Overactive Let-Down: Consequences and Treatments
by Mary Jozwiak,
Villa Park, Illinois, USA
from LEAVEN, September-October 1995, p. 71
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time
Eight years ago, as a new nursing mother, I thought Sarah just didn't like to nurse. She would often cry and fuss at my breast, choking on milk. She had frequent stomach aches and green curdy stools that blasted out with loud, almost comical, noises. She did have plenty of wet diapers and was growing like a weed though. I suspected something was wrong with my milk and tried many suggestions (including, I'm afraid, a few formula feedings). Although the doctor said my milk "just didn't agree" with my baby, I kept nursing. Overcoming nursing strikes and nipple confusion, I eventually eliminated the formula. After several months our problems seemed to dissipate. However, Sarah rarely nursed for comfort; she got her milk quickly and went on to other things.
With my second baby, I resolved: no bottles, no matter what. Like Sarah, Rebecca experienced gas, lots of gulping, sputtering and choking at let-down. My let-down actually hurt. Milk would spray and I would leak nonstop. Becca's green stools were incorrectly diagnosed as "lactose intolerance." To my relief, the doctor said she was very healthy; she gained three pounds and grew an inch in the first three weeks. He said to continue doing what I was doing. Again, I eliminated dairy products and a host of other foods from my diet. It helped a little but Becca remained gassy and fussy like her sister. It wasn't until Becca was ten months old and no longer having problems that I ran across some literature on overactive let-down. Everything made sense.
When a mother has an overactive let-down, milk is ejected forcefully from the breast and in great quantity. If this happens early in the feeding, baby may swallow air and consume too much foremilk in proportion to hindmilk. When baby fills up on the watery foremilk, he may get a stomachache from the combination of filling the tummy too fast, swallowing air to keep up with the let-down and the laxative effect of a large quantity of lactose (milk sugar). Some babies are so upset by the forceful spray of milk that they refuse the breast and go on a nursing strike.
Several solutions may help remedy an overactive let-down. When the baby is very young (a few weeks or less), a mother can try different positions so baby can be "uphill" from her breast. For example, mother can lie on her back with baby on top so he can control his head and back off if the milk ejects too forcefully. Another suggestion might be to take baby off the breast when the let-down starts, catching the overflow in a clean cloth, and placing the baby back on when the flow lessens.
If the problem continues when the milk supply is well established, another approach can be tried. The goal is to increase the amount of hindmilk baby receives and make the let-down less forceful. Let's suppose the mother begins breastfeeding on the right breast. When she feels her milk let-down, she gently removes baby and allows the forceful spray to gush into a clean cloth diaper or burp cloth. Then she places baby back on that same breast, letting him feed as long as he wants. Baby should not be timed at the breast. The mother should not use the left breast at all during this feeding. If baby needs to nurse again during the next two to four hours, the mother should offer the same (right) side. During the subsequent two to four hour period, the procedure is repeated using the left breast.
This procedure can be adjusted for both mother and baby. If the mother is very engorged or uncomfortable, she can go ahead and use the opposite breast briefly. It is important that the baby have at least six wet diapers in 24 hours. If the number drops below six, suggest that the mother go back to using both breasts at a feeding. However, most women with an overactive let-down have no trouble making enough milk with one breast at a time.
Women with a milder case of over-active let-down can use one breast at each feeding, instead of using one breast for each two-to-four hour period. Remind the mother to allow the first let-down to flow into a cloth and then re-attach the baby. These suggestions will help "tame" her let-down, and help her produce a quantity of milk her baby can comfortably handle. The baby should be fed often--the more the baby nurses, the less intense the flow of milk.
Needless to say, a baby who is having problems handling the let-down should not be introduced to a bottle too soon, if it can be avoided. The less forceful flow from the artificial nipple makes this baby a prime candidate for a stubborn case of nipple confusion and breast rejection.
As the baby grows older, he may be able to better tolerate the strong let-down. Some babies, however, will nurse only until their tummies are full and refuse to stay at the breast any longer. This lack of comfort sucking may lead to early weaning. The techniques to reduce flow described above can help even the older baby.
A mother with an overactive let-down might find reading Nipple Confusion (No. 32) and How to Handle a Nursing Strike (No. 62) helpful. She will certainly benefit from ongoing help and support of an LLL Leader. [See on-line catalog for ordering information.]
My children learned to adapt to an overactive let-down. Becca would entertain herself by popping off the nipple, watching the milk spray and giggling. Sarah got to the point that she loved the strong let-down so much she would cry and fuss when it was over! She weaned early and seemed happy with that decision although I was not ready for her to wean so soon. It was a frustrating experience for all of us that fortunately resolved in a happy--if perhaps prematurely ended--nursing experience.
Andrusiak, Frances and Larose-Kuzenko, Michelle. The Effects of an Overactive Let-Down Reflex. Lactation Consultant Series, 1987.
Benson, K.D. "Clinical Problem Solving," CERP session LLL of Illinois Area Conference. September 4, 1993, Chicago, Illinois, USA.
Mohrbacher, Nancy and Stock, Julie. THE BREASTFEEDING ANSWER BOOK. La Leche League International, 1991.