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Overactive let-down (OALD) is the forceful ejection of milk from the breast during breastfeeding. It can make breastfeeding difficult and can be the source of breastfeeding complications. It may also be known as hyper milk-ejection, Hyperlactation syndrome, Oversupply Colic Syndrome, Foremilk-Hindmilk Imbalance, and other such near synonyms. The physical or medical cause of overactive let-down is still unknown, as is whether mothers with OALD produce more foremilk due to oversupply - higher production of overall milk volume - or imbalance - higher production of the percentage of foremilk to hindmilk.
Complications
The forceful spray of milk can cause the baby to consume too much milk too quickly as well as to swallow air during the period of rapid swallowing following the let-down. The speed of the flow of milk into the mouth can cause the baby to react with reduced nursing times and aversion to nursing often described by mothers as "fussiness", "colicky", "dislikes nursing", or "is weaning".
Consumption of a higher ratio of the foremilk of the let-down compared to the later hindmilk can also lead to an imbalance of the amount of lactose (milk sugar) to lipids (fats) reaching the baby's gut, if not enough hindmilk is consumed to compensate. Babies that consume too much foremilk can often be identified by their green, watery or mucusy stools, reflux, and other gastrointestinal problems, as well as their behavioral reactions and changes to the breastfeeding relationship.
Overactive let-down that continues or worsens can lead to the constellation of symptoms that make up Overactive Let-down Syndrome. Babies coping with OALDS often gain weight quickly, even while nursing for short periods with long intervals. Some babies sleep for surprisingly long periods of time and depth, possibly due to an overful feeling, while others have very disturbed sleep, possibly due to gastrointestinal pain. Other babies, especially those of approximately 2-4 months of age, become increasingly upset at the spray of milk and increase their aversion to nursing even to the point of refusing the breast, which can lead to a nursing strike.
Treatment
There are effective remedies for overactive let-down, and overactive let-down syndrome, however aggressive treatment should be watched carefully by someone familiar with the condition as the mother is at a higher risk for plug ducts, mastitis and other breast infections.
This condition can take a long time to control and can be frustrating for the mother and baby, but when controlled effectively a long and satisfying breastfeeding relationship is possible. Mothers with this condition may be given various incorrect rationales for their concerns such as "having weak milk", or "bad milk", it's "just colic", the baby will "grow out of it", or the child is "allergic to your milk", or a food in the mother's diet.
There are no valid reasons to stop breastfeeding due to this condition.
References
- Andrusiak, Frances and Larose-Kuzenko, Michelle. The Effects of an Overactive Let-Down Reflex. Lactation Consultant Series, 1987.
- Benson, K.D. "Clinical Problem Solving," CERP session LLL of Illinois Area Conference. September 4, 1993, Chicago, Illinois, USA.
- Mohrbacher, Nancy and Stock, Julie. THE BREASTFEEDING ANSWER BOOK. La Leche League International, 1991.
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