The technical term for let-down is milk-ejection reflex. It refers to the ?ejection? of hind milk (the rich, fatty milk) from the milk glands, down into the milk sinuses and finally out through the nipple to the baby. The let down occurs several times during a feeding and can be powerful at times. As the baby begins nursing he may gulp to keep up and eventually come off the breast sputtering and choking. Some babies will shut down and go to sleep because it is too overwhelming, while other babies become fussy because they have a tummy ache. To summarize, it is a problem of ?too much, too fast?. Some mothers also feel an intense tingling in the breasts while having their let-down reflex.

There are many things that can be done to help baby cope with this ?out pouring? of milk. Here are the tips that I offer to mothers.

Feeding Baby
? Try feeding the baby as soon as he shows any signs of hunger. A very hungry baby can create a strong let-down reflex. If he is relaxed and sleepy he will be calmer during the feeding.

? Feed the baby frequently following your baby's hunger cues. Offering the breast often will reduce breast fullness. The strength of the let-down reflex increases with breast fullness. So the more frequently a baby nurses, the less intense the ?out pouring? of milk will be.

? Nurse the baby on one breast per feeding. Breastmilk changes during the feeding. The amount of fat increases the longer the baby nurses at one breast. This results in the baby getting just the right amount of calories needed. The power of the let-down reflex decreases during the feeding, helping baby to keep up.

? The first let-down reflex is usually the most powerful. Try massaging the breast or pumping for a few minutes allowing that first let-down to flow into a cup or a burp cloth. If baby begins gulping while at the breast, take him off for a minute and take a slow, deep breath allowing the let-down to occur.

Positioning Baby
? Once the baby is positioned and latched on, I encourage mothers to lean back so that baby is more on top of the breast rather than hanging below it. This allows baby to have more control of the milk flow. He can pause to suck, swallow and breathe and even allow milk to dribble out if needed. This will decrease gulping and swallowing air. Having mother lay on her side with baby level to the breast can also be helpful.

Latch On
? Be sure the baby is facing the breast. While cupping the breast with thumb on top and fingers below (well back from the areola, the dark circle around the nipple) tickle baby's bottom lip until he opens wide with tongue down and quickly bring him to the breast. Once on the breast, his lips should be flanged (like fish lips) and the nipple and much of the areola around it. His nose and chin will be touching the breast. If you hear smacking or clicking, or it hurts, break the seal with your finger and try the latch again. A proper latch on will allow baby to better keep up with the fast flow.

Burping
? It is important to burp baby to allow the gas bubbles to escape. Burp slowly and frequently. Allow the baby to remain upright for a while after feedings to allow milk to digest. Occasionally a large bubble gets under the milk and when baby burps, the entire feeding also comes up. Don't panic and don't be surprised if baby needs to ?fill up? again. If baby spits up large amounts frequently, speak to your health care provider.

Be patient, over time mothers? milk supply usually settles down and as babies grow they learn to keep up with this ?out pouring? of milk. I always encourage mothers to look at the positive?you have an abundant milk supply and you are providing the best nourishment for your baby! As always, if you continue to have concerns seek out a local La Leche League Leader or Lactation Consultant.

References:
Colic in the Breastfed Baby Newman, J, (1998) Electronic Version, http://www.breastfeeding.com/