If you have a baby who is fussy while breastfeeding, it might be due to a forceful letdown.
Read on to find out exactly what a forceful letdown is and what you can do about it.
Why is my baby choking on my breast milk?
The milk let down (or milk ejection reflex) occurs when your baby attaches to your breast and begins to suckle. A forceful letdown (or overactive letdown) is the term used to describe a particularly fast let down or fast flow of milk that usually occurs at the start of a breastfeed.
Mothers with a forceful let down sometimes notice their babies are very fussy feeders – often pulling away from the breast, coughing, spluttering, or gulping on their milk.
Many mothers with a forceful letdown have asked themselves or others the question: ‘Why is my baby choking on my breast milk?’
It happens because the flow of milk is too fast for the baby to handle. It can cause anxiety about breastfeeding for both the mother and her baby but it’s helpful to know there are strategies you can use to help slow the flow of milk.
What causes forceful letdown?
An overabundant milk supply is often associated with a forceful letdown; however, that’s not always the case.
If you’ve had a longer amount of time between breastfeeds than usual, or if you’ve skipped a feed, you might find that your letdown reflex is stronger the next time you breastfeed your baby.
A forceful letdown also depends on your baby’s ability to handle your milk ejection reflex. A newborn baby or a baby who was born prematurely might not be able to handle an overactive letdown or fast milk flow in the same way an older baby would.
How do you fix a forceful letdown?
If your baby is struggling to handle the fast letdown of milk while breastfeeding, there are things you can do to help slow down a fast flow.
#1: Express some breast milk before a feed
The most forceful letdown is usually the first letdown of a breastfeed. It can be helpful to stimulate the first letdown before attaching your baby to the breast, so that when your baby does latch on, the flow of milk has slowed down.
Hand express a little milk – just long enough for your letdown reflex to be triggered. Wait until your milk changes from a forceful spray into a steady drip and then try attaching your baby. You will most likely find that your baby attaches to the breast more easily once the flow slows. Some mothers will collect their expressed breast milk to feed to their babies at a later stage; other mothers are happy to express a small amount of milk into a towel.
Another technique is to let your baby nurse until your milk lets down, take your baby off your breast and catch the forceful let down, then reattached your baby to continue the breastfeed.
If you can avoid expressing with a breast pump in the early weeks, this is advised. The more milk you remove from your body, the more milk your body will make, so using a pump to express milk can boost your milk production and further contribute to a forceful let down.
#2: Change breastfeeding positions
Sometimes, simply changing the position you are in to breastfeed your baby can slow the flow of milk.
If you usually breastfeed your baby in a seated position, try a semi-reclining or lying position instead. In a semi-reclined breastfeeding position, you baby’s head is higher than your breast. This means your milk essentially has to travel uphill, against gravity, which helps to reduce a fast milk flow. Laid back nursing also gives your baby better control, allowing him to attach himself and come off the breast on his own.
In a side lying position, your baby has a better ability to let excess milk dribble from the sides of his mouth than he would in a classic cradle hold.
#3: Use nipple shields
For a mother with an overabundant milk supply and an overactive letdown, nipple shields can be a useful tool to use while breastfeeding.
By using a nipple shield, you are putting a barrier between you and your baby and this reduces the stimulation to your breasts. This method can be effective in helping reduce an oversupply and forceful let down but it must be done under the guidance of a lactation consultant.
#4: Block feeding
Block feeding is advised to help breastfeeding mothers with too much milk reduce their supply.
Block feeding works by breastfeeding your baby on only one breast for a certain period or ‘block’ of time. Breastfeeding on the same breast for a few feeds in a row reduces the amount of stimulation in the other breast. When the first block of time has ended, you change sides and feed only from the other breast, for the same amount of time.
Breastfeeding from the same side for several breastfeeds in a row helps both breasts make less milk overall.
Anything that reduces stimulation to your breasts and potentially affects your breast milk supply, such as block feeding, should be done temporarily and under the guidance of a lactation consultant.
Does overactive letdown go away?
An overactive letdown can be common in the early weeks postpartum when your breast milk supply is still regulating. After your baby is born, milk production is controlled by your hormones, before it changes to working on the principle of supply and demand. It can take about 6 weeks for your milk supply to regulate and some mothers find they make too much breast milk in this time.
To avoid making too much milk, it is advised to avoid expressing breast milk with a breast pump unless there is a good reason to.
Anything that increases milk production during this time will contribute to an overactive letdown. Having too much breast milk can also lead to blocked milk ducts and mastitis.
You can read more about mastitis in BellyBelly’s article Mastitis | Breastfeeding, Symptoms and Treatment.
Once your milk supply has regulated, you will most likely notice a change in your fast letdown. It’s also possible, though, for some mothers to have a forceful let down and fast flow of milk for their entire breastfeeding journey.
With practice, babies become better at breastfeeding and many babies learn to adapt to their mother’s fast let down and milk flow.
Can forceful letdown cause reflux?
An overactive letdown can cause symptoms similar to reflux. Some symptoms of reflux in babies are:
- Frequent spitting up or vomiting
- Fussy breastfeeds
- Gagging or choking while breastfeeding
- Trouble gaining weight.
These symptoms are very similar to those of a breastfed baby whose mother has an overabundant milk supply and/or an overactive let down.
If you are concerned your baby might have reflux or if you have any other concerns about your baby’s health, talk to your baby’s doctor or pediatrician.
For further information on reflux, you can read BellyBelly’s article Reflux In Babies | 10 Common Questions Answered.