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?
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:
- 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.
- 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