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“You’ve got so much milk! You’re so lucky!” “No, I’m bloody not”: oversupply, ‘colic’ and ‘reflux’

4/22/2015

63 Comments

 
When we’re so used to new mums worrying about low milk supply, it’s easy to forget what life is like for women at the other end of the spectrum.

Imagine a baby with the natural urge to come to the breast but when they get there they find it overwhelming, distressing and unsafe.

Imagine a young baby who chooses NOT to breastfeed when they need comfort and reassurance.

Oversupply can be miserable for everybody concerned and it doesn’t help when you’re surrounded by people telling you how lucky you are.

It’s important that we know what oversupply can look like, what to do about it and what it’s not. There is an epidemic of confusing oversupply and its accompanying symptoms for ‘colic’ and ‘reflux’. There are many babies right now being dosed with infacol, lactase drops, Gaviscon and reflux treatments, when the issue is simply that mum has too much milk or that improvements can be made with an adjustment to positioning.

It’s not clear why some mums seem to produce more milk than their babies need. In some cases it might be as a result of expressing with powerful modern electric breast pumps (and mums getting the message that regular pumping is part of normal breastfeeding). Perhaps they have more prolactin than average or large amounts of glandular tissue. Often there’s no obvious cause.

The problems will normally start to show themselves after the first week or so. It may be that some feeds are less of a problem (perhaps nights are easier) or that every feed is a struggle. A baby will look like someone dealing with a large volume of liquid being pushed down their throat which is not surprising as that’s often what’s happening. You may hear spluttering and choking. A baby may break off to take a breath (and mum may notice a spray of milk). A baby may cry or be obviously distressed and grumpy.

This baby will probably not feed for long. They may not need to because they are getting what they need in such a short time. As a result, these are the babies of mums who really don’t need the ‘advice’ to ‘feed for at least 20 minutes or baby won’t reach the fattier milk’ and a great demonstration of the fact that you can’t make rules about how long a feed should last.

Sometimes a baby may break off prematurely when actually they could have done with a bit more. If this is going on it will be reflected in the baby’s weight gain and these are the babies who are more likely to have mucousy green frothy nappies or have some digestive discomfort. These are the babies who are going to develop the symptoms that look a lot like ‘colic’.

Colic isn’t a very useful word. It’s a term used as a threat to new parents. It’s the thing we fear but we don’t really know what it is we are fearing. Unhappiness and lots of crying seems to be the basic summary but normal healthy otherwise happy newborns will have periods in an ordinary day where they are fussy and unsettled. It’s normal for a baby to cry on and off for most of an evening. It’s normal for a baby to only be calmed on the breast and want to feed almost constantly for several hours. It’s normal for parents for feel desperate and confused and perhaps worry that either there’s a problem with milk supply or their baby is behaving unusually because something is wrong. If they are calmed on the breast (even if only for a short time and they don’t actually appear to be swallowing much) then that sounds like normal evening fussiness.  One definition of colic (Wessel’s definition) is three hours of crying,  three days in a row,  three weeks in a row. By that definition, no one can say that a week old baby has colic or even a two week old baby. Normal evening fussiness may not develop in the first couple of weeks. A common call to the helpline goes like this: “Help! When we first got home from the hospital, our baby slept in the Moses basket in the evening and we ate dinner and watched TV and then we all went to bed together at 11ish. Now my baby cries most of the evening. He wants to feed constantly from about 6pm to 10pm. I haven’t even got time to eat dinner or go to the toilet. Is this colic?” That doesn’t sound like colic but normal cluster feeding or growth spurt behaviour and normal behaviour for a baby in the first few weeks of life. The parents who get the evening shift are luckier than the ones who get the 1am-4am slot. 

It’s also normal for babies to be windy. The reality is that a large group of mums perceive their babies to be windier and fussier than average but we can see that statistically that doesn’t make sense. If lots of babies have periods of being fussy and windy and unsettled, that IS normal. We need to check latch and positioning because when there’s a problem that means an opportunity for air to get in. It’s surprising how many babies struggling with wind and digestive pain are more comfortable once changes are made: the gape has improved;  the tongue is placed correctly on the breast; the head is tilted with the chin burying into the breast and once that cheek is touching the breast (on both sides). It's also normal for babies to be grumpy just before they poo. You'd think this natural process would be nice and easy but no.

However beyond what’s normal, babies dealing with oversupply and overactive letdown are more likely to be windy and more likely to be dealing with digestive discomfort.

How would we know it was due to oversupply? We’ll see that classic behaviour on the breast of the bobbing on and off and struggling with faster flow. We may also find a baby who is more likely to get hiccups, get trapped wind, produce explosive poos and bring up milk after a feed.

Bringing up milk after a feed isn’t the reflux we worry about. The word reflux just means ‘a flowing back’. It’s normal for some milk to come back out when little babies have immature sphincter muscles at the top of their stomach. If they take in too much milk, a bit comes back up again. That’s not a negative, that’s a safety mechanism that prevents stomach stretching and overfeeding. Plus the baby gets breastmilk with all its lovely growth factors and immunological factors sliding past on the way down and on the way back up again! When an air bubble comes out, sometimes milk comes out. The milk surrounding the trapped air bubble will come out too. All perfectly normal. Messy but normal.

When it’s not just milk coming out but acid too and a baby is in pain, that’s the reflux that we might worry about. A baby bringing up with a look of surprise on their face rather than a look of pain doesn’t need medication. These are the babies with a “laundry problem” rather than a “medical problem”. Unfortunately it’s the laundry problem babies that are sometimes still finding themselves in the GP surgery. Parents are worried that too much milk is coming up and they want to stop it happening. Sometimes these are parents focused on intervals between feeds and believing that that the small amount of milk coming out is preventing them from reaching the 3 or 4 hours their baby book says should be the aim. GPs may provide Gaviscon – a thickener that stops the stomach contents from lifting up through the oesophagus – but as we already know this may not be the ideal if this process is actually a safety mechanism. Gaviscon has other side effects: the thickening continues through the system and these babies may start to develop constipation and certainly have firmer stools. We end up seeing babies in genuine pain with constipation due to medication that was trying to solve a problem that wasn’t actually a problem in the first place. When you give a baby infant Gaviscon, you are giving them sodium alginate and magnesium alginate which form a gel in the stomach when they come into contact with stomach acid and thickens the stomach contents. Let’s not do that unless we really need to, not to avoid normal posseting. 

When babies spit up, it can look a lot. Mums talk about ‘the whole feed’ coming back up. This is unlikely to be the case. If you get 1 fluid oz (30ml) of cow’s milk out of the fridge and spill it down the front of a baby gro, I think you’ll be surprised how far it will go. They will be drenched. If a baby is taking in 60-80ml and even 20 mls comes out, that’s still going to look like a lot but the majority is left happily behind. It can be normal for a baby to posset after EVERY single feed. This still isn’t a baby in need of medication.  Another problem with giving Gaviscon is delivering it to a breastfeeding baby. The manufacturers suggest mixing the powder with cooled boiled water to make a paste and then giving it AFTER a feed using a syringe or spoon. I worry that many mums will be tempted to give a bottle (with potential impact on latching or milk supply) just to deliver this medication. Plus giving a young baby something in a spoon when they will usually still have a tongue thrust reflex is an impossible mission. Syringe feeding a sleepy baby (breastfeeding contains hormones like oxytocin and cholecystokinin which encourage drowsiness) is likely to be an aspiration risk. This may well mean feeds end early and babies are broken off before the right amount of high fat content milk has been reached.

So please let’s not give Gaviscon to babies that bring milk back up but aren’t in pain doing so.

If ‘colic’ or ‘reflux’ is to do with oversupply, it can be fixed. Colic is usually used to describe babies with digestive discomfort. They may raise their legs while crying or we may hear their tummies rumbling. They may be red in the face or rigid with discomfort. It has been suggested that these babies have issues with their gut flora and probiotics may help. They may have hypersensitivity of nerves in the gut and the underlying cause is not known, though babies will usually grow out of it between 3 and 4 months. Some of these babies may have food intolerances. A reaction to dairy protein is a possibility though that will usually be accompanied by other symptoms such as a skin condition, unusual stools (which may even be blood flecked) and weight gain issues.  Mums who smoke are more likely to have babies with colic.

Increasingly, companies are marketing products at these understandably desperate mums. Gripe water is an old-fashioned remedy which historically contained nearly 4% alcohol (and various herbs, bicarbonate of soda or ginger).  We now realise giving babies a raft of mysterious untested ingredients seems like a bad idea when we know so much more about gut flora and the relationship of our vital friendly bacterias to the Ph of our gut. Most of us know now that it’s not wise to give young babies herbal teas or plant extracts but if the product is being made by pharmaceutical companies then we inherently trust it.  Mums are being told to use ‘colic drops’ that often contain lactase. The theory is that babies are reacting to lactose and need help digesting it. Lactose is the sugar naturally found in all breastmilk (it’s not about dairy intake) and true lactose intolerance is very very rare. To give lactase drops, we’re spoon feeding those young babies with the tongue thrust again. This time when they are hungry and hoping for breast.

At least if a mum gives Simeticone drops (which help air bubbles to clump together to leave the body more easily) it can come directly from the dropper. Although I’m not sure we have research on giving babies ‘natural orange flavour’ several times a day.

I know there are mums who find some of these products useful. Of course, babies with genuine acid reflux find thickeners helpful.  I know there are mums who like giving droppers and other products. They feel it helps. I’m not down on everything on the shelves in Boots the Chemist.

I’m just saying that if you suspect oversupply or positioning and attachment might be your issue, get some breastfeeding support before going down to the pharmacy or to the GP. Let’s try and solve the underlying problem rather than fiddling around with spoons and exposing our babies to unnecessary chemicals.

Chemicals can be wonderful but let’s save them for the babies who can’t have their issues resolved after a fifteen minute chat with a lactation consultant or breastfeeding counsellor.

If your baby is gulping and choking and it appears to be about the volume of liquid going down their throat; if your letdown pain is quite strong; if you pump a large amount in a very short time; if you get extremely engorged and uncomfortable inbetween feeds – these could be clues that oversupply is an issue. You may hear baby clicking which indicates a loss of seal and can be associated with a large volume of milk. Baby may slip off or attempt to shallow the latch to cope with the flow.

What can be done about it? First of all, let’s check that some of these issues aren’t about positioning and attachment problems rather than oversupply. Babies may protest, shallow their latch, be fussy, slip off and wiggle around when mums just need to position them in a different way. We’ll assume you’ve had positioning checked and it’s clear there’s too much milk. Let’s also check you haven’t been removing your baby from the breast prematurely which can also result in some of the lactose overload problems and fussiness associated with oversupply. Ideally baby will come off the breast when they choose to do so or when they have stopped actively feeding and swallowing. If you are not sure what swallowing looks like, this video can help: https://www.youtube.com/watch?v=7giyNvlCW18 It's also true that babies with tongue ties (especially posterior tongue ties that are often missed by healthcare professionals) are sometimes the babies struggling at the breast - bobbing on and off and choking and spluttering. Babies with tongue restrictions will have problems grooving the tongue and swallowing the bolus of liquid effectively. If your baby is fussy, it's a good idea to get their tongue assessed alongside a general check of latch before you start any kind of supply adjustment.

How old is baby? If baby is under six weeks, you might be in a group of mums who start off with overproduction but things settle down as the body gets used to your baby’s natural levels of intake. Your body regulates from the higher prolactin baseline to the one that will become the norm for the rest of your time breastfeeding. So it may well be that your supply eases without you having to do anything at all. If we fiddle around with your supply in the early weeks and then you experience this shift, things might go too far the other way so it may be wise to hold on and see. That doesn’t mean that you can’t do anything though if your baby is really struggling with fast flow.

Milk comes out because of your milk ejection reflex (the oxytocin arriving in the breast and contracting muscles to push the milk down through your ducts) and your baby’s ability to remove milk using their tongue and create negative pressure inside their mouth. It’s not much about gravity. But if liquid is flooding into your throat and you are UNDERNEATH the flow, that’s more likely to be overwhelming. You won’t feel safe taking a breath. You are more likely to feel out of control and feel the need to break off. When we feed babies in a cradle hold, cross-cradle hold or rugby hold and they are under the breast, it’s understandable they feel more overwhelmed. If we lean back so the baby is more above the breast, this is likely to prevent the milk pooling in the back of their throat and hopefully they will feel less out of control.
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You could get them on in their usual position but then scoot your bottom forward and lean back – just make sure you have back support for yourself. You could also use positions where the baby is seated, perhaps with one leg astride each side of yours and their mouth level with the breast. By changing position, we’re hopefully going to result in the baby staying latched on properly throughout the feed. This is going to mean less air getting in and less windiness, colic and possetting.

I’ve heard of mum pumping before every feed to take off the faster milk. This really isn’t sensible as you’re stimulating your supply and telling your body to keep production at this level. One option might be to get the letdown started and then you could let the faster milk flood off into a muslin cloth before reattaching baby but this wouldn’t be fun in the long term. Some mums also get results by pressing on their breast with the side or heel of their hand at the begnning of a feed and blocking off a section of their breast but again this isn’t wise in the longer term and it could increase your risk of blocked ducts.

If changing positioning doesn’t help things and your baby is a couple of months old, it could be time to consider reducing your supply on purpose. We know that when the breast is full, this slows milk production. A fuller breast stretches the prolactin receptors in the alveoli so more prolactin can’t be received. A fuller breast accumulates a whey protein known as FIL (feedback inhibitor of lactation) and this seems to slow milk synthesis.

Before we play around with supply, we want to make sure that this isn’t a baby struggling with other issues such as weight gain. It is true that some mums with significant oversupply could still have a baby with weight gain problems. If a baby is taking in a large volume of milk, they may be filling up before they get to the higher fat content milk. They may have frothy green mucousy stools and be particularly gassy from getting the larger doses of lactose which we find in the lower fat content milk. When lactose is in large quantities, baby may not be able to digest it all effectively. It may travel through the gut undigested and this faster transit can result in greener poos. Undigested lactose can move into the large intestine and start to ferment and produce extra abdominal gas.  Good bacteria are important part of digestion so it makes sense that we are concerned that babies with digestive problems are potentially struggling with gut flora issues. If we take the edge off your supply, they should hopefully start to receive proportionally more of the higher fat content milk.

However it’s not sensible to intentionally reduce your milk supply without proper supervision if your baby has green stools and weight gain problems. This can also be a sign of insufficient milk supply. A baby may also bob on and off the breast and protest when the flow is too slow. This is a time to talk to a lactation consultant or an experienced breastfeeding supporter. It’s important to note that green poo can be a normal coloured poo for a happy healthy baby. We’re only going to worry if it’s frothy, mucousy and accompanied by other symptoms.

A way to reduce supply, when we are confident that is the problem, is to use a technique called block nursing. This means the baby stays on one breast for a block of time. This isn’t because we aim for them to have slower milk for a few feeds in a row but because it means the neglected breast will accumulate milk and the body will receive signals to reduce production. If you aren’t already doing single-sided feeding (offering only one breast for each feed), you can start with that. If that doesn’t improve things, you could then spend 24 hours experimenting with two feeds on each breast. That’s going to mean something like 4-6 hours with all the feeds being on the same side. The neglected breast may become engorged and even a little bit uncomfortable and this will send messages to reduce production. Then you swap and the other breast gets its turn to be fed from for a block of time. After 24 hours of blocking, you could then return to single sided feeding and see if things are any easier. In some extreme cases, mums may need to block on one side for three feeds or even more.

This technique can mean that mums are more at risk of blocked ducts or even mastitis. Once you come back to the neglected breast after a gap of time, flow may be particularly overwhelming so this is a good time to use that technique where the first milk floods off into a cloth before the baby attaches properly. After the first feed back on that side, it’s a good idea to check that no firm areas remain and the breast has been drained effectively. You may have firm areas before a feed and even lumps which may just be the glandular tissue full and distended under the skin. All the way along, let’s use our instincts. If a baby is indicating that they aren’t happy staying on one breast and they need more, this may be a time to abandon this method and try something else and check our thinking.

If mums have a history of mastitis (and that may not be unusual if mums have a history of overproduction), the idea of block nursing can be a scary one. An alternative option is to use natural remedies that reduce milk production. Applying cabbage leaves to the breast can reduce supply (which is one reason we want to be cautious in recommended this to brand new engorged new mums). Sage is also a useful herb. I once spoke to a breastfeeding supporter who claimed she spoke to more mums with supply problems after Thanksgiving and Christmas and all the sage and onion stuffing. That sounds a bit unlikely unless they are serious stuffing fans but sage does appear to have an effect. If you are not ending breastfeeding, you’ll need to be cautious. Kellymom.com (http://kellymom.com/bf/can-i-breastfeed/herbs/herbs-oversupply/) recommends taking ¼ teaspoon of dried sage three times a day for up to three days. It can be combined with food or drank with vegetable juice.

Some mums also reduce their milk supply using pseudoephedrine, an ingredient in decongestant and cold and flu medicine. Birth control pills containing oestrogen can also reduce supply. However I hope no one is starting off with decongestants and hormonal contraception without proper guidance and having tried other remedies first.

Sadly there aren’t fixes for every baby with colic symptoms or reflux symptoms. Some of these families are going to need medication and all the support they can get. However let’s just check that babies we know aren’t part of the trend of misdiagnosing colic and reflux when actually the problem is latching and positioning or oversupply and it can be sorted with some skilled help. I have known many mums and babies who have had ‘colic’ and ‘reflux’ disappear overnight with after a short conversation on latching or a couple of days of supply adjustment. But that doesn’t make the pharmaceutical companies any money, does it? And our GPs may not have the 15 minutes to spare nor the training in breastfeeding to resolve an issue that could be pretty straightforward.

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My book is available now from Amazon.co.uk and from other retailers.

"You may be worried about breastfeeding and worried that it might ‘not work’. This is a common feeling when you live in a society where breastfeeding is often sabotaged by incorrect information, patchy support from a stretched health service and powerful messages from formula companies. But it’s not a feeling that is entirely logical. We are mammals. We get our name from the dangly milk-producing bits. It defines us. 

This book aims to make you as well-prepared as possible. I would like you to breastfeed for as long as you want to and as happily as possible. I want you to feel supported. 

Some of this new life with baby will be about flexibility, responsiveness and acceptance. If you are used to a world of schedules and decisions and goals, it may be a bit of a shock. Learn about human biology before you think it sounds a bit too scary! Babies are the products of millions of years of evolution, and we are too; if we can just tap into our instincts and trust them a little bit. 

Success comes when we tap into those instincts and when we know when to get help when our instincts aren’t answering all of our questions. 

Can everyone who wants to breastfeed make it work? No. Not everyone may be able to exclusively breastfeed due to medical issues. Most of these people can give their baby breastmilk, though, which the book also covers. (And let’s not start this journey by imagining you’ll be someone who won’t make it...!)"

http://www.amazon.co.uk/dp/B019JE5E44

63 Comments
Roxanne S.
6/3/2015 06:54:03 am

This is a great article! What are some herbal remedies to low milk supply?

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Emma Pickett
6/26/2015 02:59:09 am

Did you lower milk supply? (which connects with this article) Or herbs to increase milk supply?

Fenugreek is often taken by mums to increase supply though we can't say there's a lot of evidence to support this and it's not safe for everyone to take it. Blessed thistle and goat's rue are also common choices. Have a look on kellymom.com.

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Emma Pickett
6/3/2015 08:27:29 am

Hi Roxanne,

Sage is usually the most commonly used (taken orally). Also cabbage leaves applied to the breast, Jasmine and fresh peppermint. Have a look here:

http://kellymom.com/bf/can-i-breastfeed/herbs/herbs-oversupply/

Best Wishes,
Emma

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Anna
6/22/2015 10:12:46 pm

I had my GP suggest everything from low supply, silent reflux, feeding too often (so extend to 4hrly feeds), colic, pump and bottle feed, 8 weeks was a good go at breastfeeding so I should just formula feed until I went to a local walk in breastfeeding clinic at my child health centre who said I had a huge oversupply and a fast letdown and suggested demand block feeding.
That man changed my life and my supply.
I'm still breastfeeding now at 17 months and Id have quit at 2 months if I listened to my GP.

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Marie
6/17/2020 03:37:27 pm

How long did you blockfeed for to see results?

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SMum
6/23/2015 10:09:22 pm

I had oversupply and fast letdown with my first baby, but like you mention I was told that was a good thing. It wasn't until about 4 months that I was educated about the block feeding method and the semi-reclined position, and it was miraculous the difference it made. I'm pregnant with my second and wondering if I should be expecting the same, or if it varies from baby to baby?

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Emma Pickett
6/24/2015 02:05:54 am

It is likely that you will experience oversupply again. In fact possible more likely as we build on previous prolactin receptors from the last lactation and often produce more milk second time around. Hopefully this time you'll be prepared with positioning tricks. After about 4-6 weeks, if it's a real struggle then it may be appropriate to begin to think about block nursing again (but we don't want to do it too early). Hope all goes well.

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Parny
6/26/2015 01:21:50 am

Thank you so much for this article! I struggled with bf my 6wk old in the beginning that i was ready to give up. It is easier now, still sprays but to know that there's other women out there like me is reassuring. Everything makes sense now! Thank you!

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Suzanne
6/26/2015 02:47:25 am

Great article !
Can anyone answer if there's a way to reduce the letdown only but not supply? As I'm expressing and don't want to loose my supply.

Thanks

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Emma Pickett
6/26/2015 03:01:14 am

Unfortunately not. Supply and speed of letdown usually go hand in hand.
If you are breastfeeding and fast letdown is a probably, that's the time to use a more reclined position. Try positions where the baby isn't under the breast. I've also heard of mums pressing the heel of their hand into the breast to reduce flow but we need to be careful about that as pressing at the wrong time could increase flow and could contribute to blocked ducts.

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Liz May
11/19/2015 11:59:02 pm

I'm always confused by the phase "oversupply". If mother was making too much milk for baby and baby only took what she needed, wouldn't the extra milk sit in the breast and activate FIL and therefore reduce supply for the subsequent feeds???

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Emma Pickett
11/23/2015 03:59:14 pm

One of the interesting things about FIL is that it's just a theory. There is a hypothesis about how it works but we don't really fully understand it. The science of lactation has made huge leaps in the last 20 years and there are things still waiting to be found. We do know that when milk is removed from a breast at full storage capacity, that will trigger milk production. FIL is only a hypothesis but it appears that the signals to slow will only really effectively operate when the breast is at full storage capacity (just as distension of the prolactin receptors is likely to only slow production when storage capacity is full). When a mum has a very forceful overactive letdown, we may also find that more milk is removed than the baby needs/wants and it's not as though the baby has localised control and the ability to tailor-make the amounts of milk that is needed. A mum with oversupply is also likely to have overactive letdown and get letdowns triggered in between feeds. Production is stimulated at regular intervals.

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Hannah
2/13/2016 10:51:06 pm

Incredible article talking a lot of sense- sitting here breast feeding covered in sick with trying to keep a baby upright and finally I may have a realistic explanation to my babies behaviour thank you. Now to try and slow the flow!

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Samantha
3/2/2016 02:26:01 am

I think I have an overactive let down. On my right breast i get lumps around the areola when I am engorged or when my milk lets down. What could this be from? They go away after my son nurses for a bit! They are in the same spot and have been coming and going for about a month. They are not painful at all.

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Mary
1/4/2017 03:51:35 pm

Omg I get this too! What did yours turn out to be? I think it's just milk rushing through the ducts?

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Denise
3/9/2016 10:40:22 am

Really helpful article. My daughter is 14 weeks and has always preferred the left breast, but over the past week has become quite distressed when feeding on the right side, and won't feed unless it's an overnight feed. The supply is very forceful, and I'm unsure why it's suddenly changed. I have had blocked ducts twice in past month on that side. A more upright feeding position hasn't helped. I'm not sure what to do as I don't want to affect supply on the left side. Thanks

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Emma
3/9/2016 04:18:24 pm

Sometimes you can try pressing the side of your hand into the breast to slow the initial flow. It's not something you'd want to do throughout the feed (as that would increase blocked ducts risk) but at the beginning. You can also practice block nursing on one side to reduce supply. Spend more time on the less forceful side (and maybe use some expressed milk too if baby wouldn't be happy about just feeding on the less forceful side for a couple of feeds in a row). The larger producing side will get signals to reduce supply if it goes through a period of engorgement. Just assess carefully for blocked ducts after it's been fed from the first time. And the first time after a gap, you may want to let the forceful milk flood off into a cloth before resuming the feed (but I wouldn't actually pump it).

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Juliet
5/17/2016 06:25:26 am

Hi. I'm on baby no. 3 he is 4 weeks old. I've had oversupply problems with my first two. My eldest had reflux and despite trying diff positions etc I ended up with constant blocked ducts and mastitis. He is clicking a lot and very gassy, constant hiccups etc. I'm feeding off only one side per feed this time and not expressing at all just the odd tiny few drops if I get very uncomfortable so I think that's a better start. I'm not getting on with repositioning with baby above breast as the ducts are getting blocked as the breast isnt draining. A lot of positions like rugby ball etc I find too difficult as a big heavy baby (10lb 5 at birth now over 11). I'm not very big and my back and shoulders can't take his weight. I am going to contact a bfeeding consultant to help with positioning etc but I'd like to move onto a bottle for one feed a day as I'm not coping with juggle of commitment also in two weeks I'm out for the day and want to know best way of dealing with missing feeds without getting engorgedbetc. Feeling bit fed up!

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Vicky
9/2/2016 06:53:56 pm

Hi,
My baby is 6 weeks (male, first child) and I suspect I have an oversupply.
When my milk initially came in I was incredibly engorged (I have stretch marks around the areoles while I didn't get a single stretch mark from the pregnancy itself, lucky I know!). During the 2 weeks of engorgement I was hand expressing into a towel pre feeds to soften the nipple/areole so my son could latch. His latch had always been great and lactation consultants in hospital were always pleased even during this engorgement phase.
During some feeds milk may pool around his mouth, and sometimes he comes off choking and I notice that my let down is fast. I could extinguish a fire with my spray. My son is gaining weight too effectively and exhibits reflux symptoms - we is held upright for some time after feeds to help with this and sleeps on an incline. I feed him from one breast per feed, re-offering the same side if he detatches. He tends to posset a lot particularly in the morning or after feeds when my breasts are more engorged. For instance he sleeps for a 6 hour stretch in the evening and wakes ravenous. My breasts are full after such a break and he'll feed well and efficiently, but lately had been rooting for more, feeding for longer and then posseting more, which is doubling the feed, nurse and settling time. By the end of the day my breasts are softer for feeds and he possets less and can go down to sleep without the "reflux". During cluster feeds I sometimes feel that I am empty and can't keep up with his demand, though I know that's not the case. What can I do to mitigate the impact of oversupply when my breasts are full?
Thanks!

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Emma
9/3/2016 11:47:20 am

You may find that things naturally start to calm any time from now. In fact, you are describing some of the signs of things settling. Around 6 weeks, some women do find things get easier. If you've tried laid back positioning (where he is more above the breast and feeding against gravity) when breasts are fuller and that still doesn't help, perhaps try and meet with an IBCLC or BFC to check your latch. They can also observe what's going on and could talk to you about supply reduction if it's needed. But you may not need to get to that stage. Fingers crossed it settles soon.

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Anna
11/3/2016 04:06:26 am

I wish I had seen this earlier, I have had an oversupply and fast let down which, now at 6 weeks has just stabilised. We have tried all the medicines but have not been convinced by any of them. My husband and I made the decision to take our baby off all the drugs, it has made no difference, meaning they were doing nothing. I have passed this on to my friends who have the same problem and hopefully they can understand better and not need to medicate. Thank you so much.

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Christina Gaehl
12/19/2016 03:32:27 am

This is incredibly helpful and very interesting. 3rd time mum here with a one month old baby, incredibly strong letdown pains and breasts have grown huge this pregnancy. Baby clearly struggles and shows a lot of reflux symptoms, projectile vomits, squirms, grunts, hiccups, hates being put down/not being upright, tummy rumbling etc...So you think there is a good chance it will settle down over time? I was booked in to see GP this week but may go to local breastfeeding clinic instead now...Thanks for posting.

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Emma Pickett
1/4/2017 06:21:12 pm

How is it going, Christina? We often say that if it hasn't settled by 6 weeks, a helping hand may be appropriate. How did you get on?

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Christina
1/6/2017 10:10:25 am

Hi Emma,
Thanks so much for following up! My babe is 7 weeks old now. I went to the breastfeeding clinic 2 weeks or so ago and they were quite helpful giving some more practical advice around feeding techniques and frequency. I find it's slowly settling down. My letdown pain is getting less strong, and the overactive letdown is happening less frequently too (I still need to wear nursing pads though!). I've also resorted to feeding from the "weaker" boob before bedtime. Bub still vomits a lot but it may be getting a bit better, haven't noticed as many tummy rumbles etc anymore. So I think overall it's getting there! She has become more settled over the last few days and is happier lying down, fingers crossed it will stay like that for a bit...oh and on the positive side of things she has put on over 2kgs since birth, up from 3.14 at birth to 5.3kg today - so that is a nice side effect! I'll keep doing what I'm doing and hopefully it will be alright. The only thing I'm wondering about is, she is pretty squirmy and unsettled in the early morning hours, from 4.30am or so, meaning I hardly get any sleep from then on...is this due to more milk intake around that time due to high prolactin etc? And possibly less upright time overnight? Anything I should be doing w/r to this? Either way, thank you again for sharing your knowledge, your article gave me the confidence and optimism to persevere. Thanks!

Michaela
1/14/2017 02:11:15 am

This is a brilliant article! thank you so much as it has been a interesting read.
I Would be very grateful for your advice if possible as I'm struggling to get answers from my local health team and breastfeeding support.
I too suffer with a massive oversupply and fast let down since my baby was 2 weeks old. I have stopped all medicines (gaviscon lactase drops and gripe water) and have been feeding in an upright/ leaning back position for several weeks. she is now 7 weeks old and I have noticed a improvement this week.
The problem I have is that I don't feel my let down reflex so I have been expressing off the fast flow milk before feeding (this can often be pumping 60-90mls off before it slows).Ive tried waiting for my let down and getting the fast flow milk to flow onto a towel technique but this has been unsuccessful. Also tried block feeding but my baby feeds every 4+ hours each time so just get very engorged.
Is there anything else I can do as I don't want to be expressing if it causes oversupply (and it's also very time consuming each feed too!)
Many thanks in advance.

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Emma Pickett
1/14/2017 08:52:37 am

Hi Michaela,

I would suggest experimenting with very gradually reducing the amount you are pumping. If you move very slowly, by either reducing by minutes or quantities, your baby will experience some fast flow but now that they are older they may surprise you by what they can cope with (especially if you lean back during a feed). If it turns out they are still struggling, you can always remove them again at that point. Hopefully over time your body would have a chance to adjust. At this point, you're telling the body to continue producing and even increasing supply further. It could also be that your baby is missing out on some useful hydration and nutrients that come proportionally more in earlier milk. If gradual pumping achieves nothing, and you'd rather not use blotched nursing, sage is worth experimenting with. Good luck!

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Michaela
1/14/2017 02:24:50 pm

Thank you for replying. I give her the fast flow milk via a bottle halfway or at the end of each feed to make sure she gets some of nutrients. But will give your advice a go and reduce pumping and try block feeding. Thank you and Best wishes Michaela

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Emma Pickett
1/14/2017 09:04:24 am

Hi Christina, for some odd reason I can't reply directly to you so have to start a new comment thread. What you are describing is really normal. Evening cluster feeding and evening fussiness gets lots of attention but morning fussiness is not unusual and just less discussed. We often find babies may start with longer blocks of sleep but as the night goes on some become more wakeful. It may not necessarily be fixable. I wouldn't suggest you aim to have upright time overnight as that doesn't improve sleep for you overall. You could have a think about night time positioning just in case she is ingesting more air because of the latch. We just want to still focus on breast filling the mouth, both cheeks and chin making good contact, making sure baby doesn't slip while they're feeding (which may happen if we support all their weight on our arms and hands). What position are you using for night feeds?

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CHristina Gaehl
5/1/2017 02:08:25 am

Hi Emma,
Thanks for your response and excuse my late reply please. My oldest has started school and it's been a bit of a whirlwind. The advice to ensure good latch and not supporting all weight with arms and hands at night time has been very helpful, thank you. It totally hadn't occurred to me that feeding lying down may in fact be a better position than sitting up to feed (while half zombied it is very likely that baby will slip off slightly in that position!). Anyway, in the end, it helped a little, but as you said, just natural fussiness that goes away as they get a little older. She ended up being a very gassy baby for the first 4 months of her life resulting in LOTS of screaming...then at 4 months it was like someone flicked a switch and she was so much happier. Boobs have completely settled down too, to a point where I have started offering both sides at a feed. Amazing how even on the third go I still had so much to learn, and how it is so true that every baby is different. Many thanks again for your support.

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Francesca
10/19/2018 07:54:42 am

This is so similar to my situation.
Baby is 7 weeks & is currently being treated for reflux with ranitidine but I am convinced the root of our issues are oversupply & fast letdown in my right breast.
She is still really unsettled after some feeds & squirms & grunts a lot. Hiccups, coughs etc...right breast will leak over an ounce during letdown when I’m feeding on the let!
The trouble is I can’t seem to reduce the supply in this right breast as every time I try to block feed it gets engorged to a v painful point ‘ I get scared of getting mastitis again.
What’s the best way to reduce oversupply in just the one breast, especially without reducing the supply of the left (which we have no issues with)
Thanks in advance Emma!
Francesca

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Emma
10/19/2018 08:20:45 am

Hi Francesca, It is really hard. to just do one breast and I can hear you are worried about mastitis. It might be worth trying a variation on block nursing which starts with full drainage. The idea is you are removing the 'milk lakes' which helps things to reset. You can read a bit more about it here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075483/ Might be worth a try.

Best Wishes,

Emma

Catherine G
1/16/2017 10:40:55 am

Thank you so much for this article! Ive been struggling with my four week old but never realised oversupply was the issue. Your tips have really helped. Looking back I think over supply was also an issue with my first baby but interesting to read that supply can increase with subsequent babies.

I have prolactinoma- a small (benign) tumour in my pituitary gland means my body makes too much prolactin and this caused problems conceiving. No one has ever mentioned that it might affect breast milk supply- do you know anything about this?

Thanks again for this informative and sensible article!

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Emma Pickett
1/16/2017 01:28:44 pm

Hi Catherine,

Yes, your condition absolutely impacts on supply. Mums with prolactinoma will commonly have oversupply due to prolactin levels. Which has its upside and downsides! Sorry to hear no one has explained this to you before. It sounds like you are getting on top of things now but it can certainly add to the challenge! With each baby, more prolactin receptors are laid down in the breast so it can get harder in some ways but easier in the sense your experience can help you cope. Hope things continue to be more settled for you.

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Catherine G
1/17/2017 10:51:11 am

None of the midwives or health visitors I've ever met over two pregnancies and two babies has known what prolactinoma is, let alone how it might impact breastfeeding. And no one has ever suggested to me I might have over supply, despite my baby having some clear symptoms.I feel much better educated now I've read your blog.

Barbara
4/24/2017 09:21:23 pm

Hi! My baby is almost seven weeks and we've been dealing with what I think is oversupply since about the two week mark. I've been block feeding for the most part with one breast per feeding (baby fills up fast and is gaining weight rapidly) along with positioning adjustments and although things have improved, I haven't seen a major difference in the gas, discomfort when pooping, colic at night, etc. Now it seems like we are seeing some reflux with lots of spit up at every feeding. Is it too early to try block feeding for two feedings for a period or should I give it more time? If not, how long should I try this before returning to one breast per feeding? Thanks for this great article! Baby isn't a fan of laying on his back in his crib, is congested and has trouble staying asleep as well.

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Emma Pickett
4/27/2017 09:15:44 am

Hi Barbara, you're certainly ticking lots of the boxes but it's worth getting a face-to-face assessment (if you haven't already) as latching or tongue function issues can also lead to the situation you are describing. If you are confident it's overproduction, I would suggest some gentle block nursing from around the 6 week mark could be appropriate. I would suggest starting with just a 24 hr period of blocking - 2 feeds per breast or 4-6 hours per breast as a guide. Then after the 24hrs resume normal single sided feeding. Hopefully you would have experienced some fullness/ engorgement in those 24hrs. If that isn't sufficient, you can always repeat or attempt a longer block but it's a gentle start. Good luck!

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Samantha link
5/30/2017 07:13:42 pm

Thanks for the info- very helpful!

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Charlice Eedu link
6/22/2017 02:51:37 pm

Thank you for sharing this.

These are some other useful tips for calming the baby if you experience the baby is fussy.

Your baby may calm down if you:
Lay him on his back in a dark, quiet room or lay him across your lap and gently rub his back. You can swaddle him snugly in a blanket and try infant massage.

Put a warm water bottle on your baby's belly or have him suck on a pacifier.

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Julia
7/29/2017 08:51:51 pm

I've been diagnosed with "true oversupply" but really struggled to find support to reduce my supply. My 12 week old has no weight gain issues (90+% for height and weight), but chokes and gags at feeds. I've been block feeding (first double blocks for one week and then triple blocks - so the same side 3 times for 2 weeks). I hand express at the beginning of each new block until I have 3 or less ducts spraying, I typically get 2-4 oz in under 5 minutes. Using this method, things seem to mostly be working, but if I don't hand express or when I tried to go back to 2 blocks, he chokes and gags. There is still so much milk he comes on and off, rarely feeds for more than 5 minutes, and still cries a lot because of the large number of burps (5-15 a feed). He has about 7 feeds a day and must be getting enough milk because of his weight gain, but his poo is often green and never seedy. It is particularly challenging at night because he has started going a longer stretch of 7 hours, but chokes then. Sometimes I set my alarm to hand express in the middle of the night so the flow will be better, but the time he wakes is so unpredictable that it's hard to know when to do it and seems crazy to wake up when he's sleeping. Any advice would be greatly appreciated.

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Emma Pickett
1/6/2019 03:06:26 pm

Hi,

I received notification that a Lianna left a comment on this article but the internet has eaten it! If you are Lianna, please feel free to email me directly!

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Michelle
5/29/2019 12:36:45 am

Thank you so much! I was considering medication before reading this and feeling very unsure but this article has given me hope!

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Andreea
7/22/2019 05:22:32 pm

Very useful article! I had oversupply until 3 days ago and I managed to fix it using the block feeding technique described above. My 2 months old baby has been having poo with mucus and streaks of blood for a month; he had blood tests done (everything came clear) and stool tests (no infection or bacteria, just high calprotectin which means intestinal inflammation). He is gaining weight well, no rash or allergy symptoms). The doctors are saying that mucus and blood might be normal for breastfed babies...but I am not convinced. How long after fixing the oversupply do you think I might see normal poo, with no mucus or blood in my baby’s nappy?

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Emma Pickett
7/23/2019 10:05:16 am

Hi Andreea,

I hope things get easier for you and your baby. There’s quite a lot of variation in the time it might take for a gut to repair. If we imagine that your baby may have had secondary lactose intolerance then we may be looking at something like 3 to 8 weeks before the gut returns to normal. Some info here: https://www.breastfeeding.asn.au/bf-info/lactose
I agree that blood and mucus shouldn’t be considered normal and hopefully things will get easier for you both.

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Chenden link
7/30/2019 03:19:46 pm

Just came across this while searching for information on baby bottles. Although this isn't entirely related, but now I can see how this is going to benefit moms especially those still new to parenting and not experienced at all.

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XY
10/21/2019 08:36:40 pm

Hi Emma, thanks for sharing this useful information! It has helped me greatly and gave me hope when I first discovered the idea of oversupply causing all these issues (e.g. gassiness, reflux-like symptoms and choking etc.) at the 4 week mark. I've since tried block feeding (for both one feed and two) for weeks and things have gotten better, though the gassiness, reflux-like symptoms, nasal congestion, large amount of vomitting (usually with phelgm) and explosive poos are still there. Mainly gassiness, reflux-y and congestion now. Vomit and explosive poos are occasional. My baby's poo has never been green though, but she has had a tendency to poonami since week 1! She'll go about 4-5 days without poop even in the first week.

Things are getting better, and the block feeding seemed to have worked to a point where I needed to feed from both breasts on some afternoons, evenings and the last feed before she sleeps for the night. I also tried using cold cabbage for a day or two to relieve the engorgement (with my unfed breast up to 12hours between feeds).
I've taken care to avoid any milk boosters too.

However, recently my supply went up again at 10 weeks. Not sure why that happened. It could be because of her growth spurt at 9 weeks or the wonder weeks. I noticed she likes to comfort latch in the week or so before the supply went up.

Does comfort latching increase supply? Should I stop her from comfort latching? She would cry usually if so. I can't tell if she's enjoying the slower flow (for once) and drinking part of her feed, or if she's truly comfort latching. This "comfort latching" pattern usually happens in the evening or the last feed before she sleeps for the night.

Recently, she seems to be starting to sleep through (~6 to 8 hours) and I hand expressed for less than 3 minutes, then allowed the milk to drip till it stopped naturally. I collected 60ml! Should I feed her this milk when she wakes, so my body would stop producing excess?

And is it advisable for oversupply mummies to hand express if baby starts to "sleep through"? I know it would signal to my body that milk is needed at this time. I already delayed my hand expression till the breast had 12 hours between feeds (and it was very, very engorged so I couldn't sleep). I plan to express lesser each night, but am still scared that all these would mean my supply would go back up to needing to block feed 6 hours per side.

Thank you very much for your kind help!

P.S. I've seen a LC who concluded that baby has no issues latching, and is sucking very well. She feels that I should not express before baby latches even if it's engorged, because baby would "get used to the fast flow" and the fullness of the breast would signal to the body to reduce production. Baby indeed got used to the fast flow (would finish her feeds in 3 minutes at times), but baby is awfully gassy and arching her back, taking forever (sometimes an hour!) to burp.

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Emma Pickett
10/22/2019 08:08:50 am

Hi XY,

Sorry you are still both struggling with symptoms.

If you are expressing some milk overnight, you are right that this should be done as minimally as possible. I can understand why you'd want to do it after 12 hours but ideally we want your body to be signalled by baby's demands at the breast and let the breasts remain unstimulated at other times. I'd also hold off on feeding expressed milk in the morning. Baby is likely to appreciate coming to the breast to connect with you and get the balance of fat etc that they want.

Generally expressing is a last resort as it won't help your body to get the right signals from baby. Fullness when baby isn't asking for milk is the tool that ultimately helps.

Breastfeeding is about much more than milk. 'Comfort latching' is at the heart of breastfeeding. If a baby is asking to come to the breast, ideally we want to the let them. Holding them off could mean they become distressed and unsettled and could mean they ingest more air when they do eventually come to the breast. Breastfeeding is great for calming and relaxing and it should be normal to use the breast for comfort. It might mean some supply stimulation but it shouldn't be something you try and avoid. Your supply needs to settle to cope with what is normal breastfeeding. Babies particularly appreciate the breast in the evenings when they may feel overwhelmed and when they are sleepy.

Gassiness, reflux, congestion are issues that can sometimes suggest something else is going on. This might include 'reflux' that requires some medical help or even an allergy. It might be worth speaking to your doctor. In my areas, we have an allergy-specialist health visitor who could also support. I'm not sure where you are based.

If an LC is confident that you are still struggling with oversupply, it may be that longer blocks are needed. One or two feeds would be considered the early stages of block nursing. I would try and get further face to face help. Sorry it's difficult to offer remote support.

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XY
10/22/2019 10:55:30 am

Yes, I understand the idea of leaving the breast as the baby needs it. But when I hand express, I can see how fast it sprays...No wonder she's drinking so quickly and getting so gassy. I fed her the expressed milk and then continued to latch her after that (only expressed to comfort, not expressing an entire feed). Will try to express lesser each day till I don't have to express any more.

Thanks for the clarification on comfort latching. I guess yes, it's a great time for bonding and I'll look into other ways to manage my supply.

Actually I've seen two PDs regarding this, and the funny thing is, one PD says there is mild reflux, while the other confidently declared that there is none. In case it's a milk protein allergy, I'll avoid dairy for 2 weeks and observe (avoided it before and things got better, recently had a bit more dairy, but not sure if it's a coincidence). I'm not based in the US, but I'll look into seeing another PD if this continues.

Appreciate your comments and sharing, Emma!

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Emma Pickett
10/22/2019 03:54:25 pm

One thing to bear in mind when feeding expressed milk - when you express for a short while/ just for comfort, this means the milk will be high in lactose. Babies dealing with gassiness/ green stools can be struggling with lactose overload. So giving his expressed milk, and then going on the breast, may not be helping baby's symptoms. Gassiness is about ingesting air with fast flow but it can be about dealing with a high proportion of lactose. In this country, avoiding milk protein is often accompanied by avoiding soya too and Milk protein allergy is often accompanied by soya allergy. I hope you find the local support you need.

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Kate
11/12/2019 09:48:33 am

Thanks for this very informative read. My girl is now 18 weeks old and we have been suffering what I thought is reflux since she was 6 weeks old (or there abouts). She has a posterior tongue tie. We have seen the lactation consultant who recommended our paediatric chiropractor who has been amazing. My girl has a birth trauma to the left occipital area and as a result a lot of muscular spasm in the sub-occipitals which we believe are creating paediatric headaches. I am now struggling with her on a daily basis. She takes a long feed at bedtime. Usually an hour. But during the day will only take sporadic feeds of 5-8minutes. If she feeds for more than 15 it’s a miracle. She is very twisty, inconsolable and I can only settle her chest to chest, moving and shhhush-Ing. I guess my thoughts are that I should withdraw all medication - we have both gaviscon and Omeprazole (she vomits the Omeprazole back and the gavi gives her painfully thickened stool). Her poos are yellow to green and there is no blood or mucus. I am also dairy free as it was thought she may have a CMP allergy.

I guess I am just at the end of my tether with the sleep deprivation of two hourly wakes every night and the endless days of crying and cuddling and car journeys to get her to settle.

I want her to be happy but I just feel I’m failing miserably. Your article here has given me food for thought and I am going to withdraw all medication to see if she responds.

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Natalie
12/22/2020 06:26:51 pm

What if the baby doesn't want to use breast for comfort before nap - sometimes it looks like he's hungry but won't take it unless asleep. I suspect silent reflux. He is 12 weeks now. I think he connects me with pain - feeding+reflux=pain. He is fine when his dad puts him to sleep with no pacifier. When I want to put him to sleep all fussiness and sometimes massive crying happens. Sometimes dummy helps and then he will feed. He doesn't like to lye on his back or side so once put on side for feeding he starts crying. Tried biological feeding position but I have big boobs and he can latch properly and is nervous also. Any idea how to cope with that?

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Emma Pickett
12/23/2020 10:10:45 am

Hi Natalie,
That sounds tough. The big picture is obviously getting support for his reflux from your doctor and possibly meeting with a lactation consultant/ breastfeeding counsellor to look at different positions and getting an overall review of your situation. In terms of what I might suggest - It's interesting that you say he does sometimes feed after the dummy - like he was overstimulated and needed to calm and decompress before he can feed. At 12 weeks, they can sometimes get overstimulated and refuse the breast when they are in that frantic state. If he happily goes to sleep without a feed at other times, perhaps that's the way to go. Then you could feed him on wake up or part way through a feed. If you feel flow is a barrier, you could express off some of the faster milk and then offer him that breast but that isn't a long term solution if you think oversupply is the issue.

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Lauren
2/11/2021 01:15:19 am

Hi Emma,

I'm struggling with what I think is oversupply, it began suddenly at week 6, not sure what caused it and now coming up to week 8 and it hasn't settled. My baby got diagnosed with a tongue tie and had it snipped yesterday although currently the feeding is no better. He is gulping down all the easy to access fast milk at the beginning but doesnt seem to be able to efficiently get the fattier milk. I looked up lactose overload and he has all the symptoms. It's got to the point now he is so uncomfortable and gassy that he can't lie on his back in the crib so my husband and I have been doing shifts through the night so can hold him. I'm not sure how long we can maintain this and at the minute i can't see an end point.

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Emma Pickett
2/19/2021 03:24:14 pm

Hi Lauren, How are things today? Sometimes the couple of days immediately after a tongue tie division can be the roughest as we were hopeful things would turn around and it can feel even harder. It can take some time for a tongue to re-learn how to move effectively. Have you got any support you can access locally? Even if via zoom. It may be useful to have someone check your positioning and there are things that can help.

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Ava S
3/30/2021 09:19:24 am

Hi Emma,

Thank you for your wonderful article.

I suspect I have oversupply with my 6 week old son (and possibly did too with my daughter who was diagnosed with GORD and treated with omeprazole until 22 months). He doesn’t seem as unsettled as she did but most definitely on and off the breast, gulping, wheezy and gassy. I use to feed my daughter in an upright position to help with the milk not coming back up into her esophagus but I never tried her ‘on-top’ so will do with my son.
What I was wondering is if you had any experience with thyroid conditions and increased levels of prolactin? I have had a total thyroidectomy and now take thyroxine, the dosage for which is fine tuned with regular blood tests. Pregnancy and birth both trigger significant dosage changes. I thought maybe there could be a correlation between the two. Is it an elevated TSH that would increase prolactin?

I will ask to have my prolactin levels checked along with my next bloods. I remember my GP previously saying was high but I was breastfeeding at the time and her ‘normal range’ was for the broader population. Do you know what is considered a normal prolactin level for someone who is breastfeeding?

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Emma Pickett
6/4/2021 02:57:32 pm

Ava,
I'm so sorry it's taken me so long to respond. Your message got stuck in my spam filter :( Your situation is probably very different now but to answer your questions - I'm not aware of TSH levels affecting prolactin levels. Thyroid dsyfunction impacts on milk production as a result of other metabolic processes. There are some cases of hyperthyroidism being connected to overproduction (but that's not elevated TSH). The range of prolactin levels are complicated! I'm going to take a photo of a table of figures and tweet it to my account @makesmilk (look for a tweet dated 4th June) so have a look there.

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Frank C. Grantham link
5/26/2021 02:59:29 pm

It is great blog post. I am Always read your blog. Helpful and Informative blog. Thanks for sharing these information with us.

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Milla
7/9/2021 10:03:50 pm

Hi Emma,

your article helped me so much in the recent weeks and prevented me from potentially reducing my supply too much.

I enjoyed breastfeeding immensely with my daughter, four years ago but this time, my baby and I are struggling with probable oversupply and reflux issues. It's so sad that this lovely activity of feeding has been so fraught with pain for my little one so far. He is now almost six weeks old. I was recommended block feeding by various people which did help but which I stopped as soon as I read your article. Ive followed all the positioning and other advice I could find. Most days things are better now than in the early days and evening feeds are actually quite calm now. I hope that it will continue to settle...

My biggest confusion (and sometimes desperation) is that I don't know at what point to take him off the breast or prevent him from relatching. When the reflux begins during a feed he looks for comfort and starts to suck harder. Or he will end a feed with a reflux choke. He will also signal for more feeding after a feed when he becomes refluxy. Sometimes I follow those cues - often leading to mild vomiting and long settling time - and sometimes I give him a dummy instead, which then makes me wonder if I am not depriving him of the (hind)milk he needs. He is then always content with the dummy; and before feeds he does make it clear if he doesn't want the dummy but the breast instead. I should say I do feed him often, but also hesitate with that because if he is still bringing up milk after an hour it seems strange to add more milk to his belly at that point, even if he seems to want it. I can't find any advice about this anywhere ! Do you have an opinion on this?

He has been growing on the Dutch curve which is an average of breastfed and bottlefed babies and the doctor said she would expect to see more growth above the curve with a breastfed baby. However, outside of reflux he is a very happy and engaged baby and he has lots of big wet nappies.

Im very curious also what others do!

Thanks a lot,
Milla

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Emma Pickett
7/19/2021 12:01:42 pm

Hi Milla,

It's hard, isn't it? You are not alone in feeling confused or wondering whether you are supposed to have the answers. Truthfully, your decisions may vary each time depending on how tired he is and what else is going on. The breast is obviously multi-purpose and is valuable for comfort as well as nutrition. I would suggest that if he is asking for the breast, it is worth responding. Babies tend to adjust their feeding style depending on what they are looking for. But if he has fed recently, has good weight gain, is well-hydrated, and you want to try something else, you absolutely can. Bear in mind in the warm weather, he might want to feed more frequently. Best Wishes,
Emma

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Milla
12/20/2021 01:52:27 pm

Dear Emma, Thanks so much for your response. At the time I was too busy to respond. Just to let you know that around 7/8 weeks the supply settled beautifully. I was then occasionally worried it was too little but my baby grew well. We used a dummy for comfort from early on as the oversupply made suckling on the nipple for comfort a nightmare. But that has worked out really well and I also read that the sucking on a dummy helps against reflux (activating peristalsis) and it really did seem to help us.
Good luck to everyone out there with the same issue!

Emma Hudson
2/23/2022 07:12:17 pm

Hi Emma
I’ve been diagnosed with an oversupply by a specialist and have started block feeding. However when I bring my baby to the engorged breast all the bad symptoms come back (pulling off the breast screaming and then screaming until I e can calm her down) how should I deal with this do I need to hand express before she goes on or should I unlatch her during let down?

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Emma Pickett
4/26/2022 10:05:08 am

Hi Emma, I'm sorry your comment got lost in my spam filter. I hope you got the support you needed. For the benefit of others, during block feeding, switching back to the previously neglected side can be very challenging. I would experiment with both detaching her (and letting some milk flood off) and some expression in advance (although a lot will obviously stimulate supply). You'd also want to use positioning where she feels in control, ideally a reclined position. I hope things are easier for you now.

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Tamzyn
4/26/2022 08:38:06 am

Hi Emma

I just need to thank you first for this incredibly helpful blog. I wish I’d have found it first time around. I had oversupply with my first baby and I’m 6 days in with new baby and already panicking because my breasts are like rocks, never drain properly and baby struggles with let down and flow. I had thought to immediately start block feeding but am glad I’ve read that I should wait 6 weeks first as I don’t want to send my supply the other way! We are still having issues with shallow latch and clicking (waiting for posterior TT assessment).

My question is about what to do with the let down from the other breast whilst feeding, this time I’ve had two or three people tell me to use a Haaka on the other breast to collect the milk but I’m sure I was told before that this could stimulate the other breast causing more supply? I also have breast shells which would just collect the drops - would that be recommended or pushing the nipple to try and stop some of the let down on the other breast so to avoid too much leaking?

Many thanks in advance

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Emma Pickett
4/26/2022 10:02:18 am

Hi Tamzyn, Congratulations on your baby. I'm sorry you're having some difficulties. If you have question marks around latch or even tongue tie, that could be a contributing factor to your fullness so we'd want those to be fully investigated before attempting anything around supply reduction. In very severe cases, we don't always wait for the full 6 weeks but you'd want to full assessment by an IBCLC ideally. Using a device like a haakaa would strongly NOT be the recommendation. It isn't just a collector and exerts some negative pressure and could exacerbate your oversupply. Even using shells could mean some stimulation. I would suggest having a cloth/ towel/ breast pad but also pressing onto the nipple to try and slow leaking. I hope it settles for you soon.

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