When a mom’s milk lets down while nursing, it means that the cells that make and store the milk are contracting and releasing their contents so baby can start eating. While it may seem like more is better when it comes to a good let down, this isn’t always the case.
Known as overactive let down, this occurs when a very forceful let down releases a lot of milk at once. For some babies, this can actually make those first moments of nursing really difficult to handle. Think of it as drinking from a fire hose!
Babies of moms who have overactive let down may sputter or gag at the breast as they try to handle all the milk coming their way. They may pull off frequently as they try to self-regulate the flow of milk. This can lead to swallowing a lot of air during feeding, which in turn may cause excess gas. It can also cause pain for mom as the baby is constantly pulling off and trying to re-latch.
Babies may also seem fussy at the breast and may have green stools related to the fact that they ingest a lot of foremilk and end their nursing sessions early. Moms with overactive let down may also have milk oversupply — another blessing and a curse — so these babies may show very rapid weight gain. However, if a baby is not nursing well because of the overactive let down, weight gain may actually go down.
Overactive let down can also lead to a sensation of pain for mom. Some women describe it as a sharp or shooting pain that usually doesn’t involve the nipple. Any mom who is having breast pain should be examined to make sure mastitis or plugged ducts are not the culprit, but sometimes it may just be related to a really forceful let down.
The good news is there are some things you can do to manage their overactive let down. One trick is to stimulate a let down by pumping or simply doing hand massage before the baby latches, and then have a washcloth (or bottle) ready to let the milk spray into. Once the let down has passed, let baby latch on as the milk flow will now be slower and easier to handle.
Nursing baby in a position that is more “uphill” can help slow the flow of milk somewhat and let baby have more control. Positions such as the football hold, cradle hold with baby propped up more on pillows, and laid-back nursing positions can be good ones to try.
It may seem instinctive for a mom to keep pressing her baby’s head back onto the breast when he pulls off. This can actually cause more problems, however, because the baby needs to be able to breathe and self-regulate. If they keep feeling forced on the breast, they may become resistant to nursing and stop feeding well.
Luckily, over time some women do notice that their overactive let down seems to settle down somewhat, and as a baby gets older, she often is able to work with it more easily. As with any breastfeeding problems, seeing a lactation consultant can be key if the techniques mentioned here don’t help mom and baby.
Reviewed by Dr. Sara Connolly, March 2020
- Overactive let down is when a very forceful let down occurs and a lot of milk is released at once.
- This can make nursing hard for baby to manage.
- A baby may gag or sputter at the breast when an overactive let down occurs.
- There are some techniques moms can try to manage this issue.