Question:  Can lactose cause the sym of gas and fussiness in some bf
infants without having galactosemia?  Could it be from too much lactose in
foremilk?  Or is this possible?  Can there be more lactose in some bm than
othrs to cause these sym?

Amy
In response to your questions above:
Symptoms of gas and fussiness can be the result of incorrect attachment or
incorrect breastfeeding management - if baby is not correctly attached,
then often the let-down reflex is not working as well as it could thus less
fat globules are released into the breastmilk and since the baby does not
get these calories it becomes fussy as an indication of hunger. The reduced
fat content in the breastmilk results in faster gastro intestinal movement
(fat slows down gastro intestinal movement), hence not as much lactose will
be digested. This undigested lactose moves into the large intestine where
fermentation occurs due to the resident bacteria resulting in symptoms of
gas (and frothy green explosives bowel motions).
The concentration of lactose in foremilk is about the same as in hindmilk.
However, if a baby does not get sufficient hindmilk, then he is likely to
take more foremilk to satisfy his hunger (if allowed). This results in a
larger volume of bm being consumed and hence a larger amount of lactose.
The end result being that the gut cannot break down all this lactose before
it moves into the large intestine.
The management - optimise attachment and allow baby to finish feeding on
the one breast before offering the second.
An article in the Lancet 1988:382-4 discusses this very well. I have used
it a lot in my health professionals workshops and courses.
I don't know if the lactose amount in some bm is higher than in others.

Ellen McIntyre
IBCLC, South Australia