Let’s talk about fast or forceful letdown or milk flow - why it happens and what you can do to make breastfeeding more comfortable for both you and your baby.

Fast Letdown: What Is It?

Some women experience a fast or forceful letdown when breastfeeding. While this isn't always a problem, it can be challenging for some babies to cope with milk flowing out faster than they can comfortably handle. Babies need to coordinate sucking, swallowing, and breathing during feeding, and a forceful letdown can disrupt this delicate balance.

Imagine if you were in a situation where you felt like you were being waterboarded; it's an uncomfortable experience. Babies may respond differently to fast letdown. Some might sputter and gasp initially but eventually find their rhythm. Others may intentionally latch shallowly to control the flow, which can be painful for moms. In some cases, babies may fuss and refuse to latch altogether because they anticipate the forceful flow and it has become a negative experience.

Reasons for Difficulty with Fast Letdown:

Problems from a fast letdown can occur for various reasons. Sometimes, it's simply due to a natural variation in a mother's milk production (high production women tend to have faster letdowns, but sometimes the letdown can be fast even when overall production is not high or even producing a “full supply” for a baby), and a baby needs to compensate for this faster flow. Some babies may be more willing to deal with a faster flow than others.  In other cases, the flow itself may or may not be particularly fast, but a baby may have difficulty controlling even a normal flow rate for other reasons, like oral-motor discoordination, hypotonia, or tongue tie.  Not every fast letdown will be a problem, but it’s important to be aware of its possible associated symptoms in case it is contributing to nursing challenges.  

Managing Fast Letdown:

If your baby seems healthy but struggles with a fast letdown, there are several strategies you can try to make breastfeeding more comfortable for both of you:

• Reclining Position: When feeding your baby, consider reclining more. This position, although offering minimal advantage, can slow down the flow of milk due to gravity, making it easier for your baby to handle.

• Pause and Collect: If you sense a forceful letdown is about to happen, or if it already Started and your baby is struggling, take your baby off the breast for a moment. Allow the milk to spray into a burp cloth or container. Once the flow has slowed, put your baby back on the breast.

• Shallow Latch Correction: If your baby naturally latches more shallowly during fast flow, gently take them off the breast when the flow slows down and help them re-latch deeper for the rest of the feeding. This will ensure a more comfortable feeding experience and prevent nipple trauma.

• Nighttime Feedings: Babies may handle fast letdown better when they're sleepier. For babies that reject the breast due to the fast flow, consider practicing breastfeeding more during nighttime feedings when they are less likely to be bothered by the forceful flow (or they are just too tired to “put up a fight”).

• Gradual Improvement: Many women experience a gradual slowing of their milk flow over time as their milk production becomes more regulated. So, patience can often lead to improvements in the situation.

When to Seek Help:

If you suspect that your baby's difficulties are more than fast letdown alone, or if you are concerned about their overall feeding abilities, don't hesitate to consult a healthcare professional. Signs that may indicate a need for evaluation include gasping, choking, frequent loss of suction, and excessive fussiness during feeds.  If your baby is not gaining weight well and you have a feeling you have plenty of milk and a fast letdown, make sure your doctor is aware of this.  Rather than simply “switching to bottles” or formula, a baby who is struggling to gain weight in the context of a fast letdown and robust milk supply must be evaluated to see where the trouble is.  This may include the help of other specialists, including potentially a speech therapist, a breastfeeding medicine physician or IBCLC, a pediatric ENT, or a pediatric gastroenterologist, to name a few.  

Remember - while fast letdown can pose challenges for both moms and babies, there are strategies you can employ to make breastfeeding more comfortable. Remember that many of these issues tend to improve over time, and patience can often be the key. If you ever have concerns about your baby's feeding, don't hesitate to seek help from a healthcare professional.