The letdown reflex (or milk-ejection reflex) is what makes the milk in your breasts available to your baby. Tiny nerve endings on your nipple and areola are stimulated by your baby suckling at your breast.
This causes the hormone oxytocin to be released from your brain, causing muscles around the milk-making tissue in your breast to contract. In turn, this forces milk into your milk ducts and then out through tiny openings in your nipple.
What is overactive letdown?
An overactive letdown occurs when your breasts release milk too quickly during breastfeeding. This fast flow of milk can overwhelm your baby and make feedings stressful for you both.
Some common signs of overactive letdown:
- Your baby coughs, sputters or chokes during feedings, because the breast milk is flowing too quickly for him to swallow comfortably
- Your baby pulls off the breast frequently, as the volume of breast milk is too much for him to handle
- You experience breast pain or engorgement
- Your baby seems gassy or has loose stools, because he’s taking in too much air or breast milk.
How do you know if your letdown is occurring?
Some mothers don’t feel their letdown reflex. The only way they might recognize their letdown is when their baby’s sucking changes from a quick shallow suck at the very start of the feed to a deeper, more rhythmical suck when the letdown occurs. They might also notice milk leaking from one breast, as their baby feeds from the other side (as the letdown occurs simultaneously on both breasts).
Other mothers who feel their letdown, might feel:
- A tingling sensation in their breasts
- A sudden feeling of breast fullness
- A slight pain in their breasts
- A sudden feeling of thirst.
Some mothers who feel their letdown reflex in the early weeks might feel it less, or not at all, later on.
How to tell if you have an overactive letdown reflex
Some mothers have an overactive letdown reflex (or a fast one).
Do you notice any of the following when your baby feeds?
- The baby comes off your breast near the start of a feed gagging or coughing
- He makes big gulping sounds while breastfeeding (particularly at the start of a feed)
- You hear clicking sounds while the baby feeds (particularly at the start of a feed)
- You notice excess milk leaking from your baby’s mouth during feeding
- He often spits up milk
- The baby is very windy or unsettled.
If these signs are familiar to you, you might have an overactive letdown. An overactive letdown commonly occurs with an oversupply of breast milk. But it can also occur on its own.
You can read more about oversupply in BellyBelly’s article Oversupply Of Breast Milk | 7 Signs Of An Oversupply.
Here are 6 tips to help deal with an overactive letdown:
Overactive Letdown Tip #1: Optimise your baby’s attachment
When babies have a shallow latch on the breast, they might have difficulty controlling the milk flow, particularly if mothers have an overactive milk ejection reflex, forceful letdown, rapid flow or too much milk (oversupply).
To help your baby attach well to your breast:
- Hold your baby close so that his chest is touching yours
- Bring his nose directly opposite your nipple
- As he tips his head back, the top lip will brush over your nipple; this encourages the baby to open the mouth wide
- When the mouth is open wide, hug your baby to your breast, aiming for your nipple to be pointing towards the roof of the baby’s mouth.
Overactive Letdown Tip #2: Try different breastfeeding positions
Different breastfeeding positions work best for different mothers and their babies. Trying different positions can help you work out what works best for you and your baby.
Many mothers with an overactive letdown find the following positions helpful:
- Laid back nursing. In this position, your baby is placed on your chest, facing you. You can use a reclining chair or pillows can be placed behind you for support. In this position, your baby’s tongue is able to cup your breast better and this might help him to control a fast flow better
- Side lying position. Lie down on your side and bring your baby close and facing towards your lower-most breast. Supporting him with one hand behind the neck and shoulder blades. This position makes it easier for your baby to pull back from the breast while the flow is fast and then go back on, therefore having more control over the flow.
Overactive Letdown Tip #3: Burp your baby more often
If your baby gulps and constantly comes on and off the breast during feeds, he might be swallowing air.
Check whether your baby needs to burp (e.g. by putting him up over your shoulder) after he finishes feeding from the first breast (or when he comes off). This might help him digest what he drinks more easily.
For tips on burping your baby, you can read BellyBelly’s article How To Burp A Baby.
Overactive Letdown Tip #4: Breastfeed more often
Breastfeeding your baby more often helps to decrease the milk volume your baby receives at each feed, while still making sure the baby gets enough milk overall. When you let your baby nurse on demand, according to need, your breasts regulate how much milk to make.
When there is less milk in the breast, the flow of milk is typically slower and the breasts are filled with fat rich milk. You might notice your breasts also feel softer between feeds. This can make breastfeeds easier for your baby.
For more information, you can reads BellyBelly’s article How Often Should I Feed My Baby?
Overactive Letdown Tip #5: Catch the fast flow
If the above strategies don’t help enough, you might find it helpful to wait until your letdown occurs and then take your baby off the breast, catching the extra milk – in a towel, for example. Then, once the milk flow slows again, you can put your baby back on the breast. Beware, though – some babies really dislike this method.
Overactive Letdown Tip #6: Hand express off the fast flow
Use this method only if the above strategies don’t help enough and your baby seems distressed by the fast flow and, for example, is refusing to breastfeed. You could try expressing off the fast flow of milk before putting your baby to the breast.
This is a last resort strategy because it stimulates your breasts to make more milk, which is something you don’t want – particularly if you already have an oversupply.
If you do this, try expressing a little less milk each time, until you are no longer expressing before breastfeeding.
The good news is that many mothers find their overactive let-down reflex subsides, at least by around 3 months.
Overactive Letdown Tip #7: Block feeding
Block feeding is a strategy used to help regulate an oversupply of breast milk. It involves breastfeeding your baby from only one breast for a certain amount of time or number of feeds, then switching to the opposite breast for the next block of time or number of feeds.
Block feeding downregulates milk production and should therefore only be used for short periods of time and under the advice of a lactation consultant, so it does not result in a problem with milk supply.
