Do you have a fast 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 behavior starts. Some mothers may notice that this also happens at various intervals throughout the feed.
If your baby is displaying these behaviors, it may be a sign that you have an overactive letdown (forceful let down), 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, which sends impulses to the brain.
The brain then releases hormones, and the hormones cause the letdown 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 there is a sudden change with a 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 to you through four strategies that can 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 become engorged, it can be more difficult for your baby to latch, 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, which will take just 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 catch it into a muslin cloth, and that will enable the first 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. Ensure his head is a little bit higher than the rest of his body, which will give him more control over the flow.
Feed On the Same Breast
Another tip is to try to allow your baby to feed on the same breast until you feel that he has had an excellent feed.
Some babies, while feeding, are bobbing off the breast every five minutes.
If you can, encourage your baby to come to the same side for as long as possible until you are reasonably satisfied that the breast is well drained 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, 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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