Is Too Much Milk Bad For A New Born? by Michelle Roth, IBCLC
Too Much Milk Part 2: Overactive Let Down
Your baby is rooting for the breast, and you finally get settled and get him latched, only to have him pull away crying. Or maybe once he’s latched he starts to choke and sputter on all the milk he’s getting. Overactive let-down, sometimes called forceful milk ejection reflex, can be difficult for baby and mom.
One of the best ways to describe overactive let down is that “it’s like trying to drink from a garden hose that is turned on full-blast, while lying down on your back”. Common symptoms of overactive letdown include:
- A baby who gags and chokes at the breast. This also may be in the form of gulping, gasping, coughing or sputtering while nursing. It tends to happen at the beginning of a feedings, and occasionally later in the feeding when mom experiences another milk ejection.
- A baby who pulls off the breast repeatedly (often with milk squirting everywhere), or who arches his back after pulling off the breast.
- Nipple pain from baby clamping down on or “biting” the breast.
- A clicking sound when baby is nursing.
- Colic symptoms: a fussy, gassy baby who cries often.
- A baby who spits up often.
- Green, watery bowel movements.
- A baby who does not “comfort nurse,” and sometimes refuses the breast altogether.
Usually, the baby is gaining weight well, but breastfeeding is a difficult proposition because of baby’s behavior at the breast (or between feedings).
If the problem is mild, simple changes in breastfeeding management or style may reduce the amount of milk baby has to contend with at the beginning of a feeding. When the overactive let-down is more severe, and if it’s linked to an overabundant milk supply, then the issue becomes more challenging and the resolution tends to take more time.
You can begin by making some adjustments to the way you nurse in order to help your baby manage the fast flow of milk. Consider these tips:
- Pump first: If the issue is mild, express just enough milk to stimulate your first let-down. You’ll capture the strongest flow, and then you can put baby onto the breast with milk already moving. Later let-downs tend to not be as strong. If you have an oversupply of milk, this pumping may be counterproductive as it signals to your body to make more milk.
- Put pressure on the breast: Try using a “scissors” hold (with the nipple between the forefinger and middle finger) to restrict milk flow, or use the heel of your hand to put pressure on the side of your breast, especially at let-down.
- Take baby off: If your baby starts to choke or sputter, unlatch him and let the excess milk spray into a towel, cloth or diaper, then allow him to resume feeding when the milk ejection has decreased.
- Use gravity to your advantage: Positioning your baby more upright at the breast can help him manage the flow of milk. Try sitting him on your leg, or for a smaller baby, using the football hold with the baby nearly sitting. Keep his head higher than the breast, if possible. Consider “laid-back” breastfeeding, where mom is reclining, and the baby is above the breast. This creates a situation where milk has to work against gravity! Consider side-lying, which is at least gravity neutral.
- Work on an asymmetrical latch: with the baby’s nose opposite the nipple, wait for a wide-open mouth with the baby head tipped slightly back. This will help keep the nipple far back in the baby’s mouth so that he doesn’t clamp down on it, or push it out of his mouth.
Next, if the forceful let-down is linked to an overabundant milk supply, you will need to work at down-regulating your supply. (See also Too Much Milk Part 1: Oversupply (add hyperlink)).
- Finish the first breast first. You can allow your baby to come on and off the breast repeatedly if that is what he needs to manage the flow of milk. Just put him back to the same breast. Milk ejections later in a feeding tend to be milder, and your baby should be able to manage them better than the initial let-down.
- Nurse often. Sometimes with overactive let-down, moms get very sore nipples because of the way baby uses his tongue and gums to manage the flow of milk. So frequent nursing becomes painful and many moms avoid it. However, closely spaced nursing sessions may help to keep the flow slower, and may mean baby is getting fattier milk (which may help with a foremilk/hindmilk imbalance which often accompanies oversupply and overactive let-down).
- Try block feeding: when an overactive let-down is associated with an oversupply of milk, nursing on the same breast for several feeding in a row can lower the milk supply to a more manageable level. Start with a three hour block – anytime the baby is hungry in that time period put him to the same breast. Then, switch sides for the next three-hour block. If three hours doesn’t show any marked improvement in the manageability of the milk flow, consider adding time to the block. Add one-hour increments until nursing becomes easier for the baby.
Keep in mind that babies who are sputtering on a huge influx of milk tend to take in lots of air, too. So babies dealing with forceful milk ejection tend to need burping more often.
As your baby grows, his body will mature and he will get better at handling the flow of milk. Also, as your milk supply becomes more established – around the six to 12 week mark – you may notice the milk isn’t as copious as it once was. This doesn’t mean your milk has suddenly vanished; it just means the supply has evened out to meet baby’s needs.