Low Milk Supply

Mother: Primary Predisposing Factors

• Lack of milk producing breast tissue.
• Prior breast surgery (especially those with peri-areolar incisions or breast reduction procedures)
• Insufficient glandular syndrome.
• Polycystic Ovarian Syndrome.
• Diabetes T1, T2, or insulin resistance.
• Thyroid dysfunction.
• Obesity.
• Retained placenta.
• History of female infertility.
• Previous radiation or chemotherapy.
• Spinal cord injury, depending on the injury.

Mother: Secondary Predisposing Factors

• Infrequent breastfeeding.
• Chronic, inadequate breast emptying.
• Supplementation with breastmilk substitute or other liquids.
• Tobacco use.
• Chronic alcohol use.
• Dietary restrictions (<1200 kcals/day).
• Rare medications used, including Estrogen-containing products, pseudoephedrine, methylegonovine, cabergoline and bupropion.

Baby: Predisposing Factors

• Weak suck or poor transfer of milk.
• Tongue-tie (Ankyloglossia).
• Hyper or Hypotonia.
• Torticollis.
• Oral structural problems.
• Cardiac or respiratory problems.

For additional contributing infant factors, review the section on Infant Weight Loss.

Infant growth should be tracked using the CDC Growth Charts listed below:

• WHO growth standards - monitor growth for infants and children ages 0 to 2 years of age in the U.S.
• CDC growth charts - monitor growth for children age 2 years and older in the U.S.
• Training Course on Child Growth Assessment (WHO)

• Acknowledge the mother’s concern regarding low milk supply (real or perceived) and offer support.
• Conduct thorough health and breastfeeding assessment of both the mother and baby or refer her to a Lactation Consultant for further evaluation.
• Objectively document the infant’s growth pattern using the CDC and WHO growth charts, as applicable by age.
• Provide the mother with education on how to identify proper milk transfer and adequate milk intake.
• Suggest moist heat to be applied 3-5 minutes prior to feeding. This will improve perfusion to the area and enhance her milk-ejection reflex (let-down).
• Use breast massage and compression during feedings.
• Feed frequently, whenever baby shows early feeding cues or 8-12 times/day.
• Avoid long intervals between feedings, no more than one 5-6-hour interval in 24 hours. Do not restrict the baby’s night feedings.
• Pump or hand express between feedings. Use hands-on pumping to increase stimulation and optimal breast emptying.
• Encourage skin-to-skin contact with infant to increase oxytocin levels.

Clinical Guidelines

• Brodribb, W. (2018). ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018. Breastfeeding Medicine, 13(5), 307–314. 
• Kellams, A., Harrel, C., Omage, S., Gregory, C., & Rosen-Carole, C. (2017). ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeeding Medicine, 12, 188–198. 
• Taylor, S. N. (2018). ABM Clinical Protocol #29: Iron, Zinc, and Vitamin D Supplementation During Breastfeeding. Breastfeeding Medicine, 13(6), 398–404. 

References

1. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
2. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier.