The reader is strongly encouraged to get the assistance of a Qualified
Lactation Consultant (IBCLC) or their baby's physician in the
treatment of Oversupply Syndrome.
Lactation Clinic POLICY:
A. The breastfed infant presenting with symptoms of colic or fussy
baby will be observed for Oversupply (Overactive Let-Down) Syndrome.
B. Baseline infant weight must be established before starting
treatment.
C. Treatment should not begin before baby is 3 weeks old.
D. Milk supply should be well established. (Initial engorgement
at lactogenesis may temporarily produce the same symptoms. However,
the symptoms will resolve as maternal engorgement decreases.)
E. Evaluation is based upon the presence of multiple symptoms.
Most infants will exhibit over half of the symptoms listed below
along with excessive weight gain.
F. All infants must be followed with serial weight checks whenever
an alteration in feeding method and/or pattern is made.
G. The infant may present in the clinic as a failure to thrive
despite an overabundant maternal milk supply (Woolridge and Fisher
382). Careful assessment and follow-up of the syndrome may prevent
failure to thrive. Symptoms of failure to thrive may be masked
by the early introduction of supplemental feedings and/or solids.
H. Syndrome may totally resolve spontaneously at 3-4 months possibly
due to the normal reduction in maternal serum prolactin levels.
GENERAL INFORMATION:
A. Overactive Let-Down was first described by Andursiak and Kuzenko.
Michael Woolridge and Chloe Fisher described the same symptoms
as Oversupply Syndrome.
B Further study (over 500 cases in Kaiser Permanente Riverside
lactation clinic in 4 years), indicates the syndrome is a fairly
common cause of colic like symptoms in the breastfed infant.
C. Symptoms may be related to the infant getting too much milk
too fast (excessive flow), air swallowing, the high concentration
of lactose in foremilk, the volume of foremilk and/or lack of
adequate hindmilk intake (Andursiak and Kuzenko 3; Nursing Mother's
Association of Australia 3, 12, Woolridge and Fisher 382-384).
D. Woolridge and Fisher reported that 28% of the infants (50 babies
in 18 months) referred to their clinic had symptoms of overfeeding
syndrome. They classified 50% of those cases as severe. After
corrective feeding management techniques were initiated 79% had
partial or complete resolution of the syndrome. (383)
E. High lactose feeds are associated with rapid gastric emptying
and fermentation in the infant gut resulting in abdominal distention.
Lactase supply may be overtaxed resulting in lactose malabsorption
symptoms. The same symptoms have been reported in toddlers who
were fed skim milk by their parents to prevent later atherosclerosis.
(Incorporation of milk fat in the diet alleviated these symptoms
in the toddlers.) (Woolridge and Fisher 384)
F. Initial clinical impressions suggest that the condition may
be iatrogenic in nature. However, recommendations for all mother's
initially nursing their infants at both breast with each feeding
to ensure an ample milk supply should continue (Woolridge and
Fisher).
G. Persistent maternal sore nipples and latch-on problems lasting
longer than 3 weeks, should also be investigated for Oversupply
(Overactive Let-Down) Syndrome. The infant typically clamps the
nipple to reduce the flow and does not strip the milk from the
milk sinuses resulting in poor emptying of the breast (Woolridge
and Fisher 383). Persistent engorgement has also been noted.
H. Recommendations here are for those infants who are symptomatic.
I. Baby's Symptoms:
1. Appears colicky, fussy, gassy.
2. Burps "like an adult" or burps poorly.
3. Passes large amounts of flatus.
4. Spits up frequently, often appears to be large amounts.
5. May have tentative diagnosis of gastric reflux.
6. Gains weight quickly (1-2 pounds/week).
7. Often is 1 pound or more over birth weight at 2 weeks
of age.
8. Gulps with feedings or appears to choke with let-downs.
9. Pulls off the breast frequently or chews at the breast.
10. Grunts frequently between feedings.
11. Abdomen appears full and distended especially after feedings.
May have hyperactive bowel sounds.
12. Will latch on only to the nipple or pinches nipple during
feedings.
13. Wants to nurse very frequently.
14. Has short feedings (5-7 minutes).
15. Nurses minimally on the second breast or refuses to take
the second breast after nursing well on the first breast.
16. Has a stuffy nose after feedings.
17. Early or frequent ear and/or sinus infections.
18. Has many (10-15) wet diapers per day.
19. Has unusual stooling patterns:
a. semi thick stools often described as "yellow cottage
cheese", or "Peanut butter".
b. Infrequent, large stools that remain liquid to soft
in consistency.
c. Frequent diarrhea like stools that may appear slimy
and have and acrid smell due to fermentation of lactose in the
infant gut.
20. Wants to suck hands or pacifier frequently.
21. If nursed lying down, may leave a "puddle of milk in the
bed," choke or gulp less frequently.
J. Maternal symptoms:
1. Persistent sore nipples, often with a linear crack across
the nipple face.
2. Nipple may come out of baby's mouth pinched, not round.
3. Mother feels that she has too much milk or complains of constant
leaking.
4. Mother feels that she doesn't have enough milk because the
baby appears to be "always hungry" or "not satisfied".
5. Mother complains of pain deep in the breast between feedings
which may be from nerve irritation due to persistent nipple pinching.
(The resulting neuritis symptoms may need to be treated with Ibuprofen
400 mg. every 4-6 hours as an anti-inflammatory for 2-3 days).
6. Mother complains of painful let-downs that sting or burn.
7. History of repeated engorgement, plugged ducts and/or mastitis.
8. Mother may have questions regarding her dietary intake as
related to infant fussiness and gas.
9. Positive family history for "colic".
a. Had a similar history with a previous child.
b. Sisters who nursed report colicky babies.
c. Maternal grandmother reports problems with breastfed children
and colic.
A. HISTORY
1. Age of baby.
2. How often fed.
3. How long at each breast.
4. Number and type of wet diapers in the last 24 hours.
5. Baby's stooling pattern.
6. Any signs of infant illness.
Fever, jaundice, stuffy nose etc. . .
If signs of illness are present refer to the medical provider.
7. Sore nipples.
8. Pain in breasts between feedings.
9. Weight gain pattern for the baby.
B. ASSESSMENT
1. Complete labor and birth history.
2. Physical exam, weight and suckling assessment of the infant.
3. Visual assessment of maternal nipples before and after nursing
session.
4. Observation of a nursing session:
C. TREATMENT
Goal of treatment is to reduce milk flow to a level that the
infant can tolerate by reducing breast stimulation.
Note: The treatment for Oversupply Syndrome is deliberately left off my web site because in our clinic we've seen the treatment backfire and babies loose weight. It is important that the diagnosis is accurate before any treatment steps are taken. If a lactation consultant is not available to you, you may contact me via email regarding your situation. I prefer to evaluate your situation first and then send personalized treatment information. To obtain a copy of the OSS evaluation form click on the email me button below and request Oversupply Evaluation form.
Copyright Marie Davis, RN, IBCLC 1999 ![]()
Last Reviewed: