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Hindmilk vs. Foremilk. What does it mean that the pediatrician says my milk ‘isn’t rich’? Babble.com’s Parental Advisory.

We just returned from our two-week checkup with our son’s pediatrician. Our son is back up to his birth weight after a rocky start to breastfeeding. He’s gained about twelve ounces this week, but the doctor seemed to think this was not that much. She said, “Maybe your milk isn’t rich.” What does this mean, and should I be worried about it? I was feeling like everything was fine, but now she has me wondering. – wish I were a rich mom

Okay, so first things first. If your son has gained twelve ounces in a week of breastfeeding, it seems like everything is going great. The goal is from half to one pound of weight gain a week. Even with our questionable math skills, we can tell that you’re right in the pocket. So there is no need for concern. We’re going to guess from her language that your doctor is of the older generation. The concept of “rich” milk is a fairly old school one. It’s not total hogwash, but it is a somewhat misguided way of looking at breastfeeding. Not to mention an anxiety-producing thing to say to a new mother.

The “richness” of milk refers to its fat content. Breast milk comes in two forms: foremilk and hindmilk. For lack of another analogy, we’ll say that the foremilk’s like low fat, and the hindmilk’s half and half. The quantities of each type of milk that your baby ingests with each feeding are variable. The ratio of fore to hindmilk can be affected by any number of factors. Perhaps it’s possible to make more or less of the fatty hindmilk depending on your personal biology. But it’s definitely possible to futz with the ratio by making changes in your feeding patterns.

Here’s how it works: When you first start feeding, the baby gets foremilk. This thin fluid is packed with protein and handles the bulk of the baby’s hydration needs. The hindmilk comes in later, towards the end of a feeding. So one way to encourage a higher hindmilk quotient is to feed for a long time on each breast. And conversely, if you feed for a short time, your baby will be more likely to get just foremilk. This is one reason that people often recommend early feedings to be unrestricted in length as well as frequency. Another idea is to do two turns on each breast, but you have to be sure to get to both twice.

However, we repeat, there is no indication from your baby’s weight gain that you have a problem with your hindmilk quotient! You do have another possible problem, and it’s one that many new parents come up against. A lot of pediatricians’ knowledge of breastfeeding leaves a little to be desired. They know what they know, and usually haven’t done a lot of research since they learned it in the first place. So if you’ve got an older pediatrician, revel in her experience with children and babies, but don’t count on her having the latest data on breastfeeding. If she says something that doesn’t sound right, feel free to delve further elsewhere.

Although it would be nice to have a pediatrician you trust wholly about everything, the reality for most of us is somewhat less perfect. It’s not a problem to take some of what your doctor says with a grain of salt. But if you feel like what she’s saying is interfering with your confidence, or starts to feel truly off, you may want to look for a more likeminded sort. At this point, though, it seems like the best road for you is straight ahead. Keep up the good work!

Have a question? Email parentaladvisory@babble.com


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