overabundant milk supply

8/3/2019 Overabundant Milk Supply

1/12

This Provisional PDF corresponds to the article as it appeared upon acceptance. Copyedited andfully formatted PDF and full text (HTML) versions will be made available soon.

Overabundant milk supply: an alternate way to intervene by full drainage andblock feeding

International Breastfeeding Journal2007, 2:11 doi:10.1186/1746-4358-2-11

Caroline GA van Veldhuizen-Staas ([email protected])

ISSN 1746-4358

Article type Case Report

Submission date 2 September 2006

Acceptance date 29 August 2007

Publication date 29 August 2007

Article URL http://www.internationalbreastfeedingjournal.com/content/2/1/11

This peer-reviewed article was published immediately upon acceptance. It can be downloaded,printed and distributed freely for any purposes (see copyright notice below).

Articles in International Breastfeeding Journalare listed in PubMed and archived at PubMed Central.

For information about publishing your research in International Breastfeeding Journalor any BioMedCentral journal, go to

http://www.internationalbreastfeedingjournal.com/info/instructions/

For information about other BioMed Central publications go tohttp://www.biomedcentral.com/

International BreastfeedingJournal

2007 van Veldhuizen-Staas, licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
mailto:[email protected]://www.internationalbreastfeedingjournal.com/content/2/1/11http://www.internationalbreastfeedingjournal.com/info/instructions/http://www.biomedcentral.com/http://creativecommons.org/licenses/by/2.0http://creativecommons.org/licenses/by/2.0http://www.biomedcentral.com/http://www.internationalbreastfeedingjournal.com/info/instructions/http://www.internationalbreastfeedingjournal.com/content/2/1/11mailto:[email protected]


2/12

Overabundantmilksupply:analternativewaytointerveneby

fulldrainageandblockfeeding

CarolineGAvanVeldhuizenStaas1

1Privatepractice,Merkelbeek,TheNetherlands

Emailaddress:

CGAvVS:[email protected]


3/12

Abstract

Background

Toomuchortoolittlemilkproductionarecommonproblemsinalactationconsultantspractice.

Whereasunderproductioniswidelydiscussedinthelactationliterature,overabundantmilksupply

isnot.InmypracticeIworkwithwomenwhoexperiencemoderatetosevereoversupplysyndrome.

Inmostcasesthesyndromecanbesuccessfullytreatedwithfullremovalofmilkfollowedby

unilateralbreastfeedingad libwiththesamebreastofferedateverybreastfeedinacertaintimeblock

(blockfeeding).

Casepresentations

Fourcasesofover-supplyofbreastmilkarepresented.Themanagementandoutcomeofeachcase

isdescribed.

Conclusions

Overabundantmilksupplyisanoftenunder-diagnosedconditioninotherwisehealthylactating

women.Fulldrainageandblockfeedingofferanadequateanduserfriendlywaytonormalize

milkproductionandtreatsymptomsinbothmotherandchild.

BackgroundBreastfeedingisthemethodoffirstchoiceforfeedinganyinfant.BoththeWorldHealth

Organization(WHO)andmanyleadingorganizationsofpediatricians,aswellasmany

governmentsadvisethatchildrenbeexclusivelybreastfedforahalfyearfrombirthandcontinueto

bebreastfedincombinationwithsuitablefoodsforanextendedtimeafterthat[1].Breastmilk

productionisaninborncapabilityinwomen,withonlyrareexceptionsduetoanatomicalor

physiologicalpathology.Evenintheserarecases,partialbreastmilkproductionmaysometimesbe

possible.Eventhoughtheseexceptionsareextremelyrare,awidespreadbeliefexiststhatmanywomenarenotcapableofproducingenough,orgoodenough,milkfortheirchildren[2].Methods

totreatrealorperceivedlowmilksupplyarewellreferencedintheliterature[3].Overabundant

milksupplyorhyperlactationontheotherhandisnotdiscussedindepthintheliterature.Thereis

noconsensusontreatmentorterminology.However,overabundantmilksupplycanbeas

devastatingforthecontinuanceofbreastfeedingasunderproduction.Inthispaper,Iproposea

definition,etiologyandapossibleinterventionwhichhasbeenfoundtobemoreeffectiveinmy

practicethanothercommonbreastfeedingmanagementsolutions.

Definitionofoverabundantmilksupply


4/12

Inday-to-daylanguagetheproblemoftoomuchmilkismostlyreferredtoasoverproduction,

overproductionsyndromeoroverabundantmilksupply.Intheprofessionalliteraturetheword

hyperlactationisalsoused,butislinkedtodifferentdescriptions[4-7]:

1.Overactiveproductionbythemilkproducingglandsduringlactation.Thisisalsoreferredtoas

overproductionoroverproductionsyndrome;2.Milkproductioninanon-lactatingwomanorinaman,alsoreferredtoasgalactorrhea.Some

referencesusegalactorrheaalsoindefinition1;

3.Continuanceoflactationbeyondthenormalperiod.

Thefocusofthispaperisthefirstdefinition:anoverabundantsupplyofmilkin

anotherwisehealthylactatingwoman.

Physiology

Inphysiologicallactationfullnessofthebreastandgalactostasis(milkremaininginthebreast

withoutremoval)willleadtoadecreasedmilkproduction.Theaccumulationofmilkinthebreast

willreducethebindingofprolactintoitsmembranes.Thiswillhappeninanybreastthatgets

overfilled,independentofthestatusoftheotherbreast.Thereductioninthebindingofprolactinto

membranereceptorswillcreateaninhibitoryeffectonlevelsofmilkproduction.Infullalveoli

lactocytes(milkproducingcells)willhavealowereduptakeofprolactinfromtheblood.Ifthefull

breastisemptied,prolactinagainwillbindtothemembranereceptors,thusenhancingmilk

synthesis.Themoreemptythealveoli,thehigherthemilksynthesisrate,slowingdownasthe

breastrefills[8-10].Evidenceexiststhattherearetwointeractingmechanismsregulatingtherateof

milksynthesis.ThefirstinvolvestheFeedbackInhibitorofLactation(FIL)."FILisanactivewhey

proteinthatinhibitsmilksecretionasalveolibecomedistendedandmilkisnotremoved.Its

concentrationincreaseswithlongerperiodsofmilkaccumulation,downregulatingmilkproduction

inachemicalfeedbackloop.Theinhibitionofmilksecretionisreversibleanddependenton

concentration;itdoesnotaffectthecompositionofthemilkbecauseitaffectsthesecretionofall

milkcomponentssimultaneously"[3][p.76].FILhasbeenidentifiedasasmallproteinsynthesised

bythesecretoryepithelialcells(lactocytes)thataccumulateswithinthealveolarlumenalongwith

othermilkconstituents.HoweverasFILisanautocrineinhibitorofmilksynthesis,milksynthesis

declinesasFILaccumulationwithinthelumenincreases.Whenmilkisremovedfromthebreastthe

concentrationofFILdeclinesandmilksynthesisonceagainincreases.Theothermechanism

involvestheinteractionoflactocyteswiththebasementmembranetowhichtheyareattached.Itis

hypothesisedthatasthebreastfillswithmilk,theshapeofthelactocyteschangessuchthatthe

prolactinreceptorisdeactivatedandmilksynthesisisslowed,andeventuallyceases[11].AlthoughtheFILandcellshapemechanismslikelyactindependentlytoinfluencetheactivityof


5/12

prolactinuponthebreast,theinteractionandinterplayofthesetwofactorsuponmilksynthesishas

yettobefullyelucidated.

Descriptionandetiology

Hyperlactationcanbecausedbybreastfeedingmismanagement,hyperprolactinemiaorcongenitalpredisposition.Livingstonedefineshyperlactationasmotherandchildhyperlactationsyndrome,

becauseinbothmotherandchild,symptomscanleadtopathology[7].Thehyperlactatingwoman

willoftenexperienceaconstantfeelingof(over-)fullness,engorgementandtension.Shemayleak

milkinbetweenfeedings,orleakcopiouslyfromtheoppositebreastduringfeedings,andhasan

increasedriskformastitis.

Theinfantmayappeartobeagreedyfeeder,strugglingnottochokeoraspiratemilk.Heorshe

mayoftenspitupafterfeedingsand/orhavereflux-likesymptoms,andsufferfromintestinalgas,

colicandexplosive,oftengreenandfoamystools.Thebabymayshoweitheraveryloworavery

highweightgain.Thebaby'sstruggletocopewithrapidflowmayresultinrestlessnursing

behaviour,orevenaversivebehaviour,suchasbreastrefusalorshortenedfeeds.Fussiness,crying

andpossiblelowweightgaincanleadthemothertothinkthathermilkisinsufficientinquantity

and/orquality.

Aninfantdrinkingfromanoverproducingbreastmaynotbeabletoemptythebreastfarenoughto

obtainthefattermilkthatisavailableinthemoreemptybreast.Therelativelyhighsugar,butlow

fatcontentofthedietmaycauserapidgastricpassage,whichmayleadtolactoseconcentrationsin

thesmallboweltoohighfortheinfantslactasepotential,resultinginfrequentdiarrheicbowel

movements[12].

Acommonsecondarysymptominhyperlactationsyndromeisasub-optimalnursingtechniquein

theinfant.Thismaybetheresultofthechildsattemptstocopewithanoverabundantmilkflow,

sometimesslippingfromanoptimumlatchinordertoclampdownonthenippletoslowtheflow,

oftentraumatizingthemothersnippleintheprocess.Ortheinfantmaydevelopaconditionedhabit

ofdrinkingbutpassivelysucklingatabreastthatwillgivemilkwithoutanyeffortbytheinfant

itself.Thishasthepotentialtoleadtosupplyproblemsafter4-6weekswhensupplystimulation

patternstransitionfromprimarilyhormonalstimulationtofeedbackinhibitionmechanisms.

Usualtreatments

Atreatmentforoverproductioncommonlymentionedbylayadvisorsistopumpsomemilkdirectly

priortobreastfeeding[13,14].Rationaleforthisoptionistostimulatethesurgeofthemilkejection

reflexandallowthepeakoftheoverwhelmingmilkflowtopass,removesomeofthelower-fat

foremilkandtoenablethechildtoreceivethefat-richhindmilksooner.Anargumentagainstthis


6/12

approachisthatfrequentpumpingincombinationwithnormalbreastfeedingwillincreasemilk

productionandeventuallyincreasetheproblem.Manyprofessionalsarenowadoptinganevidence-

basedapproachtoreducemilksupplybyenhancingbreastfeedingmanagement.Wilson-Clayand

HooverfollowLivingstoneinadvisingtonotdecreasefeedingfrequency,buttodecreasethe

numberoftimesthatthechildwillbeofferedtheotherbreast[15].Theyadviserestrictingbreastfeedingatonebreastforasetnumberoffeedingsorasetamountofhours.Therationalefor

thisistoproducearelativegalactostasisinthetemporarilyunusedbreast,leadingtoareductionof

milkproductionduetotheaccumulationofthefeedbackinhibitoroflactation(FIL)andthechange

inlactocyteshape,bothofwhichleadtoadeclineintherateofmilksynthesis.Thispracticewill

needcloseobservationforsignsofpluggedductsandmastitis.Thedifficultyinthisapproachisthat

thetotalpoolofaccumulatedmilkisreabsorbedveryslowly.Thispattern,ifnotcarriedout

graduallyandcarefully,riskspluggedducts,discomfortandpotentialmastitisforthemotherandmayforcethebabytocontinuecopingforalongtimefromthestartofthetreatment.Berghuijs,

describingcompletedrainageofbothbreastsasatreatmentforhyperlactation,presenteda

significantmodificationofthismethodinacasediscussion[16].Sheintroducedthetermmilk

lakestodescribethecumulativeproductionandstorageofmilkduetothecombinationof

overactivemilkproduction,inter-feedingleakageandinefficientdrainagebytheinfant.Berghuijs

advisescompletemechanicalpumpingfollowedimmediatelybyunrestrictedbilateralfeeding.In

herviewtheaccumulatedmilkistheproblemandfrequentbilateralfeedingwillregulatemilk

productionafterthemilklakeshavebeencleared.ThismethoddoesnotuseFILtodecreasemilk

production.Bilateralstimulationateveryfeedingsessionmayleadtoaveryfastincreaseinmilk

productionandnewfillingofthemilklakes.TheBerghuijsapproachhoweverdidleadtothe

developmentofthemethodpresentedinthisarticlewhereemptyingthebreastisfollowedbyaway

touseFILinordertodecreasemilkproductiontomoredesiredlevels.Pharmaceuticaltreatment,

forinstancewithpseudoephedrineorestrogen-containingcontraceptionisanotherpossibility

sometimesmentioned[17].Bothofthesecanleadtounwantedside-effects.Naturopathictherapists

tendtoadviseSalvia officinalis(theculinaryherbsage)asatinctureorconcoction[18].Sageisapowerful

lactationinhibitorandshouldbeusedwithcautioniftheaimistodecreasesupply,ratherthan

lactationsuppression.

Whatismostneededistofindawaytoquicklyreducetheexcessofmilkwithoutincreasingmilk

production.Mostremediesfocusonthisreductionsidewhilefailingtotakeintoaccounttheinfant's

sideofthissyndrome.Theoptimaltreatmentwouldthusalsoincludeawaytoensurecomfortable

nursingforthebaby,withouthavingtodrinkagainstanoveractivemilkflowandwithout

interferingwithphysiologicgastroenteralfunction.Inoverproducingmothersthebabytendsto

receivearelativeoverloadoflactoseandarelativeshortageoffat.Normalgutfunctionneedsa


7/12

balancebetweencarbohydratesandfatinthefoodthatisbeingdigested.

Inmyprivatepractice,IhavedevelopedthiscombinationofremediesintoonethatIcallthefull

drainageandblockfeedingmethod(FDBF).

DescriptionofFDBFThetreatmentsequencestartswithanas-complete-as-possiblemechanicaldrainageofbothbreasts.

Itisimpossibletoreallyemptyanactive,lactatingbreastcompletely,becausetheproductionof

milkisanongoingprocess.Emptyingthebreastisamajortriggerforrenewedproductionactivity.

Manualexpressionisapossibility,too,butinmostcasesmechanicalextractionwillworkmore

efficientlyandrapidly,especiallyifasimultaneousdoublepumpisused.Theinfantwilllatchon

immediatelyafterdrainageandwillbeofferedbothemptybreaststosatisfaction.Manyinfants

willfallasleepfullysatisfiedwithhighfathindmilk,manyforthefirsttime.Subsequentlytherest

ofthedayisdividedintoequaltimeblocksstartingwithaboutthreehours,initially.Everytimethe

infantshowshungercuesorothersignsofinterestinthebreastthesamebreastwillbeoffered

withoutanyrestrictionineitherfrequencyordurationoffeeds.Attheendofsuchatimeblock,or

afteramulti-hourperiodofsleep,babywillbeofferedtheotherbreastforallfeedswithinthenext

timeblock.Itisimportantthatthebestpossiblepositioningandefficientlatchingtechniquesbe

usedstartingrightfromtheveryfirstfeedingafterpumping,forthesakeofboththebabys

improvedsucklinghabitsandthemotherscomfortandfutureproduction.Dependingonthe

seriousnessofthesymptomstimeblocksmaygraduallybeincreasedto4,6,8oreven12hours.

Forlesscomplexsituationsone-timemechanicaldrainagewillsuffice;forothersoccasional

repetitionmaybenecessary.Intervalsbetweendrainagewillgraduallyincreaseasthesymptoms

lessen.

Mothersmustbecautionednottodrainthebreaststooofteninordertoavoidextrastimulationfor

milkproduction.Onlyifengorgementisbecomingsevereagainshouldanotherdrainagebecarried

out.InusingFDBFthemotherwillneedtobeinstructed,cautionedandmonitoredfortemporarily

recurringover-fullnessandpluggedductsormastitis.Afterthefirstfulldrainage,insomewomen

thebreastswillinitiallycontinuetoproducemorethanaskedforandthusrefill.Inmanyothersjust

asinglefulldrainagewillsufficetodecreasemilkproductiontoacceptablelevels.

Casepresentations

Case1

Mrs.Bisahealthymotherofatoddlerandaninedayoldinfant.Sheisbreastfeedingbothchildren.

Withherfirstchildsheexperiencedoversupplysyndromeduringthefirstfourmonthspostpartum.

Treatmentsincludedmilkremovalpriortobreastfeedingtosoftenthebreasts,unlatchingthechild


8/12

atthestartofmilkejectionreflextoreleasethemostpowerfulmilkflow,andstretchingfeeding

intervalstoeasebabysstomach.Afterfourmonthsoftryingthesestrategiesmilkproduction

stabilizedatanacceptablelevel.Inthefirsteightpostpartumdayswiththesecondchildshewas

advisedtousethesamestrategies,withnoeffectuntilhervisitatthelactationconsultantspractice

ondaynine.Babystartedtorefusefeedingatthebreastoronlywantedtobreastfeedlyingdown.Babywasfussyandshowingsignsofstomachproblems.Breastsremainedfullanduncomfortable

inbetweenfeedingsessions.Onehealthcareproviderurgedhertostoptandemnursing;thisadvice

wasnotanoptionforthismotherandtoddler.Mrs.Bdoesnotwanttoexperienceoversupplyfor

fourmonthsthistime.Assessmentshowedanapparentlyhealthy,wellgainingbabyandtoddler,

nippleswithintherangeoffunctional-normalwithnosignsofdamageandnooralcavity

abnormalities.Babylatchedonwell,butfussedwhiledrinking,losingvacuumintermittently.Mrs.

Breportedthattheinfanthadmultipleverywetdiapersdailyandcopiouslooseyellowstools.FDBFwasdiscussedwithMrs.B.Shedecidedtotrythis,despitesomequestioninghowthiswould

fitintotandemnursing.Shestartedexpressingbothbreastsascompletelyaspossiblethesameday,

thenputtingtheinfanttothebreast.Atobservation,thebabynursedwell,withoutlosingvacuumor

fussing.Hefellasleepafterfinishingthesecondbreast.Mrs.Bstartedblockfeedingafterthis

initialmilkexpressionandsubsequentlybreastfedad libunilaterallyinblocksofthreehours.The

toddlerwasnursedwithintheblockschedulethatwassetfortheinfantanddidnursewell.During

thefirst24hoursherbreastsstartedfillingagainandsherepeatedexpressing30hoursafterthe

initialexpression.Blockfeedingcontinuedasstarted.InthecourseofthefollowingweekMrsB.

hadtoexpressonemoretimeafter72hours,whilecontinuingathreehourblockfeedingschedule.

AtfollowupatonemonthpostpartumMrs.Breportednomoresignsofoverproduction.The

toddlerkeptnursingoccasionally,followingtheinfantsschedule.

Case2

Mrs.A.isbreastfeedinghereightdayoldhealthyboy,onebreastperfeedingsession.Babyisfussy

andnoisyatbreast,andMrs.Areportsthatshecanhearthemilksquirtintobaby'sstomach.Baby

needstoburpoften,butthisdoesnoteasehisstomach-ache.Babyisnothappy,iscolickyandoften

bringsupsubstantialamountsofmilkafterfeeding.Stoolsaregreenish,foamyandcomeoften

andinlargeamounts.Baby'sweightis310gramsabovebirthweightonday8,withoutinitial

weightloss.Previouslyhealthcareprovidersdiagnosedmotherandbabywithoverproduction

syndromeandadvisedMrs.Atohand-expresssomemilkpriortofeeding,breastfeedingwhilelying

onherback,andblockfeeding;anotherprovideradvisedtostretchfeedingintervalstoeasebaby's

stomach.TheseapproachesdidnotworkforMrs.A.andshewantstostopbreastfeedingbecause

shecannotcopewiththissituation.Visitingthelactationconsultant'spracticeisalastresort.


9/12

Breastassessmentshowedrathersmall,butfullandfirmbreasts.Mrs.Adoesnotreportanypain,

butsheisinsubstantialdiscomfortduringmostofthedayandnight.Herconcern,however,ismore

aboutbaby'sapparentunhappinessandpain.AfterdiscussionofFDBF,Mrs.Astartedwithinitial

expressionofherbreastsascompletelyaspossible;150mlswasexpressedfromtheleftbreastand

200mlsfromtherightbreast.Theupcoming24hoursweredividedintoblocksofthreehours.SpecialattentionwaspaidtoinformingMrs.A.thatbabieswillknowhowmuchmilktheyneedper

sessionandthatthereisnoneedtourgeherchildtodrinkmorethanhewantsatatime.This

resultedinmorefrequent,smallerfeedings.Mrs.A'sbreastdidrefillinthefirst24hours,butnotso

muchthatrepeatedexpressionwasneeded.Themilkejectionreflexremainedstrong,butthe

smalleramountofmilkseemedtomakeiteasierforthechildtocope.Thefirstfeedingofevery

newblockdidgivesomediscomfortinthefirstdays,butbaby'sfussinessandcolicdisappeared.

Case3

Mrs.Sisahealthy,34yearoldmotherofafifthchild,4dayspostpartum.Shebreastfedher

previouschildrenwithoutproblemsorcomplications.Thisfifthchildwasbiggerthanherprevious

children(4.530kg),andhebrokehisclavicleduringbirth.Hewassupplementedwith20mlsof

10%glucosewithintwohoursofbirthandkepthavinglowbloodsugars.Mrs.S.decidedto

breastfeedhimveryfrequentlyinordertopreventanothersupplementationandtoincreasehis

bloodsugarlevels.Babywaswithhismotherforthenext48hourswithoutmoreseparationthan

neededforabathroomvisitandhewasatthebreastmostofthattime,frequentlychangingfrom

onebreasttotheother.Bloodsugarlevelsrosequicklyandstayedhighandstable.Duringthethird

postpartumdaycopioustransitionalmilkcameinandamountswererisingthroughoutthenext24

hours.Mrs.S.becamepainfullyengorgedandthebabybeganfussingatbreast,returningsignificant

amountsofmilk.Thebreastswerehardtothetouch,redandshiny.FDBFisdiscussedandstarted

duringtheconsultation.Mrs.Sexpressedatotalamountof500mlsandstartedblockfeedingin

blocksofthreetofourhours.Therewasnoneedforfurthermilkexpressionandmilkproduction

stayedwithinnormallevelsthroughoutatotallactationperiodof30months.

Case4

Mrs.D.hasanormalfigurewithlargebreasts,cupsizeI.Sheisbreastfeedinghertwomonthold

babyboy.Herinitialengorgementdidnotdecrease.Thebabyisbreastfeedingfrequentlyatshort

intervals,afewminutesatatime.Babyisnotfussyatthebreast,hasnogastrointestinalproblems

andisgrowingwithinthehigherrangeofnormal.Breastassessmentisdifficult,becauseevery

handlingofthebreastcausesmilktospray.Breastsdonotfeelveryhard,butarefirmandfull.

FDBFisdiscussedwithMrsD.andshestartsmilkexpressionduringtheconsultation.She


10/12

expresses360mlfromtheleftbreastand340mlfromtheright.Breastsdonotfeelmuchdifferentto

thetouch,butMrs.Bdoesreportafarlessheavyfeeling.Afterexpressing,thedayandnightwere

dividedintoblocksof4hoursinitially,butthisprovedtobenotworkingasexpected.Fulldrainage

wasrepeatedthenextdayandtheblocksweresetat6hours.Onthethirddayofintervention

expressionneededtoberepeatedandblocksweresetat12hours.Thisatlastdidslowdownmilkproduction.Nextmilkexpressionfollowed36hoursafterwards,andafinalexpressiontookplace

48hoursafterthelastone.Mrs.Dkeptblockfeedinginblocksof12,occasionally24,hours.

Attemptstoshortenblocksto6hoursledtoincreasedmilkvolumeseachtime.

Discussion

Insomewomenitseemsthatthemechanismofregulationofmilkproductiondoesnot

automaticallyworkwell.ThiscancreatethemilklakesBerghuijsmentions,andtheongoing

productionofmoremilkthanneeded.Asthorough-as-possibledrainageofthemilkproducingand

storingsystemsandthenpaceddemandtobothbreastsnormalizesthesystemsofsupplyand

demand.Thisnormalizationcanworkoutratherquickly.Theeffectsonthebabywillshowwiththe

firstfeedaftermechanicaldrainage.Theinfantwillsucklewithoutfussinessandwillhavethe

unfamiliarbutpleasantexperienceofanimmediate,gentlemilkflowofdoublecalorie,highfat

milkthatwillnotdisturbcoordinationofhisorherbreathingandswallowingmechanismsand

gastrointestinaltractsymptomsorcolicwillquicklydiminish.Overabundantmilksupplyisanoftenunder-diagnosedconditioninotherwisehealthylactatingwomen.Symptomscanoccurin

bothmotherandchildandmayleadtopathologyinboth.Fulldrainageandblockfeedingoffersan

adequateanduserfriendlywaytonormalizemilkproductionandtreatsymptomsinbothmotherand

child.

Moreresearchwillneedtobedonetounderstandwhysomewomenwilleasilyproducemuchmore

milkthanneededandwhyforsomeitissohardtoregulatemilkproductiontomeettheneedsof

theirchildren.

Competinginterests

Theauthordeclaresnocompetinginterests.

Acknowledgements

Writtenconsentwasobtainedfromthepatientsforpublicationofthesecasestudies.ThankstoDr

MarkCreganforassistancewiththedescriptionofthephysiologyoflactation.


11/12

References

1.Globalstrategyforinfantandyoungchildfeeding[http://www.who.int/child-dolescenthealth/

New_Publications/NUTRITION/gs_iycf.pdf]

2.DykesF:Westernmedicineandmarketing:constructionofaninadequatemilksyndromein

lactatingwomen.Health Care Women Int2002,23:492-502.

3.WalkerM:Influenceofthematernalanatomyandphysiologyonlactation.InBreastfeeding

Management for the Clinician: Using the Evidence.Sudbury,Massachusetts:JonesandBartlettPublishers;2006:51-82.

4.The American Heritage Stedman's Medical Dictionary.2ndedn.Boston:HoughtonMifflinCompany;2004.

5.HealthAtoZ[http://www.healthatoz.com/healthatoz/Atoz/ency/galactorrhea.jsp]

6.Healthenotes[http://health.enotes.com/medicine-encyclopedia/galactorrhea]

7.LivingstoneV:Toomuchofagoodthing:Maternalandinfanthyperlactationsyndromes.Can

Fam Physician1996,42:89-99.

8.CoxDB,OwensRA,HartmannPE:Bloodandmilkprolactinandtherateofmilksynthesis

inwomen.Exp Physiol1996,81:1007-1020.

9.CreganMD,MitoulasLR,HartmannPE:Milkprolactin,feedvolume,anddurationbetween

feedsinwomenbreastfeedingtheirfull-terminfantsovera24-hourperiod.Exp Physiol2002,

87:207-214.

10.DalySE,OwensRA,HartmannPE:Theshort-termsynthesisandinfantregulatedremoval

ofmilkinlactatingwomen.Exp Physiol1993,78:209-220.

11.BerryCA,ThomasEC,PiperKME,CreganMD:Thehistologyandcytologyofthehuman

mammaryglandandbreastmilk.InTextbook of Human Lactation. EditedbyHartmannPE,HaleTW.

AmarilloTexas:HalePublishing;2007:43-54.

12.WoolridgeM,FisherC:Colic,"overfeeding",andsymptomsoflactosemalabsorptioninthe

breast-fedbaby:apossibleartefactoffeedmanagement?Lancet 1988,2:382-384.

13.Storknet:Oversupply:toomuchmilk[http://www.storknet.com/cubbies/breast/AS-

toomuch.htm]

14.BabyClub:Teveelmelk?(InDutch)

[http://www.babyclub.be/BabyClub/VragenOuders/Voeding/Te+veel+melk.htm ]

15.Wilson-ClayB,HooverK:TheBreastfeedingAtlas.In.ManchacaTexas:LactNewsPress;

2005:111-113.

16.BerghuijsS:Casus(inDutch).(Nederlandse Vereniging van Lactatiekundigen) NVL Info2000-3:31-32

17.AljazafK,HaleTW,IlettKF,HartmannPE,MitoulasLR,KristensenJH,HackettLP:

Pseudoephedrine:effectsonmilkproductioninwomenandestimationofinfantexposurevia

breastmilk.Br J Clin Pharmacol2003,56:1824.


12/12

18.AppliedHealth:Sage[http://www.appliedhealth.com/nutri/page8453.php]

overabundant milk supply

Documents