<Lactose overload though is definitely a condition which exists and I
think
that is what some people are describing when they use the term
foremilk/hindmilk imbalance.>

Denise,

I'm glad you articulated this further. I have found it very valuable in
phone counseling for quick problem solving for the many WIC mothers who
have no  desire or inclination or transportation to attend LLL meetings.
It even helps to explain how this may cause a pattern such as "cluster
feedings"

I have changed the way I describe this since the posting from Dr. Jack
and others describing mothers questioning "When do I get to the
hindmilk?"

I usually don't mention lactose at all to a mother who has no specific
scientific training, (such as the respiratory therapist I spoke to last
week, or dieticians, nurses, biology teachers, etc.)

The word "lactose" immediately seems to cause some to jump to the
conclusion it is a long-term problem, and they then mention a relative,
or a "lacto-free" product etc.

I simply just bypass that and explain the increasing creaminess of the
milk the more thorough the removal from the breast. I sometimes suggest
they express some when the breast is considerably softened, to prove it
to themselves.

I say it digests more gradually, seeming to "stick to the baby's ribs
longer" (a common U.S. layperson's saying for satisfying the appetite
better and longer.) They can easily identify with the example of the
effect of a rich, creamy dessert at the end of a meal.

I prefer to have the mothers try thorough milk removal from the first
breast (possibly by 2 or more feedings on the same breast if C cup or
beyond). For women whom I suspect have a smaller storage capacity, (my
personal bias: A and possibly B cup size), I suggest going back to the
first breast if desired (i.e.using the third breast).

I explore this thoroughly according to each mother/baby situation, and
prefer to refrain from going into describing complete exclusion of dairy,
etc. as a first line of explanation, because once again it often leads
into muddy waters confusing lactose and CM protein.

I save myself a lot of explanation time by simply describing the
marvelous creaminess as the reason it is worth trying for a week or so to
observe for changes in the baby's response before further suggestions if
needed at follow-up calls.

Jean
******************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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