Insufficient or Low Levels of Breast Milk

Delivery, Postnatal

Your baby is breastfed and you’re wondering if you have enough milk to meet all his needs? With growth spurts arriving at different times, many parents wonder whether breast milk isn’t rich enough, or whether it’s produced in sufficient quantity. When it comes to quality, there’s no room for doubt! Your milk is the best for your baby. When it comes to quantity, it’s a minority who will have insufficient milk production. In this post, we’ll talk about more specific circumstances that can potentially lead to milk insufficiency.

In the event of a lactiferous production problem, at the 3 or 4 week visit, parents will often say:

  • that their baby is constantly unsatisfied at the breast, is restless, lets go of the breast, cries at the breast or simply refuses it; he may bite the nipple or pull it, sending his head backwards;
  • frequent suckling;
  • that the duration and frequency of feedings increase, leading to nipple injuries;
  • the baby falls asleep from exhaustion and wakes up after a few minutes to ask for the breast again.

In such cases, your practitioner should examine your baby to ensure his or her growth and development. Before concluding that you’re not producing enough milk, you need to assess the situation as a whole.

According to pediatrician Jack Newman, the mother is responsible for transferring the milk to her baby, and the baby reacts to the flow of incoming milk. This means he may fall asleep, not because he’s tired, but because the milk is no longer flowing quickly enough into his mouth to encourage him to continue feeding. The baby stimulates the nipple as he latches on, but he doesn’t pull so hard, he gives the signal, the message transmitted to the mother’s brain, to encourage the milk to be ejected. The baby is not passive!

Suckling is not physically so difficult for the baby, who has everything he needs to do it. However, if the baby is not well established at the breast, has a poor latch, or does not stimulate his mother sufficiently, the milk flow may be negatively influenced and indirectly affect the quality of the baby’s suckling and his satisfaction during feeds.

Baby-related causes of milk insufficiency

  • Very weak suckling or a very sleepy baby. That’s why it’s so important to encourage the mother to produce a satisfactory flow of milk for her baby as soon as possible after delivery.
  • The baby is not able to take the whole nipple in its mouth, right down to the base. It is at the base of the nipple that the neurotransmitters are located to stimulate production. In this situation, the baby’s positioning at the breast needs to be reviewed in its entirety, and sometimes just changing the alignment can make all the difference.
  • A baby may refuse the breast because he has difficulty managing the intake of milk that flows too quickly from the breast (strong ejection reflex).
  • A baby with severe jaundice is often more sleepy.
  • A hypotonic baby (lacking tone).
  • A baby with reduced jaw mobility (for example after using forceps), torticollis, plagiocephaly, cleft lip and/or palate or a restrictive tongue.)
  • A particular health condition, such as a muscular or skeletal problem (mobility disorder), or a cardiac, neurological or infectious problem. In connection with the condition identified, the use of medication can have an impact on the quality of the baby’s suckling at the mother’s breast.
  • A baby may refuse the breast after too early use of a bottle (with a teat) or an amusement pacifier (confusion).

Some causes of lactiferous insufficiency linked to the mother and the practice

  • The pacifier: Some parents use the pacifier in profusion instead of putting the baby to the breast to stimulate production. This interferes with milk production (reduced frequency of feeds).
  • Latching on: some mothers have flat, invaginated or large nipples. Depending on the baby’s mouth and morphology, it’s not always easy for them to take the whole nipple into their mouth. As a result, neurotransmitters at the base of the nipple are not properly stimulated.
  • Photo - maman qui allaite son bébéThe baby’s position: it’s important to position the baby correctly for feeding, for better stimulation. Sometimes all it takes is to align the baby a little differently towards the breast, and the latch is improved.
  • Both breasts should be stimulated at every feed to promote milk production and a good flow of milk for the baby, rarely just one, as this can reduce the mother’s milk production over time.
  • Medication: If the mother is taking any kind of medication, this may indirectly influence production (for example, certain decongestants containing pseudoephedrine, or certain contraceptives). Hormones are very sensitive, sometimes even when using medications theoretically compatible with breastfeeding. Every woman’s situation is different, so we must stay vigilant.
  • Hypothyroidism: If the mother suffers from hypothyroidism (a decrease in the work of the thyroid gland, which has an influence on several other organs in the body), this can have an impact on production. If this condition is treated, production often stabilizes afterwards.
  • Hypoplasia: A mother known to have hypoplasia (i.e. fewer mammary glands in her breasts). Hypoplasia can affect one breast only (unilateral) or both at once (bilateral). You can ask your provider to examine your breasts to confirm this. Also, if you haven’t noticed any real changes in your breasts throughout your pregnancy, this may be a clue.
  • Breast reduction: A mother who has had breast surgery to remove mammary glands (breast reduction) for back pain or other problems. If the nipple has been moved, the nerve endings to the nipple have been cut, thereby cutting off the signal to the brain for milk production.
  • Mammary prostheses: We’re seeing more and more cases of the opposite (mammary prostheses added to certain breasts). If the nipple has not moved and the prosthesis has been inserted under the breast, there is generally no problem with milk production. However, all surgery is carefully monitored. The structures have been touched and traumatized. As a general rule, there are no problems feeding the baby with a breast augmentation.
  • Polycystic ovaries: If the mother has already been diagnosed with polycystic ovaries, this may also influence milk production.
  • Placental retention.
  • Post-partum haemorrhage.
  • Hypertension and preeclampsia.
  • Pregnancy diabetes, with insulin.
  • Mastitis.
  • Fatigue, stress and pain elsewhere in the body can, of course, have a negative impact on milk production.
  • Caffeine and smoking can also influence production.
  • A new pregnancy.

Solutions

The practitioner will advise you once the potential causes have been identified, the history of the pregnancy and birth is known, and a feed has been observed. He or she will take the baby’s weight and ensure that it is gaining at least 25 to 30 g per day.

Then, as a first step, he may recommend non-pharmacological measures to improve the situation for you and your baby:

  • Review the 5 Rs: Right moment, Right position, Right latch, Right nipple grip, Right suction;
  • Review breastfeeding positions;
  • Review your medication (ex: contraception, synthroid for hypothyroidism, iron to treat anemia);
  • Use breast-feeding aids judiciously, such as breast tips (e.g. flat nipples), electric breast pumps (to increase stimulation), etc., depending on the situation.
  • Can I temporarily supplement the baby’s weight gain? If so, how: with the cup, with the dal (small tube) or with the spoon, so as not to confuse it and interfere with breastfeeding?

Since every situation is unique, the breastfeeding resources available to you will help you realize your desire to breastfeed, without compromising your baby’s needs.

Additional information:

Marie Fortier
The baby expert

Article updated: April 2025.

References :

Discover our videos

Subscribe to a monthly or quarterly package now to access full videos.

Prenatal Yoga
17-18 weeks pregnant, Prenatal

Prenatal Yoga

Doing yoga during pregnancy is both possible and a great idea. In addition to soothing discomfort during pregnancy and feeling
Support During Pregnancy and delivery
33-34 weeks pregnant, Childbirth, Prenatal

Support During Pregnancy and delivery

The birth of a child should take place in a calm, trusting and loving environment. The people accompanying a woman
Dad and Pregnancy
27-28 weeks pregnant, 7-8 weeks pregnant, Prenatal, Videos for members only

Dad and Pregnancy

Dad’s place during pregnancy and childbirth is important. Each father experiences the adventure differently. Marie meets Laurent, who talks about
Baby Purees
Baby/parents

Baby Purees

Marie welcomes Mélissa Labonté, a dietician and nutritionist, to talk about baby purées. Introducing solid foods is a significant step

View all available videos

Compte

Warning

The mariefortier.com website and the comprehensive information it contains are intended as practical tools for expectant parents preparing for the arrival of their baby. These are not meant to replace the skills, knowledge, and experience of qualified health professionals who are familiar with the facts, circumstances, and symptoms specific to each individual. As such, Marie Fortier Inc. and its employees cannot be held responsible for any potential adverse effects or consequences resulting from the use of information provided on this website. It is the user’s responsibility to consult a physician or other qualified health professional for personal matters concerning them.