What is Lactose Overload?

Lactose overload is a breastfeeding issue that can cause babies to cry due to gut discomfort. It is the only condition directly linked to significant crying in otherwise healthy breastfed infants due to increased gut discomfort or pain.

If your baby is unsettled, it's important to have an IBCLC observe breastfeeding and assess your baby’s oral function, and to consider seeing a doctor to rule out any underlying medical conditions. While terms like 'colic', reflux, or allergy are often used to describe fussy babies, research indicates that these are not typically the causes. In cases of lactose overload, gut pain specifically causes the crying and fussiness in breastfed babies.

Lactose overload often occurs when a mother has an abundant milk supply. There is no issue with the milk itself or the baby’s lactase enzyme, which digests lactose in the small intestine. The problem arises from the baby not getting a balanced composition of the milk in the breast - so in other words, baby isn’t drinking enough “hindmilk”, which contains slightly creamier composition of milk, a situation that can be managed by adjusting breastfeeding techniques.

I would like to stress the point here, that all milk is good milk! There are simple ways to encourage baby to take not just the initial let downs of milk, but remain at a softened breast to drink the milk with a “fattier” composition.

Lactose overload can also happen if there are issues with how the baby latches onto the breast. Poor latch can prevent the baby from feeding comfortably, causing them to pull away before they can access the richer hindmilk. Another reason to reach out for a 1:1 lactation consult to rule out any oral function issues your baby may be quietly experiencing.

Lactose overload varies in severity. Many breastfed babies experience mild symptoms, like gassiness and passing a lot of wind, which may not require any change in breastfeeding practices. However, it is beneficial for breastfeeding mothers to be informed about lactose overload and how to manage it if necessary.

Understanding How Lactose Overload Happens

At the beginning of a breastfeed, the milk is high in volume and rich in lactose (lactose is the really important, brain-building stuff!). This is when you might hear your baby rapidly sucking and swallowing: suck, swallow, suck, swallow. Towards the end of the feed, the milk becomes lower in volume but higher in the fattier, creamier content, and the baby's sucking pattern changes to more frequent sucking with less swallowing: suck, suck, suck, swallow - this is your baby scrapping end of the dessert tin!

This fattier composition of milk in breast milk serves two important functions:

▪ It slows down the contractions of the gut.

▪ It triggers the "I'm full" signal in the baby's brain.

If the baby doesn't receive enough composition of this type of milk, the high-volume, lactose-rich milk passes through the gut too quickly to be properly digested by the lactase enzyme in the small intestine. This undigested lactose then reaches the colon, where it ferments, causing gas and potentially leading to acidic, explosive, and frothy stools. This condition can sometimes be associated with diaper rash.

This condition is misdiagnosed as lactose intolerance (which is incredic=bly rare in babies) or dairy intolerance. Please read on before you jump to any conclusions about your beautiful breastmilk!

Identifying Lactose Overload in Your Baby

Babies experiencing a lactose overload often display several signs, especially when they are not getting a balanced composition of ncomponents from breastfeeds:

▪ Frequent feeds: The baby wants to feed very often because the "I'm full" signal isn’t activated.

▪ Rapid weight gain: The baby gains a lot of weight due to frequent feeding and a plentiful milk supply.

▪ Frothy, sometimes explosive stools: The baby’s stools are frothy and explosive.

▪ Excessive gas/wind: The baby passes a lot of wind, not just occasional loud gas, but large quantities, sometimes every hour.

▪ Tight, bloated tummy: The baby’s stomach appears tight and bloated with gas.

▪ Unsettled behaviour: The baby’s tummy fills up quickly during feeding, leading to a desire to keep sucking but an inability to relax and suck to sleep. It's essential to ensure a stable latch during feeding.

▪ Frequent crying: The baby cries a lot.

Managing Lactose Overload in Your Baby

Offering Both Breasts per Feed Most women should begin their breastfeeding journey by offering both breasts per feed. This practice stimulates both breasts and helps establish a good milk supply with frequent feeding in the first few weeks, ideally about 8-12+ times a day. However, some women with a naturally generous supply find their baby does well with just one breast per feed.

Remember, everyone is different and if you need reassurance about your breastfeeding it’s easy to reach out for advice!

Offering One Breast per Feed or Over Multiple Feeds If you suspect your baby has lactose overload, the key is to manage your milk supply to ensure the baby gets more of that creamier composition of milk during feeds.

Allowing a breast to become full sends strong signals to your brain to down-regulate supply. So this will naturally reduce its milk supply, which increases the creamier composition and content.

What to do? Just offer one breast over a few hours (or longer for severe cases) while letting the other breast fill up as much as possible before switching. This canoe challenging and uncomfortable for women with abundant supply - try to follow your body and that feeling of pressure and “fullness” rather than the clock. Use comfort measures during this time (cold compresses on the breast, pain relief).

It typically takes about 2 days for the changes in cream content to alleviate symptoms such as bloating and gassiness. Therefore, the crying and explosive stools won’t stop immediately.

For women with a very generous supply and a baby with severe lactose overload, it can help to let some milk flow freely at the beginning of a feed. You can do this by offering your baby a breast crawl to make their own way to the breast, or you can remove the baby when the first letdown occurs and let the milk flow onto a breast pad or into a sterile container (not a silicone breast pump or anything with suction!). However, don’t do this too often as it may frustrate the baby. Avoid pumping milk before feeds, as this can stimulate the breast to produce more milk and exacerbate the issue.

The Risks Associated with these Techniques for Managing Lactose Overload

There are two main risks to be aware of:

▪ Risk of Mastitis: Letting a breast become too full can cause milk ducts to back up, potentially leading to mastitis. This risk is higher for women with a very generous milk supply. To prevent this, incrementally let one breast fill as much as safely possible, feeding from the other side as long as you can before switching.

Consider purchasing the E-Guide: Mastitis Management to know exactly what to do if symptoms arise!

▪ Insufficient Milk Supply: Reducing your milk supply too much can result in not having enough milk to meet your baby’s needs. This is a serious risk that must be avoided.

To prevent these outcomes, go slow! Experiment gradually, observe your baby’s behaviour over a few days, and monitor breast health and appearance.

Make sure there are no underlying latch issues, so your baby can feed comfortably without fussing or pulling away. If your baby remains fussy, consider scheduling a 1:1 consultation with a lactation consultation here to address any issues.

FAQs

Massaging does not elevate cream content and can cause breast tissue drag in the baby's mouth, hindering milk transfer.
No, nipple damage is likely caused by your baby having a poor or shallow latch at the breast. If your baby is not attaching and transferring milk effectively from the breast then it may be the root cause to lactose overload and warrants assessment by an IBCLC lactation consultant.
Reclining doesn't change milk flow, as it's primarily governed by the contraction of milk glands and the vacuum in the baby's mouth, irrespective of the mother's posture. However, reclining often appears beneficial as it aids in the baby's sense of stability during a feed, helps baby manage flow of milk (drinking like a “bubbler” rather than a “waterfall”), encourages baby to get a deeper latch at the breast and is often more comfortable for Mum!
If babies are in a stable position, they tend to continue suckling persistently even if the milk supply is low (referred to as marathon feeding). They can typically handle even forceful let-downs if they are positioned securely.
If they are stable at the breast and continue to not manage the flow of milk well it is worth having an oral assessment and review by an IBCLC Lactation Consultant.
Fussiness and back-arching during breastfeeding, as well as refusal of the breast, indicate either positional instability or dysregulation at the breast.
Frothy explosive stools and the other symptoms mentioned here are associated with lactose overload.
If you are ever in doubt about reflux or allergy please see you doctor to discuss your concerns.
If you’re experiencing Bach-arching, refusal or any of the listed symptoms consider reaching out to an IBCLC Lactation Consultantmfor breastfeeding review.
Unless your baby has a gastroenteritis, green poo and/or mucous are not considered normal, but it is common in babies.
Once lactose overload has been addressed green or mucous poo should normalise. If not it is worth review with an IBCLC Lactation Consultant for oral assessment and breastfeeding review.