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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.

March 23, 2012: Author’s note 7 years after publication: Over the 7 years since we wrote this manuscript, we continue to see mothers and babies with these same clinical problems, and we are still learning. Here’s a quick look from 2012 at what we wrote in 2005. Specifics can be found in a link at this site soon.

  1. During the last 7 years our treatment strategies have become much more simple and flexible since our earlier strategies encouraged too much of the rigid and rule-based left-brained thinking that often causes or contributes to hyperlactation.
  2. In this manuscript, we never once mentioned using hands on the breasts as a strategy for preventing or resolving the problems of hyperlactation, and yet in recent years we’ve found this has revolutionized our management approach.
  3. We’ve found that when dealing with hyperlactation, pumping can often be counterproductive.
  4. Underweight slow weight gain babies are in a category of their own. Regardless of their symptoms, by definition the underweight baby is NOT drinking too much, and in our experience, typical strategies for addressing hyperlactation can be counterproductive or even dangerous. In particular, staying on one side “to get to the hindmilk” doesn’t work with these sleepy, flow-dependent babies. Side switching may be helpful, but is rarely sufficient, and medical attention is critical.
  5. While hyperlactation appears to be increasingly recognized by lactation professionals, left-brained strategies abound, and resolution is often elusive, even by those who correctly identify it.
  6. Much more research is needed in all of these areas, as well as in several interesting and related areas discussed in our longer note.

Finally, the thoughts and suggestions given here cannot replace appropriate medical attention by a physician or other medical provider. We do not encourage self-treatment, particularly when symptoms are severe. Readers seeking lactation support can locate an International Board Certified Lactation Consultant (IBCLC) in their geographic area at “Find a Lactation Consultant”


Rights: Copyright 2005 Elsevier.

NOTICE: this is the author’s version of a work that was accepted for publication in Newborn and Infant Nursing reviews. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Newborn and Infant Nursing reviews, [5, 1 (2005)] DOI: 10.1053/j.nainr.2005.02.007

Publication Title

Newborn and Infant Nursing Reviews

Published Citation

Smillie, C.M., Campbell, S.H., Iwinski, S. (2005). Hyperlactation - How left-brained 'rules' for breastfeeding wreak havoc with a natural process. Newborn and Infant Nursing Reviews, 5 (1) 49-58.