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Breastfeeding: Let-Down Reflex



  • Your baby's sucking triggers nerves in your nipples when you breastfeed. Tiny muscles start the flow of milk. When this happens, it’s called the let-down reflex or milk ejection reflex.
  • When your let-down reflex is working well, your baby easily gets milk and your breasts drain well. Your let-down reflex may not work well if you are stressed, separated from your baby, or had previous breast surgery.


What is the let-down reflex?

When you breastfeed, your baby's sucking triggers nerves in your nipples. These nerves carry a message to your brain, and a hormone called oxytocin is released. Oxytocin flows through your bloodstream to your breasts, where it causes tiny muscles to start the flow of milk. When this happens, it’s called the let-down reflex or milk ejection reflex.

Once your let-down is working well, usually by 2 weeks after you give birth, you may feel a pins-and-needles or tingling sensation in your breasts when you breastfeed or pump. Milk usually will drip from one breast while you are feeding on the other side. Sometimes your let-down will start when you hear your baby cry or when you think about breastfeeding your baby. When your let-down reflex is working well, your baby easily gets milk and your breasts drain well.

What causes a poor let-down reflex?

Several things may keep your let-down reflex from working well.

  • You are stressed, anxious, or tense. For example, you may have sore nipples or be trying to pump breast milk during a short break at work.
  • You are separated from your baby. For example, your premature baby is still in the hospital.
  • You have had previous breast surgery, such as breast reduction or enlargement surgery, that damaged the normal nerve pathways to the nipple.
  • You smoke. Cigarette smoking interferes with the let-down reflex.

How can I improve my milk flow?

To help trigger your let-down reflex and improve milk flow:

  • Try to breastfeed or pump in a place that is familiar, comfortable, and restful.
  • Drink water or herbal tea whenever you sit down to breastfeed or pump.
  • Play soft music or do relaxation exercises before you breastfeed or pump.
  • Gently massage your breasts before you breastfeed or pump.
  • Have your partner give you a backrub before you breastfeed or pump.
  • Put a warm washcloth or heating pad on your breasts or take a warm shower before you breastfeed or pump.
  • If you are pumping because you are separated from your baby, put a photograph of your baby by the pump.

What is an overactive let-down reflex?

Some mothers have a forceful let-down that causes too much milk to flow out of the breast too quickly. You may have sharp, shooting pain, and your baby may gulp, cough, and sputter while feeding. This happens most often within the first month of breastfeeding. To decrease your milk flow:

  • Breastfeed your baby on just one breast per feeding to decrease the amount of milk your breasts make.
  • Do not stimulate your breasts by pumping them or taking long hot showers.
  • Put cool cloths on your breasts for 15 to 30 minutes between feedings.

To help your baby deal with forceful let-down:

  • Hold your baby upright, with his or her bottom much lower than the head. Support your baby in this position while breastfeeding.
  • Lie back and place your baby’s tummy on your tummy. This laid-back breastfeeding position lets gravity slow down the flow of milk.
  • Burp your baby often if he or she swallows a lot of air.
  • Breastfeed when your baby is relaxed and sleepy. Gentler sucking will keep your milk from flowing so fast.
  • You can wait until let-down starts, take your baby off your breast, and let some milk collect in a towel or diaper before continuing to feed your baby.
  • You can hand express or pump your breasts when your breasts first let down to relieve the pressure, and then put your baby on your breast.
Developed by Change Healthcare.
Pediatric Advisor 2022.1 published by Change Healthcare.
Last modified: 2019-12-23
Last reviewed: 2019-12-16
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2022 Change Healthcare LLC and/or one of its subsidiaries
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