Breast feeding (overabundant milk supply)

Also known as overproduction or overproduction syndrome, this condition is often under diagnosed in otherwise healthy lactating women (1)

Causes of overabundant milk supply include:

• poor attachment - this leads to ineffective removal of milk, the infant suckles a lot which may stimulate the breast to produce a lot of milk
• moving from one breast to another before the infant is finished on the first breast.

This results in infants getting milk which is low in fat (foremilk) and infants suckle more to get more energy stimulating the breast to produce more milk (2)

Suspect overabundant milk supply when the following symptoms are observed:

• in the mother
  • painful letdown
  • milk spraying from the opposite breast during feeds (3)
• in the infant
  • during let down when the milk flows fast the infant may choke and splutter and arches back or become fussy (3)
  • cries as if the infant has colic and wants to feed often
  • has frequent loose stools which may be green in colour (2)
  • rapid weight gain
  • frequent very wet nappies
  • passing a large amount of gas (3)

Strategies for the management of overabundant milk supply include:

• help mother by giving information and support on effective positioning and attachment
• feeding the baby when he/she is calm - early feeding cues (3)
• advice the mother to offer only one breast per feed and let the baby finish by him or her self. This will allow the baby to get more fat rich milk (hindmilk). This should be monitored daily to avoid a large drop in milk supply (2,3)
• a little amount of milk can be expressed until letdown has slowed down and then feed the baby
• in women who experience continued forceful letdown reflex, breastfeeding while lying on her back or holding the breast with the fingers closer to the areola during feeds (2)
• frequent burping (3)

Reference:

• 1. van Veldhuizen-Staas CG. Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeed J. 2007;2:11
• 2. World Health Organization (WHO) 2009. Infant and young child feeding. Model chapter for textbooks for medical students and allied health professionals
• 3. British Columbia Reproductive Care Program 1997. Nutrition part 1. Breastfeeding the healthy term infant