Ellen brings up a most excellent issue.  I hope I am summarizing her
comments correctly as "is it the quantity or the quality" that is causing
g.i. distress?  A wise physician once told me that if she met a baby gaining
1#/week then she would expect it to be colicky (of course not always the
case but you get the idea).  She explained that, tho all babies make
lactase, they only make so much.  So, if the intake is considerable (and
some of these little ones are amazing what they can consume) necessarily
some of the lactose will not be digested before reaching the colon.  I've
heard this termed "overfeeding colic".  Sometimes limiting a baby to the
same breast for several feeds will do the trick.

A huge issue in my area is *starving in the quest for the holy grail of
hindmilk*.  Is anyone else seeing this?  The mother reads that hindmilk is
the good stuff and baby should therefore empty the breast - one breast is
probably enough.  Regardless of supply and demand mom then limits baby to
one breast - gotta get that hindmilk!  Baby gains slowly and mom's supply is
shot by the time she's referred to me.

The misperception that hindmilk is this hard-to-extract separate entity
living deep within the breast is messing with women's common sense (i.e.
feed the baby - not just let baby suck for hours).  Foremilk/hindmilk
imbalance is rare yet most of the women I meet (older, professional, busy on
internet) worry about it.  Sigh.  And most of the babies I meet are fussy
coz underfed, not because they need more fat in milk.  I like to remind moms
we managed to feed our babies for thousands of years, not by worrying about
time, or fat content, but probably by watching the baby.  As Rebecca Glover
says "Follow Me Mum".

Joanna Koch, IBCLC N Ca

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