Overactive Letdown: Can a Baby Choke on Breast Milk?

Many nursing parents would consider having too much breast milk a good problem to have—and to some extent it is. However, excess breast milk supply can also be uncomfortable for you and your baby. And in very rare situations, it may also be dangerous. In fact, your newborn could end up choking while breastfeeding. In fact, parent Rebecca Taylor, in 2017, posted in the Facebook group Breastfeeding Mama Talk about calling 911 because her baby was choking on her milk.

Learn more about how having overabundant milk can cause a baby to have trouble breathing while breastfeeding, including how to avoid choking while breastfeeding to keep your newborn safe.

Can a Baby Choke While Breastfeeding?

Some gagging and gurgling are pretty normal as newborns get the hang of sucking and swallowing during breastfeeding. But things can become scary if your baby actually starts choking as happened with Taylor: "He turned blue and I really thought I was going to lose him." Luckily, her baby was OK, but her story brings to light a breastfeeding issue you might not be aware of: overactive, or forceful, letdown.

"Apparently this 'freak' accident can actually happen to babies and it's more common than I thought. Especially when you have an overactive letdown and produce too much milk (something some people wish for)," says Taylor. In fact, research shows that an overabundant breast milk supply, which is also called hypergalactia, hyperlactation, or oversupply often results in a baby choking during letdown.

How Choking During Breastfeeding Happens

While any baby can choke during breastfeeding (or bottle feeding), this problem occurs most often with newborns and nursing parents who have an overly abundant milk supply, explains says lactation consultant Sara-Chana Silverstein, IBCLC.

"After 25 years of working with babies, I've seen that many babies whose mothers have a lot of milk do tend to 'choke' on it," says Silverstein. "Some women have what is called a fast MER or Milk Ejection Reflex, which means that the milk releases from their body in a very forceful manner, or 'explodes' out of the ducts."

What Is Breastfeeding Letdown?

Letdown is simply the release of milk from the breast. It's a reflex that happens when nerves in your breasts are stimulated (typically by your baby's sucking or pumping) and signal the release of oxytocin, a hormone that prompts tiny muscles around your milk-producing cells to contract, squeezing milk into the ducts. How long it takes can vary from person to person or even from feeding to feeding, but it's usually anywhere from a few seconds to a few minutes.

The letdown reflex ensures that your baby gets enough milk. It's a pretty powerful thing and can be triggered not just by your baby's sucking, but also by sexual contact and even psychological factors. For example, once you've been breastfeeding for a while, you may find that the sound of your baby's cries (or any baby crying) can get your milk flowing.

Many breastfeeding parents describe letdown as a tingly, pins-and-needles sensation in their chest, which can happen right after birth or even several weeks into breastfeeding. The tickly feeling is actually milk making its way through the ducts to your nipples. Letdown usually occurs in both breasts at the same time, so it's perfectly normal to drip from one breast while your baby feeds from the other (you can use nursing pads to catch the leakage).

Coping with Overactive Letdown

If your baby is choking, gagging, or gasping at the start of the feed, or if they clamp down on the nipple or keep pulling off, it may well mean they are getting too much milk too fast. This can be alarming or frustrating for the baby and breastfeeding parent alike. Here's how to manage a forceful letdown:

Slow down your supply

A forceful letdown often comes with an oversupply of breast milk, so one way to deal with the problem is to reduce the amount you're making. Silverstein has a strategy she recommends for getting it under control.

"When the mother is breastfeeding from one side, say the right side, she takes the palm of her left hand, presses the nipple on her left side in toward her ribs, and counts to five," says Silverstein. Applying this counter-pressure several times per feeding sends a signal not to let the milk down in that breast.

Stick to only one breast per feeding

Nursing from only one side can help. "In my experience, I have found that using one breast exclusively per feed is the best method," Silverstein says. This method ensures the breast fully empties, the flow slows down and the baby gets all of the higher fat "hindmilk," which helps them feel full and stop nursing.

Another strategy, called "block feeding," is to use only one breast for a block of time (at least a few hours) in order to reduce supply in the other breast before switching sides for the next block.

Make sure your baby is latched properly

Small adjustments in the baby's breastfeeding latch can make a big difference. "Babies who choke often do not have a deep enough latch, which is why they choke," explains Silverstein. "The milk is supposed to go straight down into their throats, and with a shallow latch too much milk remains in their mouth." If the baby is latched deeply, they can better learn to handle the flow.

Switch up your nursing position

Try different nursing positions. Placing the baby at a more upright angle makes gravity work against the milk's flow. Laid-back nursing, with the baby on top of a reclining nursing parent, can slow things down. Side-lying nursing can help extra milk spill out of the baby's mouth to prevent choking. In any position, when you feel letdown coming on, you can remove your baby from the breast (have a towel ready) and then put them back on when the flow slows a bit.

Get Help From a Lactation Consultant

If you're still encountering choking issues while breastfeeding, enlist an international board-certified lactation consultant (IBCLC). They can guide you in managing all of these strategies, which can help your baby nurse more effectively and comfortably at the breast.

"I have seen slowing down the milk makes babies much less gassy and colicky," advises Silverstein. And if your baby is dealing with this issue, don't freak. "I have been around hundreds of babies who were choking on their mom's milk," Silverstein says. "After seeing 18,000 babies in my office, we have never had to send a baby to the hospital."