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20 years
My milk flow has increased and while breastfeeding, my baby turns her face away because she can't handle the flow and she chokes. What should I do?
Oct 20, 2014
2nd opinion

Dr. Zakia Dimassi Pediatrics
This is overactive breast milk let-down, whereby milk gets ejected forcefully and in big amount from the breast. If this happens early in the feeding, the baby may swallow air and consume too much foremilk (the less concentrated milk) in proportion to hindmilk (the more concentrated milk) . When the baby fills up on the watery foremilk, tummy ache may result from the combination of filling the tummy too fast, swallowing air to keep up with the let-down and the laxative effect of a large quantity of lactose (milk sugar). Some babies are so upset by the forceful spray of milk that they refuse the breast.

Solutions?
In the 1st few weeks of life, you can try different positions so baby can be "uphill" from her breast. For example, you can lie on your back with baby on top so she can control her head and back off if the milk ejects too forcefully. Another suggestion might be to take baby off the breast when the let-down starts, catch the overflow in a clean cloth, and placing the baby back on when the flow slows down.
If the problem persists when the milk supply is well established, you should focus on increasing the amount of hindmilk the baby receives and make the let-down less forceful. So if you begin breastfeeding on the right breast, as soon as the milk let down happens, gently remove the baby off your breast and allow the forceful spray to gush into a clean cloth. Then put the baby back on that same breast and let her feed for as long as she wants. If your baby needs to nurse again during the next two to four hours, offer the same (right) side. During the subsequent two to four hour period, the procedure is repeated using the left breast.

If you happen to be very engorged, you can use the opposite breast briefly.

If your over-active let-down is not that severe, you can use one breast at each feeding, instead of using one breast for each two-to-four hour period. Remember to always allow the first let-down to flow into a cloth then begin breast feeding.

It's also important to know that when your baby is having problems handling the let-down, it's recommended not to introduce her to a bottle too soon as long as this can be avoided. The less forceful flow from the artificial nipple makes this baby get confused between your nipple and that of the bottle and so may end up with breast rejection.

As the baby grows older, expect better handling of the strong let-down as she will have better abilities to suck and swallow. Some babies, however, will nurse only until their tummies are full and refuse to stay at the breast any longer. This lack of comfort sucking may lead to early weaning. The techniques to reduce flow described above can help even the older baby.
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