Do you have an overactive letdown?
It’s not uncommon for some babies to cough, splutter and even to arch their backs when feeding at the breast – and generally appear quite distressed.
Initially when doing the first fast sucks things may seem fine, but as soon as the milk lets down, this unsettled behaviour starts. Some mothers may notice that this also happen at various intervals throughout the feed.
If your baby is displaying these behaviours it may be a sign that you have an overactive let-down (forceful letdown) and it can be quite distressing for you and your baby.
You may also be experiencing sore nipples as your baby tries to clamp down to control the forceful flow of milk.
When your baby comes to the breast, he needs to do fast sucks initially.
This sends impulses to the brain. The brain then releases hormones and the hormones cause the let-down of milk. The milk lets down on both of your breasts at the same time. So you can imagine that if your baby has been happily ‘calling’ the milk and then he is suddenly faced with a really fast flow of milk, he will cough and splutter as he tries to control the flow.
He may swallow lots of air in the process and may also become quite windy and unsettled. Some even bring up milk because of the frequently swallowed air.
I want to talk you through a few strategies that can really help.
One of the first things is to allow your baby to come to the breast frequently to feed, keeping your breasts as soft as possible all day and night.
Try to prevent any engorgement. Engorgement is when your breasts may feel overly full to the point of pain. If you get engorged it can be more difficult for your baby to latch at the breast, together with the fast flow issue! Keeping your breast as soft as possible will enable the flow to be as slow as needed, and a lot more manageable for your baby.
A little hand expression before latching your baby will enable the first fast-flowing milk to come off the breast. This may just take a few seconds of hand expression. Have a look at the information on the technique of hand expression if you have never done that before.
Before each feed, take the smallest amount of milk off the breast. You don’t have to collect it or give it to your baby. You could just catch it into a muslin cloth and that will enable the initial fast bit of milk to slow down, which in turn will make the feed more manageable for your baby.
It can also make a big difference to allow your baby to feed in more upright positions – you can recline back and allow your baby to rest against your body. He can feed at any angle around the clock face of the breast, as long as his head is a little bit higher than the rest of his body This will give him more control over the flow.
Feed On Same Breast
Another tip is to try to allow your baby to feed on the same breast until you feel that he has had a really good feed. Some babies, while feeding, are bobbing off the breast every five minutes, but if you can, encourage your baby to come to the same side for as long as possible until you are fairly satisfied that the breast is drained as well as it can be, before offering the other side.
I must stress that it’s important to remember to hand express (with your hand only, not a pump) on the breast where your baby isn’t feeding, just to keep yourself comfortable if you feel uncomfortably full. This will help to prevent blocked ducts.
The good news is that as your baby gets bigger he will be able to control the flow of milk a lot better and your supply nearly always settles down.
Review dates, references & further resources
Version 1.1 published in March 2019. Next review date: Jan 2022
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