Fast Milk Flow
Fast Flow Management with "Tailored Breastfeeding"
Baby Behaviors to Wanting Slower Flow
If the baby perceives that his mother’s milk rate is consistently too fast, every nursing session will seem challenging for mom and baby. When coping with milk flow that is too fast, the baby will show signs that he is working hard:
In an attempt to decrease the rate of milk flow, a baby may:
- He may tug at his ear while nursing
- He may scratch at his face
- He may squirm
- He may try to roll his body out away from the breast
- He may push against his mother
- He does not look as if eating is restful, but more as if it is an athletic event.
In an attempt to decrease the rate of milk flow, a baby may:
- Take the breast into his mouth with a shallow latch especially if the breast is full
- Clamp on the nipple with his jaws especially when the breast is firm with milk
- Bunch up the back of his tongue, pinching the nipple to protect his airway
- Role away form the breast, so his head is facing the breast but his chest is rolled away from mom
Baby's Ease of Breathing and Swallowing
I have found that when a baby has difficulties with milk flow, his mother often takes the “blame.” A mother may think she has an oversupply of milk, or milk flow that is too fast or too slow. Actually, her supply and her flow may be average, but her baby may need extra time and support to learn, coordinate and manage the suck/swallow/breathe process. Simply put, a baby’s unease in breathing and swallowing often show up as difficulties handling milk flow.
Breathing Difficulties
If a baby has breathing difficulties, fast flowing milk will challenge him. Taking the breast deep into his mouth causes the milk to squirt out of the breast, and pushes the baby to swallow. He may struggle to find time to breathe.
If your baby has breathing difficulties, you will likely recognize some of the behavior you saw in the list above on too-fast flow. More signs include:
If your baby has breathing difficulties, you will likely recognize some of the behavior you saw in the list above on too-fast flow. More signs include:
- He may gulp the milk so fast it looks as if he was starving. He may be swallowing fast to clear his airway to breathe. A pattern might be gulp, gulp, gulp, gulp, gulp, gulp, and gulp, gasp, breathe, pause, gulp, gulp, and gasp and so on. A more controlled pattern might be suck, suck, suck, swallow breathe.
- He may drip milk out of his mouth throughout the nursing not just at the end when he is full or the very beginning with the first letdown on an extra firm breast.
- He may fuss if pulled in close to the breast, as he needs breathing room.
- He may pull back and clamp on the nipple to control the flow.
- He may use the back of his tongue, curling it up and pinching the tip of his mother’s nipple to protect his airway.
- He may fuss if his head is held in to the breast, as he does not have the freedom to pivot his head.
- He may nurse more comfortably when he is held with his bottom down and his head up so he can breathe better than if he were in a side lying position.
- He may want to turn his body away turning his head so he can take a controlled breath and then swallow.
Swallow Difficulties
If a baby has a difficult time swallowing he will be challenged by a fast milk flow. He might share many of the same behaviors as the baby with breathing issues.
- He may gulp with each swallow, but it will not be a series of rapid swallows. His swallows will not seem effortless.
- He is likely to drip milk out of his mouth throughout the nursing session. (He may also drool so that his bib or clothing is usually wet.)
- He may tip his head back to help his swallow.
- He may turn his head to the side to swallow
What You Might Try
Managing fast flow Each child is unique. What one baby considers too fast may be just right for another baby. The first step in management is therefore to discover what makes the milk flow too fast for this baby. Management will be different if the baby has breathing or swallow issues, than if the problem lies in the mother’s over abundant fast-flowing milk supply.
Modifying Baby's Breastfeeding Position
Even small changes in positioning can be a big help for babies struggling with flow issues. Watching your baby’s cues for his physical comfort is an important first step to discovering these subtleties.
In experimenting with positions to help your baby handle fast flow, it can be helpful to reevaluate so-called “good positioning”. You’ve probably read that good positioning means the baby is tummy to tummy with mom, that he does not turn his head away to swallow, that he opens his mouth wide to nurse, flanging his lips, and that he takes the nipple deep in his mouth.
Here is new information for you. What we in the Western world have come to view as “good positioning” is actually “maximum flow positioning.” The baby receives the flow directly to the back of his mouth, and he has no way to avoid, deter, or lower the flow to his comfort level. While this works for most babies, it is not the best position for all babies.
Many times mothers find that to help a baby deal with fast flow they need to break the rules of "good positioning.” Babies with suck, swallow and breathe issues, or babies with GERD-reflux, are examples where this is the case. Even babies with effective breastfeeding skills have times when they prefer the option of a slower flow, for instance, when a mother’s breasts are heavy with milk.
To find your baby’s preferred position, watch his cues and be open to assist him as he shifts and adjusts himself--even if the adjustment is unorthodox.
Remember, while the principals of "good positioning" are useful in resolving some breastfeeding difficulties, being locked into a form and not being mindful of how the baby reacts to it can cause problems. At times, we focus so much on an "effective” nursing position that we don’t get the baby’s subtle message that he is finding it challenging.
In experimenting with positions to help your baby handle fast flow, it can be helpful to reevaluate so-called “good positioning”. You’ve probably read that good positioning means the baby is tummy to tummy with mom, that he does not turn his head away to swallow, that he opens his mouth wide to nurse, flanging his lips, and that he takes the nipple deep in his mouth.
Here is new information for you. What we in the Western world have come to view as “good positioning” is actually “maximum flow positioning.” The baby receives the flow directly to the back of his mouth, and he has no way to avoid, deter, or lower the flow to his comfort level. While this works for most babies, it is not the best position for all babies.
Many times mothers find that to help a baby deal with fast flow they need to break the rules of "good positioning.” Babies with suck, swallow and breathe issues, or babies with GERD-reflux, are examples where this is the case. Even babies with effective breastfeeding skills have times when they prefer the option of a slower flow, for instance, when a mother’s breasts are heavy with milk.
To find your baby’s preferred position, watch his cues and be open to assist him as he shifts and adjusts himself--even if the adjustment is unorthodox.
Remember, while the principals of "good positioning" are useful in resolving some breastfeeding difficulties, being locked into a form and not being mindful of how the baby reacts to it can cause problems. At times, we focus so much on an "effective” nursing position that we don’t get the baby’s subtle message that he is finding it challenging.
Let the Baby Control the Position and Latch
- Let the baby choose to turn his head to the breast but keep his tummy turned out if he wants that. Don’t keep turning him back to the tummy to tummy position. Turning his body away from the breast allows him to have a more controlled swallow. The milk will not squirt so deep into his mouth. He may feel less challenged to protect his airway.
- Let the baby pull off the breast whenever he wants to. Some babies want to take a breather when the milk is coming fast.
- Let him stop if he cues you for a break. He may want to burp or pass gas and then resume nursing again.
- Let the baby test the waters. Babies may bob with their heads off and on the breast before they settle in to nurse. They will often bob three times before they settle.
- Let the baby put his little mouth on the nipple and lick with his tongue. Babies do this to assess how fast they expect the milk to flow. Is the nipple wet and spraying or dry and not yet flowing?
The baby will choose how deep to take the nipple and how close to turn into the breast from the feel of the breast and the nipple, based on his experience. Allow him to take the nipple in only as deep as he wants. This is a real leap of faith for a mother who has had her nipple in the vice of a baby’s jaws! He may now start sucking stronger and more rhythmically or be more gentle on the nipple. If he can control the position and latch, a mother may be surprised that he no longer clamps, or pushes his tongue up against his pallet to squish mom’s nipple. He no longer needs these behaviors to manage milk flow.
However, if letting the baby take the lead does not result in less clamping, a mother should look for expert help in perfecting his ineffective suck, such as a Feeding Therapist, CranioSacral Therapist or Chiropractor.
Nipple Shields Can Help to Handle Milk Flow
Sometimes changing the nursing position is simply not enough to fix the underlying challenge. Using a nipple shield can be an additional help because it slows down milk delivery. There are a variety of reasons to use a nipple shield. In this case, we will exclusively explore issues of milk flow. An International Board Certified Lactation Consultant can help you discover if this tool will work for you and your baby. As with other tools, there is a learning curve to use it, and it is not always the right tool for every situation.
A nipple shield is a thin, soft, flexible silicone nipple. It is placed on mother’s breast over the nipple area. The shield can help to hold the flow of milk back if the milk is coming too fast for the baby. The milk can flow into the baby's mouth only as fast as the holes in the nipple shield allow.
Without a nipple shield, the milk will drip and flow away when the baby pulls off the breast. If the baby pulled off and stopped sucking because of a too-fast flow, he may be timid when he begins to suck again. Concerned about triggering another fast flow, he may not suck vigorously enough to start the milk flow.
With the shield in place, if the baby pulls off the breast or stops sucking, the milk will remain in the shield. Once the baby takes the nipple again and starts to suck the milk in the shield will flow right away and he can control the flow. Many babies feel less overwhelmed and challenged, and will begin to suck vigorously again.
A nipple shield is a thin, soft, flexible silicone nipple. It is placed on mother’s breast over the nipple area. The shield can help to hold the flow of milk back if the milk is coming too fast for the baby. The milk can flow into the baby's mouth only as fast as the holes in the nipple shield allow.
Without a nipple shield, the milk will drip and flow away when the baby pulls off the breast. If the baby pulled off and stopped sucking because of a too-fast flow, he may be timid when he begins to suck again. Concerned about triggering another fast flow, he may not suck vigorously enough to start the milk flow.
With the shield in place, if the baby pulls off the breast or stops sucking, the milk will remain in the shield. Once the baby takes the nipple again and starts to suck the milk in the shield will flow right away and he can control the flow. Many babies feel less overwhelmed and challenged, and will begin to suck vigorously again.
A Mother’s Overabundant Milk Supply Can Create Special Challenges
Having "too much" milk can cause some difficulties. Mothers with an overabundant milk supply are prone to plugged ducts and breast infections from inadequate drainage. Babies can become stressed because they are not getting their comfort needs met. Every time the baby sucks, he gets a lot of milk that he has to struggle to deal with. He may signal that he wants to nurse, but then fuss and become unhappy once the milk lets down. What should have been peaceful nursing session turns into a fretful time.
Even though having too much milk presents problems, the mother may find that others do not recognize her challenges, and that dealing with her issues is a lonely road to travel.
Even though having too much milk presents problems, the mother may find that others do not recognize her challenges, and that dealing with her issues is a lonely road to travel.
About Oversupply
A mother’s milk supply can be overabundant for many reasons. A mother may arrive at oversupply because she originally overused the strategy of pumping to relieve engorgement. The removal of much more milk than her baby could comfortably hold can result in building a supply too large for her baby's needs. Once a mother gets into a cycle of pumping, she may find it hard to break. The good news is that changes in breastfeeding management can bring the milk supply under control.
Some mothers find that their supply swings from too much to not enough. The mother may find, if she does not sleep enough, eat and drink just the right foods to support lactation, or has more stress than usual, her supply responds with a drop in volume. This rollercoaster can make for a stressful ride.
On the other end of the spectrum, some mothers have hormonal issues such as Polycystic Ovary Syndrome (PCOS), which can cause supply issues. About a third of mothers with PCOS have overproduction, while another third has low supply.
Some mothers find that their supply swings from too much to not enough. The mother may find, if she does not sleep enough, eat and drink just the right foods to support lactation, or has more stress than usual, her supply responds with a drop in volume. This rollercoaster can make for a stressful ride.
On the other end of the spectrum, some mothers have hormonal issues such as Polycystic Ovary Syndrome (PCOS), which can cause supply issues. About a third of mothers with PCOS have overproduction, while another third has low supply.
A Mother Speaks
One mother, Shannon, whose baby was sleepy with a "lazy suck" spent hours on the breast with little weight gain. She wrote, "Beverly, it's amazing! I wanted to try the nursing hold you described, just to see.... well it's amazing! She was able to take long drawing sucks rather than gulp, gulp, gulp like she has been. She also kept sucking that way past the let down for a bit! She even sucked well on the other side when I switched breasts doing it this new way... it's so amazing!"