It's important not to give a baby thickened feeds unless advised by a doctor. Since gastro-oesophageal reflux disease can be associated with medical problems, exclusive breastfeeding (i.e. without any thickeners, etc) is advisable whenever medically possible.
Usually blueish or clear, watery breast milk is indicative of “foremilk.” Foremilk is the first milk that flows at the start of a pumping (or nursing) session and is thinner and lower in fat than the creamier, whiter milk you see at the end of a session.
You may notice your milk seems thicker and creamier towards the end of a feed. This is because, as the feed progresses, the fat composition gradually increases due to the mechanics of milk moving through the breast. It's often referred to as hindmilk, while the first more 'watery' milk is known as foremilk.
Breast milk is typically white with a yellowish or bluish tint, depending on how long you've been breastfeeding. But the hue can change based on many different factors, and most of the time, a new color of breast milk is harmless.
If your breastmilk looks different from how you expected it would, you might be concerned. The colour of breastmilk varies. Colostrum is typically yellowish and mature breastmilk is typically bluish-white.
The fuller the breast, the lower the fat content of the milk. Therefore, milk that is expressed at the beginning of a nursing or pumping session tends to be more watery than milk expressed at the end. (However, if sessions occur close together – and the breast doesn't have time to refill – this may not always be true.)
Too much foremilk is also believed to cause stomach and gastrointestinal (GI) issues in babies. The extra sugar from all that foremilk can cause symptoms such as gas, abdominal pain, irritability, crying, and loose, green bowel movements. 2 You may even think that your baby has colic.
Increasing milk supply
By offering the other breast when the first is finished, and repeating breast compressions if needed, your baby will get the correct balance of foremilk and hindmilk automatically. Using both breasts when needed (and sometimes three or four!) will drive up and maintain your supply.
You make more watery or thirst quenching milk in the morning, and less volume but fattier milk in the evening. This is why your baby may want to cluster feed or fuss feed in the evenings. Your milk producing hormone prolactin is highest in the middle of the night.
Unsettled feeding
If your baby is unsettled at the breast and doesn't seem satisfied by feeds, it may be that they are sucking on the nipple alone. This may mean they are not getting enough milk. Ask for help to get your baby into a better feeding position.
Light green: Consistent green stools in a breastfed baby can indicate an imbalance of foremilk/hindmilk. Foremilk is the low-calorie milk that comes first in a feeding. Hindmilk, which is high in fat, comes second in a feeding.
If you see bright green and frothy poop in your baby's diaper that almost looks like algae, they're probably getting too much foremilk – the low-calorie milk that comes first in a feeding – and not enough hindmilk, the higher-fat, super-nutritious stuff that comes near the end.
The total milk consumed daily—not the hindmilk—determines baby's weight gain. Whether babies breastfeed often for shorter periods or go for hours between feedings and feed longer, the total daily fat consumption does not actually vary. Foremilk is not always low-fat.
After about 10 to 15 minutes of breastfeeding, the milk flow slows and transitions to the sweet and creamy hindmilk, which contains vitamins A and E, and has more fat and calories than foremilk.
This out-of-balance amount of foremilk causes a lactose overload for your baby. The undigested lactose has nowhere to go but the large intestine, where it gets fermented and creates a lot of gas. This gas is the root of your baby's foremilk/hindmilk imbalance symptoms.
The primary thickening agents used in the pediatric population include starch-based thickeners (e.g., corn starch), gum-based thickened (e.g., Xanthan or Carbo gum), infant cereals (e.g., rice or oatmeal), and the use of food purees.
To collect hindmilk for your premature baby, you should use a breast pump and separate the foremilk from the hindmilk as you pump. When you begin pumping your breast milk, it will be thin and watery. Pump for about 2 minutes, then remove the collection container from the pump.
Some people describe a “soapy” smell or taste in their milk after storage; others say it is a “metallic” or “fishy” or “rancid” odor. Some detect a “sour” or “spoiled” odor or taste. Accompanying these changes are concerns that the milk is no longer good for the baby.
Yellow is the first color of breast milk mom will see, due to the fact it is colostrum-rich, containing many of the antibodies needed to protect newborns against disease. Concentrated levels of white blood cells, leukocytes, and Immunoglobulin A can also cause this rich, buttery appearance.
"There is a wide range of normal when it comes to color for breast milk," says Hali Shields, a certified birth and postpartum doula, national board-certified health and wellness coach, and certified lactation education counselor. "Blueish, yellow, cream, orange are all normal and safe for baby."
The longer the time between feeds, the more diluted the leftover milk becomes. This 'watery' milk has a higher lactose content and less fat than the milk stored in the milk-making cells higher up in your breast.
If on the fifth day, baby's stools turn green instead of yellow, as in the case of oversupply, this may be a sign that baby can't drain the breast well enough to get past the low-fat/high sugar foremilk. In this case, though, a health or anatomy issue (like tongue tie) may be the cause.