Breastfeeding: Abrupt drop in milk supply

My daughter is five months old and is exclusively breastfed. For the past 48 hours my supply has dropped to nearly nothing. (I know the size of your breasts generally has nothing to do with the amount of milk, but I am a size 40ee and have been super full since my milk came in.) My baby seems hungry but when I offer her my breast, if the milk does not let down immediately, then she turns away and fusses. Eventually she drinks a little, but the milk seems to 'go away' and she gives up. I am eating the same as always and I'm not taking any medications. I have not had a period yet. What could be causing her fussiness and the drop in my milk supply?

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ABOUT THE EXPERT

Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

Often a mother thinks she has had an abrupt drop in her milk supply, but this really isn't very likely without any precipitating factors. There may be other issues affecting your baby's behavior at your breast.

Nursing strikes are fairly common in a baby of this age. Many moms interpret a baby's disinterest or refusal of the breast as a sign that they are ready to wean. This may be caused by teething, an ear infection, a cold, oral thrush, or a change in the taste of your milk (due to pregnancy, mastitis, a new food or medication...) It is rare for a baby under 10 months of age to spontaneously wean from the breast.

She could be teething especially if she is beginning to drool a lot, is always looking for something (someone) to chew on, and has a swollen ridge along the front of her gums, she may be on the way to cutting some teeth. This can cause fussiness at the breast or even breast refusal. (Or it may work in reverse and increase a baby's pattern of nursing.) If you feel that this may be the case, allowing her to chew on a cool teething ring prior to a feed may help to make her more comfortable.

If your milk supply has always been on the abundant side, your baby may be going through a period of breast refusal. It is very common for a mother with an overabundant milk supply to believe that she is losing her milk. Between three to six months of age, babies of moms with very abundant supplies may begin refusing feeds and acting unhappy at the breast. They may scream and stiffen, arch their back and pull away or even bite the breast. Moms think their milk is gone--but this isn't the case.

If you feel that this may be the issue, and your baby's weight gain has been normal, you may find it helpful to begin offering one breast per feed. Express on the other side as needed for comfort.

If your baby is refusing feeds and you need to begin supplementing, you can express your milk at the time of missed feeds (or following an incomplete feed) and offer it to your baby in a cup. You may also find it helpful to offer a few sips prior to a feed to take the edge off her hunger.

It is quite normal not to have resumed your menstrual cycle yet since you are exclusively breastfeeding. Many breastfeeding mothers do not get a period until their baby is well into the second year of life. If you do begin menstruating you may see a couple of days where your milk supply does not seem to be as abundant as usual. Your baby may be a bit fussier at this time. Nurse more frequently during this time and within a couple of days your milk supply should be right back to normal.

To help encourage your baby back to your breast:

  • Allow your baby lots of skin-to-skin contact. Carry her in a sling and massage her.
  • Try nursing in a darkened quiet room where there aren't a lot of distractions. Babies around six months of age are so interested in the world around them that they may have a very hard time concentrating on breastfeeding.
  • Nurse your daughter when she is drowsy. Increase nighttime feeds if these are her most peaceful.
  • Try another position. Lie down to nurse, or walk around and nurse your little one in a sling. (A change in nursing position can be very helpful in getting you over the hump. Don't worry that you will need to be standing up to nurse for the next year!)
  • Express a bit of milk by hand before putting your little one to your breast. She may be happier once your milk is flowing. If your milk slows during a feed, you can use breast massage, starting from the outer parts of the breast toward your nipple. (Some babies are very adept at doing this breast massage all on their own.)
  • Regular weight checks are important at this time.

If for some reason your milk supply is truly compromised (which does not seem likely) it is not necessary to wean from your breast. If your baby has a reduced output (less than five to six wet diapers each day and absence of regular, substantial bowel movements) and a poor pattern of weight gain (averaging less than three to five ounces each week), it is important to seek prompt evaluation by yourdoctor and a lactation consltant. They can help you to get breastfeeding back on track without compromising the health of your baby.

Whatever the cause for your baby's fussiness at your breast, be patient. I know from personal experience with this that it is much easier said than done. There is a very good chance that by working with some of these ideas you will begin to see an improvement in your little one's pattern of nursing. You may have some good feeds and then a rebound back to some that are fussy. This is normal.

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