Colorful Concerns: Exploring Perceived Reasons for and Maternal-Infant Reactions to Human Milk Color Changes Through...

Human milk color variation has been described in case reports, but no large-scale studies have characterized this phenomenon. Abrupt changes in milk color can be unsettling for parents and healthcare providers, potentially leading to unnecessary breastfeeding disruption.

The objectives of this study were to characterize self-reported human milk color variations, explore maternal perceptions of their causes, and examine factors associated with maternal breastfeeding routine changes following color variation.

An exploratory cross-sectional online survey collecting self-reported observations of milk color changes was distributed via the InfantRisk Center from March 2022 to January 2023. Descriptive analyses characterized color variations and maternal responses (n = 430). Multivariable logistic regression identified factors associated with breastfeeding routine change (n = 277).

Green was the most commonly reported color (n = 174), followed by blue, yellow, and red. Most color changes lasted 1-3 days. Perceived causes included infection (n = 256), food (n = 274), vaccination (n = 43), medication/supplement (n = 60), and blood or trauma (n = 52). Most mothers were not concerned (n = 245), and no mother stopped breastfeeding entirely. Red milk was the strongest predictor of behavior change (adjusted odds ratio [aOR] = 19.5; 95% confidence interval [CI] 4.9-77.2), followed by fear of harming the infant (aOR = 2.9, 95% CI 1.7-5.1) and maternal age (aOR = 1.2, 95% CI 1.03-1.30). Education was protective. Prior breastfeeding experience, infant health, infant age, and healthcare provider recommendation were not associated with breastfeeding behavior change.

Human milk color variation is more common and varied than previously documented. Anticipatory guidance normalizing color variation may reduce unnecessary fear across all parity groups.