Overactive Letdown?

QUESTION:  My problem with nursing began about 8-10 days ago. When my baby begins to nurse he starts out okay but then when the milk lets down (after 20-30 seconds or so) he seems to get angry and cries and pulls away. Of course, then milk is spraying everywhere! I have been handling this by pumping some at the times he pulls away, then returning him to the breast when the flow slows down. Sometimes I give him the expressed milk at the end of the breastfeeding if he seems to want it. This does not occur at every feeding but does happen enough times in a 24 hour period that I am quite frustrated. He has never nursed for very long periods, usually only about 7-10 minutes, often times even shorter. The Dr. told me this morning that this is very uncommon. He says most babies prefer a fast flow. I've not found the problem addressed anywhere. I hope you can help!

Sincerely, Carol Hill

Dear Carol,

You are a great mom! You are watching your baby, and responding to what he needs at the time.

It sounds as though you have an "overactive letdown". Milk comes so fast that your baby has a hard time handling it. Does he cough and sputter when this occurs? It also sounds like you have already figured out a good way to help your baby. Pumping just enough for your milk flow to slow down would have been my first suggestion, and you are already doing it! You can either give your baby this milk, or store it for another occasion. Things you can do to help your baby tolerate your "active letdown" would include:

1. Change your nursing position. Lie back so that milk flows against gravity, or have baby sit up facing you to nurse.

2. Hand express or pump before latching baby on to your breast. That will help take care of the rapid letdown before baby nurses.

3. Know that the mismatch between your letdown and baby's sucking/swallowing ability won't last much longer. Your baby will be able to handle your fast milk flow soon.

While I wouldn't call an overactive letdown common, it is most certainly not "uncommon". And while some babies like their milk in a hurry, not all can swallow fast enough for all moms. Your baby has gained almost 5 pounds in 7 weeks. He is getting plenty of milk in his short nursing times at your breast.

Keep on nursing! You are both doing great!

Margie Forrest, RN, BSN, IBCLC

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