Is Too Much Milk Aggravating Reflux?

QUESTION

Dear Lactation Consultant,
I'm nursing my 21-month-old along with my one-month-old. I've noticed that my milk lets down fast and furious. It seems like it's way too much for my newborn. How can I nurse her so that she's not choking on the milk? My 21-month-old certainly enjoys all of the milk, and I'm wondering if it's his nursing (twice daily) that's causing my milk to come in so fast. My daughter also has reflux, and I have the feeling that all of the milk is aggravating it (because her tummy fills up so fast). Do you think that's a possibility?

Thanks,
Gwen

ANSWER

Gwen,
You have asked some very good questions. It is not uncommon for a newborn to have difficulty coping with the milk let-down. In your case, since your 21-month-old is only nursing twice a day, I doubt that that's contributing to the problem. As a baby grows and develops, typically they get better at coordinating their sucking, swallowing, and breathing and can handle the fast flow better. However, there are ways you may be able to make the let-down easier for your baby to manage:

  1. Use a nursing position that allows your baby to nurse "uphill," with his head and throat higher than your nipple. One way to do this is to lean back in a rocking chair or recliner after latching baby on.
  2. Feed more frequently, reducing the amount of milk stored in the breast, slowing milk flow.

You could also plan to nurse your newborn right after the toddler's twice a day feedings, which would reduce the amount of milk in the breast at those times. Although it may seem as though your toddler is taking "all the milk," there is most certainly some left. Research shows that on average only 65% of the milk in the breast is taken at a feeding.

Regarding the reflux, research indicates that breastfeeding babies do better than those on formula. A feeding strategy that seems to help babies with reflux is to choose nursing positions that put "head above bottom." So if you use the cradle hold, your newborn's bottom would rest in your lap. (Sometimes crossing your legs makes this more comfortable.)

Short, frequent feedings are also recommended for babies with reflux, as larger, less frequent feedings aggravate this painful condition.If your newborn is gaining weight very rapidly (well over 2 lbs. per month), you might also consider limiting feedings to one breast. Allowing the baby to drain one breast for two-hour stretches can keep milk flow more manageable. However, this would not be appropriate if your baby's weight gain is average (2 lbs. per month or less), as it would inappropriately limit the total amount of milk taken.

Some mothers have found that sensitivity to cow's milk in their diet can contribute to a newborn's reflux. You can find out if this might be the case by eliminating all dairy products (milk, yogurt, ice cream, cheese) from your diet for at least two weeks. If this helps your newborn's reflux, it may be worth the extra effort.

Hope this helps,
-- Nancy, IBCLC

Kathleen Tackett

Dr. Kendall-Tackett is a health psychologist, International Board Certified Lactation Consultant, and Research Associate Professor of Psychology specializing in women's health at the Family Research Lab, University of New Hampshire. She is a Fellow of the American Psychological Association in both the Divisions of Health Psychology and Trauma Psychology. Dr. Kendall-Tackett is a La Leche League leader, chair of the New Hampshire Breastfeeding Taskforce, and the Area Coordinator of Leaders for La Leche League of Maine and New Hampshire.

Dr. Kendall-Tackett is author of more than 140 journal articles, book chapters and other publications, and author or editor of 15 books including The Hidden Feelings of Motherhood (2005, Hale Publications), Depression in New Mothers (2005, Haworth), and Breastfeeding Made Simple, co-authored with Nancy Mohrbacher (2005, New Harbinger). She is on the editorial boards of the journals Child Abuse and Neglect, Journal of Child Sexual Abuse and the Journal of Human Lactation, and regularly reviews for 27 other journals in the fields of trauma, women's health, interpersonal violence, depression, and child development. Dr. Kendall-Tackett is the "Ask a Lactation Consultant" columnist on Pregnancy.org and serves on the Board of Directors of Attachment Parenting International.

Dr. Kendall-Tackett received a Bachelor's and Master's degree in psychology from California State University, Chico, and a Ph.D. from Brandeis University in social and developmental psychology. She has won several awards including the Outstanding Research Study Award from the American Professional Society on the Abuse of Children, and was named 2003 Distinguished Alumna, College of Behavioral and Social Sciences, California State University, Chico.