25 minutes each. Could going 4-5 hours between pumping sessions can foremilk/hindmilk imbalance? Should I be pumping more frequently? I cut down on ppd purely for convenience.
Hi Helen! As long as you feel like you’re pretty much empty when you pump, I think it’s probably not a foremilk/hindmilk issue. 🙂
Helen, this sounds exactly like me. Oversupplier of 60-70 oz/day, 5-6 ppd to reach 120 min total, not particularly fussy baby but dark to lime green stools with occasional tiny dots of blood. I cut out dairy after speaking with my doctor about 3 weeks ago and it’s still happening. If you end up solving the problem, let me know – and vice versa! I’m afraid to empty my breasts more for fear of stimulating an even greater oversupply.
Hi! Thanks for the article.
I did have a question… I am currently an oversupplier, making about 60opd. With that, I feel like I am getting a lot of foremilk. If I reduce my pumps from 10-12 to 8ppd, will this correct my potential imbalance? When pumping 10-12x, I did 25min and plan on doing 25min with the 8ppd. Is the body smart enough to know that I don’t need as much milk, so that the hindmilk will come out faster? Thanks!
Hi Tracy! I think you should be okay to do 8 session at 25 minutes. Do you notice any issues with your baby – like green poop/fussiness?
Hi Amanda,
Thank you! Yes I’ve tried by looking at my baby’s pictures, thinking of a waterfall, massaging, heat etc but no matter what I do it’s been the same the past few weeks with no increase in supply or seeing hind milk. I am thinking of stopping all together as I’m not seeing any changes 🙁
Hello, my baby is 1 month old now and I’ve had a supply issue since he was born. I barely have any milk to supply him and have been supplementing formula (pumping 7-8 times a day and only get a total of 10oz). I never realized all I’ve been pumping is the foremilk! I’ve never gotten to the hindmilk even with pumping 20 minutes. Also my milk is coming out as drops instead of a flow (I don’t think I am experiencing a letdown at all). It’s been frustrating and I don’t know what else to do!
Hi Kristina! Congrats on your baby! Have you tried any of these methods for getting a letdown? https://exclusivepumping.com/how-to-boost-milk-supply-letdowns/
Hello ! My baby is 2 months old and had been sleeping great and eating great ! But the past week or has been more fussy and trouble getting her to nurse without fighting , her poop has been green and mucusy ! I do not pump and have very regulated milk but she seems to eat less per nurse but want to more often ! Any ideas?
Hi Clarissa! It could definitely be an issue with foremilk/hindmilk imbalance. HAve you tried block feeding at all?
Hi, I’m slightly confused by this. I think it’ll help if I explain my situation. Baby started having green poop, very gassy. I don’t pump overnight anymore, so in the morning I have a lot of foremilk. I pump on both sides, the first bottles (5-6 ounces) look like all foremilk. I’ve been emptying into a big container. Then put bottles back on and by then I pump until I’m empty. The next bottles get almost full but definitely look like hindmilk. I’ll add that to the bowl and stir it all together, and then pour from that bowl into breastmilk bags. Then each bottle I make I fill with the breastmilk bags. Is that a correct way to do that so that the mixture is better? I still feel like the mixture would be mostly hindmilk though because the first two bottles appear to be all hindmilk. The pitcher method sounded similar to what I’m doing, but I only mix during my first morning pump. The rest of the pumping sessions I don’t fill up the bottles so I get empty and it appears more mixed. I don’t pump as much as I should, so if I extend my sessions out too long, can that cause an imbalance? Should I pump q2-3 to make sure I don’t get an imbalance? Also, I could mix in a mason jar I like that idea. Could I mix in a mason jar and keep adding to the jar for the next couple days, and by day 4 what’s left in the jar I can freeze? I wouldn’t make up my bottles for the next day. I would just keep adding to it, but pouring out of it for each bottle? Also why can’t you put fresh expressed warm milk into the cold mason jar?
I think that what you’re doing is fine! I think that’s a great strategy.
(I didn’t understand what you meant by pumping q2-3?)
You can do the jar and keep adding to it before freezing on day 4.
Adding warm milk to the cold expressed milk is not recommended because the warm milk warms up the cooled milk, allowing bacteria to grow (especially if you do this over and over again). I would suggest just putting it in the fridge in the bottle you pumped it in, then at your next session dumping it in the mason jar. You might want 8oz bottles for your morning pump? Just an idea.
I read this page and still don’t feel like I know how to tell if I have an imbalance by looking at a bottle or pitcher in the refrigerator. It would be very helpful to have some pictures of what’s normal and what’s an imbalance.
Hi Ashley! The issue is that it’s very difficult/impossible to tell from a picture or even just from looking at your milk. If you have a very thin (or no) layer of fat on top of your milk after a full pumping session and your baby has green poop and is very fussy, there may be an issue. I wish I could be more helpful!
So on this post, there are two pictures. Is one of them an example of an imbalance? I feel like my milk has three layers. In a 4 ounce bottle, there is 1/4 inch of a very translucent layer at the bottom, then about 2 inches of a more creamy white layer, then a layer on top of fat that is about 1/8 inch.
I guess I’m just trying to figure out if my little one has an intolerance to something in my diet or do I have an imbalance. I generally pump 30 minutes every session and then combine in a pitcher before making bottles.
No, neither is meant to be an example of an imbalance. Sorry if that is confusing. They are meant to show the difference between hindmilk and foremilk.
To me it doesn’t sounds like an issue with an imbalance based on what you’ve said. Do you feel pretty empty at the end of your sessions. How many letdowns do you usually get?
Hi! i’ve noticed that my baby has been fussy lately mostly at night. I give her gas drops which seem to help. i exclusively pump and i’ve noticed i don’t get much fat in the bottle from what i pump. i pump anywhere from 8-9 times a day for at least 15 minutes at a time. My baby has also had some stinky green poop lately as well as some super loose poops. (almost like diarrhea with no seeds) I’m worried i might have an imbalance as i’ve cut diary out of my diet since she was born because i have a dairy problem as well. She’s only had a handful of bottles of formula since birth but i’m really beginning to notice this problem and i’ve only been pumping for 3 weeks now.
Hi Lexie! Maybe you could try doing 7-8 sessions that are 20 minutes long and see if that helps you get more hindmilk?
My little boy is almost six months old and I’m trying to slowly stop pumping. I’ve noticed since I’ve drastically cut my pumping sessions, I’ve noticed there is now only a thin layer of fat after being in the refrigerator. Is it worth giving it him the milk with little to no fat My son has had issues with gaining weight since he was born. I’m an emotional mess because I’ve tried introducing formula, but he will not take it from me. Any help would be greatly appreciated.
Hi Nadia! I would try mixing the breast milk you pump with formula – if you slowly increase it (start with just a splash), he might get used to the taste. Having formula in the bottle will also help if there happens to be too much foremilk. Hope that helps!
Hi!
Thank you for providing such helpful info! I was wondering, is it possible to have an imbalance without having an oversupply? I am currently pumping with a few nursing sessions during the day. I only manage to pump what he eats in a day so I don’t believe I have an oversupply. When I pump I only have a very thin layer of fat at the top (pumping for 20-25 min with hand expression).
Baby has been having watery green poops for a couple weeks now with a decent bit of gas. I’ve been to the doctor and stopped eating dairy/soy incase it’s caused by a sensitivity to that, but nothing is helping.
Hi Rita! I do think it’s possible without an oversupply. How many times a day are you pumping?
Hello,
My baby is very fussy/cholic. Her nappies have been grassy green the past day.
I produce a lot of milk, it goes all over the place, my daughter pulls her head back off my breast only minutes after starting a feed then cries and I struggle to get her to re latch and often she will only latch on the other breast visa versa.
She has a lot of wind, I’m doing my best to keep her upright after a feed and winding her.
she strains a lot before eventually passing wind, goes red in the face and is in obvious discomfort.
I took her for her 6 week check yesterday and the dr diagnosed an umbilical hernia, probably from draining to pass wind.
Could there be an imbalance?
Hi Bev! Congrats on your new baby! If she is switching breasts early on, I do think that could be an issue with an imbalance. I am not an expert in nursing, though, so you might want to see a lactation consultant for help!
My little one is 5 weeks old and I EP and top off with a bit of formula as my supply is low. His poop for the past few days has been green and watery and he is a bit fussy. I’m suspecting I have a case of milk imbalance. My milk separate as the image above. With 80% of the bottle being foremilk and 20% being thicker hindmilk. I am pumping 8 times a day, 15-20 each session. What can I do to regulate the ratio better??
Hi Nora! I think that is actually a pretty good ratio. Is it possible that he has a virus instead?
In the picture above, is that a good ratio? Should the foremilk/hindmilk be 50/50? Are there any good to eat that make more fattier milk or is it all really only related to how long/often you pump? Thank you for your dedication to the subject! You are helping so many, including myself!
Thanks so much Casey! That is probably a larger ratio than I have usually had. Just a small layer of fat is fine (and so is this)! I have heard that some foods can increase breastmilk fat but I don’t know that it’s supported by research (and the empty breast is). It wouldn’t hurt to try it! I hope that helps!
My boy is 5 weeks old and nursed for the first 3ish weeks but now I exclusively pump. His last couple of poops have been yellow but frothy/mucus-y. Is this a foremilk/hindmilk imbalance or maybe an allergy? He also drinks a few ounces of formula each day because I don’t produce enough just pumping. He’s very fussy and gassy and only poops once a day after massage and bicycle kicks and occasionally rectal stimulation.
I think it could be either an imbalance or an allergy – I’m so sorry I can’t answer this better. Do you notice a layer of fat on your refrigerated bottles? And how often do you pump and for how long?
Hi, I have a 6wk old and am EP. I pump about 5-6 times a day at 30mins each. I always see maybe about a half inch of hindmilk fatty layer on top and the rest is the foremilk! How can I resolve this? Also if I try to pump for longer sessions, say 40mins, will this mean my next pump session will have more hindmilk and less foremilk? I’m a bit confused as to why breasts should be fully empty- does this decrease foremilk in the sessions after?
Also, forgot to add, that I am already dumping the first few minutes of foremilk- the clear thin blue tinted milk. I always get at least 2oz of it from each breast!
Hi Jay! Congrats on your 6 week old! Is your baby having symptoms of imbalance? I just want to get the full picture.
Thank you!!! I noticed that she started getting greenish poop diapers yesterday…not so much frothy but they definitely look like avocado color…I have not eaten anything green recently. She does get gassy as well. Otherwise she is ok.
My son is 5 days old, I exclusively pumped every two hours for 20-30 minutes but decided that the exclusively pumping life isn’t ideal with a 2 year old so I tried to get my son to latch and he successfully does! But, I am producing way too much milk. Do I need to worry about losing my milk completely now that I’m on his feeding schedule and not a pumping one? He isn’t keeping up with my milk supply and I’m trying not to pump (unless my boobs are rock hard and I’m uncomfortable) then I only pump till the discomfort is gone. I want to be able to keep breast feeding but I am worried I’ll lose my milk completely?
Hi Alexis! I am not an expert on nursing but your supply is determined by how much milk is removed – so if your son is removing all the milk he needs at the breast, I think you should be fine to pump less or not at all. I don’t think you will lose your supply completely. You might want to talk to an IBCLC about how to make the transition to nursing (since that is not my area of expertise) – you might want to gradually decrease the amount you pump rather than stopping all at once, and she might have strategies for overactive letdown if that’s a problem? I hope this helps! 🙂
I’m pretty sure this is what I have. My milk separates very fast and usually in a 5 oz bottle here’s about a 1/2” of “watery” milk on the bottom. How can add more fat to my milk? I pump about 2-3 times a day and get about 10 oz each session.
Hi Brandi! How long do you pump usually? The best way is usually to pump longer. Though if you’re pumping 2-3x per day they are probably already pretty long?