When a baby starts to suckle, a reflex involving fretfulness and hormones (a neurohormonal reflex) releases milk from the breast. This reflex is known every bit the milk ejection reflex (MER) and is commonly called the "let-downward". If milk is released very forcefully information technology is sometimes called afast permit-down or an overactive allow-downwards. With a fast let-downward, milk might exist seen spurting from the breast like water from a fire-eater's hose when baby comes off the breast mid flow. Such a fast or forceful period is not necessarily a problem for a baby—many babies honey the faster pace—and it is quite normal for milk to spurt from the chest. Notwithstanding, some babies can seem to be overwhelmed and fussy by a very fast allow-down, they may cough, choke or let go of the breast and weep. This article looks at signs that tin can indicate a babe is struggling with the period of chest milk in a fast let-down and what to practise about information technology.

What does a allow-down experience like?

Not all mothers feel annihilation at all when milk begins to flow from the breast with the allow-down reflex—but they volition notice their baby starts to swallow milk more than rapidly a few minutes into the feed. Other mothers will experience a tingling or prickling sensation when milk is released from the breast. Some mothers draw it every bit a pins and needles type feeling. If the breast is very full the sensation can be stronger and may be briefly painful.

Signs of a fast or forceful permit-downwardly

Signs that a babe is struggling to cope with the flow of milk in a fast permit-down might include:

  • Choking, gasping and coughing at the chest
  • Coming on and off the breast during breastfeeding
  • Pulling on the breast and nipples (babies tin can too do this when the catamenia of milk is too ho-hum)
  • Rapid swallowing of milk with stress cues e.g. fussing, frowning, crying, finger splaying
  • Short feeds if babe gets a lot of breast milk in a short time
  • Clamping down on the nipples to slow the milk menstruum leading to sore nipples
  • Spitting upward frequently after a feed (this tin be quite normal)
  • Making a clicking sound during breastfeeding due to losing suction with the breast (babies with poor tongue function may also make a clicking sound)
  • Having trapped air current, needing to burp oftentimes
  • Fussing or crying at the breast, unable to fall asleep contentedly
  • Refusal to breastfeed
Baby frowning slightly and breastfeeding
Babe may pout or keep coming off the breast if they can't manage the fast allow-down

Fast let-downwardly and crowd

The symptoms of fast or forceful let-down listed to a higher place are often seen in babies whose mothers take too much breast milk or "crowd" however this is non always the case—a baby may struggle with period without oversupply. If yous experience you have much more milk than your baby needs encounter Oversupply of Chest Milk aslope this article for management ideas. Where advisable, reducing your supply a petty can help resolve some of the difficulties. Call up that if you and your infant are coping well with the book and flow of milk you won't need to make whatever changes.

Why does my infant struggle with the let-down?

How well a babe tin handle a fast permit-down or forceful milk menstruum can depend on their latch (the way baby is attached to the breast), their positioning (the way they are held) and how well they can coordinate suck, consume and breathe. It can be normal for a newborn baby to cough or choke occasionally with the let-down while they are still learning how to breastfeed1 and to tin be quite normal to spit up excess milk (take reflux) subsequently a feed.

Attachment and positioning

An IBCLC lactation consultant can assistance to identify whether a baby's latch or positioning could exist causing difficulties with managing the flow of milk. If baby has simply the nipple in his mouth rather than a practiced mouthful of breast it is more hard for him to control the flow of milk. Similarly sure positions can make breastfeeding more difficult for a baby.

Coordinating suck, consume and breathe

A fast let-down is not always a mother related problem (i.e. the let-down is too fast); it may exist a "baby problem" for example a infant may take difficulty managing normal flow likewise every bit fast flow. When a babe breastfeeds they coordinate their breathing with sucking and swallowing in a carefully timed sequence and then they do not swallow the wrong way causing milk to enter their airway instead of their oesophagus. If the timing of the consume is not quite correct, fluid could enter the lungs (aspiration).

Lactation consultant and breastfeeding author Cathy Watson Genna2 explains that problems with swallowing (dysphagia) are not mutual but may be seen with some premature babies, babies who have had heart surgery, babies with neurological or anatomic issues or astringent reflux and some salubrious term babies. She explains that breastfeeding does not protect against dysphagia or aspiration and not all babies will coughing or choke—some babies may cease breathing temporarily to foreclose more fluid going into their lungs. Breathing problems such as congestion or mucous can also exist a cause of difficulty handling flow rate at breast or with a bottle. In Supporting Sucking Skills In Breastfeeding Infants, Cathy Watson Genna, 2017, p164 explains that if a fast menstruum overwhelms breathing, the infant may:

  • change their sucking pattern to short sucking bursts to requite more time for catch up breathing
  • use prolonged compression to try to stem the flow again to requite time for breathing
  • pull abroad from the breast to accept a proper run a risk to breathe
  • if the menstruation is too stressful some babies may decline to suck or suck with very little pressure every bit a way of coping

For farther reading encounter Supporting Sucking Skills, 3e and contact the health professional in charge of your baby if you lot have any concerns about your baby's swallowing or breathing coordination.

Mother reclining while baby breastfeeds
Milk flow is slower when baby is above the chest

Tips for helping your infant with a fast let-down

If your baby coughs, chokes, gulps and gasps or lets go of the breast but after you take a let-down:

Bank check positioning and attachment

The deeper the latch, the amend a infant can command flow. See Latching Tips and Breastfeeding Positions for Newborns for more information.

Attempt leaning back in reclining positions

Breastfeeding positions with baby higher up the breast can help to boring the catamenia of milk considering milk flowing uphill is working against gravity3.

Try letting the fast flow subside

If the let-down is very fast, try taking baby off the breast for a moment or two until the menstruum slows a petty. A container or towel can take hold of the milk and once the menses has slowed your baby may be better able to cope with the flow. Alternatively initiate the let-downwards before infant comes to the breast and so that the fast flow has subsided. Some mothers express a petty milk earlier baby comes to the chest then the flow is slower. Bear in mind that regularly expressing milk before breastfeeding could ultimately stimulate your breasts to make more than milk which may worsen the state of affairs if your fast flow is connected to crowd.

Feed oftentimes on need

Avoiding long time intervals between breastfeeds volition assistance to reduce engorgement and faster period due to increased pressure of milk inside the breast.

Wait for early on feeding cues

It can be helpful to avoid a baby being overly hungry which tin can brand him less coordinated and accept a stronger more frantic suck. Look for early feeding cues (sucking fingers, searching with an open oral fissure) or try offering a breastfeed while babe is withal sleepy and relaxed.

Never agree the back of baby's head to force him to the chest

If milk flow is fast a baby may need to let go of the breast occasionally to breathe. Avert holding the back of a infant'southward head so that he feels forced onto the breast, he needs to be able to protect his airway past taking a suspension.

Burp baby regularly during and after a feed

Swallowing milk quickly may mean you baby needs to burp frequently.

Nipple shields?

A nipple shield tin help some babies by reducing the rate of flow of milk. Nonetheless, a nipple shield can cause other problems. See Nipple Shield Good or Bad? and contact your breastfeeding specialist if you're because using a nipple shield for a fast allow down.

Suit your milk supply

If a fast let-down is associated with having likewise much breast milk, steps tin be taken to reduce the milk supply a piddling, and this in plow can help to ho-hum a fast let-downwardly. See Oversupply of Breast Milk for more information and check with your IBCLC lactation consultant before reducing your milk supply.

Try a canteen or cup

If problems continue information technology may be necessary to offering expressed breast milk via a tedious flow teat or open cup until more assist can be sought.

Seek professional person help

Occasionally some babies may benefit from a referral to the Oral communication and Language Team (SALT) to bank check whether in that location is an underlying reason why they cannot manage the flow of milk.

Summary

Milk is released from the breast in a neurohormonal reflex known as the "let-down" at the start of a breastfeed. Sometimes the menstruum of milk in this reflex tin seem to be also fast for an individual baby and they gulp, cough and gasp and may come off the chest crying while milk spurts everywhere. A forceful flow is often associated with having "too much milk". How easily a infant tin can cope with a forceful flow of milk depends on how a baby is positioned and attached to the chest and how they tin can cope with coordinating sucking, swallowing and breathing through a fast flow. There are several ideas to try if a baby is struggling with a fast let-downward.