Clinical practice
Hyperlactation: How Left-brained ‘Rules’ for Breastfeeding Can Wreak Havoc With a Natural Process

https://doi.org/10.1053/j.nainr.2005.02.007Get rights and content

Abstract

A variety of arbitrary and often unphysiological rules for breastfeeding are frequently suggested to breastfeeding mothers. Many of these rules duplicate strategies commonly used to increase milk supply, and thus, when undertaken by the many women who already have a generous milk supply, can lead to overproduction. Oversupply, or hyperlactation, is a frequent yet often unrecognized problem that can present with a variety of distressing symptoms for the breastfeeding mother and her infant. Infants may present with symptoms suggesting colic, milk protein allergies, or gastroesophageal reflux, or may present with unusually rapid or slow growth. Mothers may present with tender leaking breasts, sore infected nipples, plugged ducts or mastitis, or even the perception of insufficient milk supply. With an understanding of the pathophysiology of these symptoms, proper diagnosis and breastfeeding management can allow milk production to return to homeostatic levels and provide dramatic symptom relief.

Section snippets

Infant Symptoms

Babies can exhibit a variety of symptoms and often arrive with a variety of diagnoses (Table 1, Table 2). These infants often “act hungry all the time,” breastfeeding very frequently, as if “starving.” Yet, clinically, they gain weight very well, frequently much faster than normal, crossing to higher weight percentiles rapidly in the first months of life. Rarely, an infant may fall below the expected growth curve for breastfed babies, and may be termed “failure to thrive.”2 Spitting up is

Overview—The Physiological Basis for the Regulation of Human Milk Production

Human milk production is regulated by a supply and demand process that occurs through the interaction of infant and mother. Key to this process are a variety of factors: infant behaviors of appetite and satiety, maternal response to infant behavior, infant suckling, maternal pituitary hormonal response to infant suckling, and local alveolar conditions affecting response.

Summary/Conclusions

Hyperlactation is an underrecognized problem that often goes misdiagnosed. Even when secondary codiagnoses are correctly identified, their treatment is complicated by failure to recognize and treat the underlying hyperlactation. Hyperlactation itself is not something inherent in the mother's anatomy or physiology, or caused by the infant's feeding style, but is rather a vicious cycle of behaviors initiated and reinforced by cultural expectations and rules for feeding, which overrule basic

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