Low Breast Milk Supply
Definition
Insufficient production of breast milk to meet an infant’s nutritional requirements, leading to inadequate weight gain and hydration issues
Often a perception issue when breasts are less full as milk supply adjusts to demand
Clinically assessed by monitoring infant weight gain and effective feeding
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Symptoms
Poor weight gain: Failure to regain birth weight by 2 weeks postpartum
Decreased wet nappies: Fewer than five per day, concentrated urine or presence of uric acid crystals
Infant irritability after feeds and signs of dehydration such as dry mucous membranes
Maternal reports of soft or less full breasts between feeds
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Treatment
Increase breastfeeding frequency: Encourage feeding at least 12 times in 24 hours and wake the infant if necessary
Optimise feeding technique: Ensure effective latch by feeding from both breasts at each session and using proper positioning and attachment
Promote skin-to-skin contact: Enhances bonding and stimulates oxytocin release to increase milk production
Adjust feeds according to demand: Feed on demand rather than strict schedules to maintain a proper supply-demand cycle
Use of galactagogues: Consider domperidone 10 mg TDS if non-pharmacological measures fail, with caution in patients with cardiac history
Consider supplemental feeding cautiously: Use expressed breast milk rather than formula unless medically indicated; paced bottle feeding may help if top-up feeds are required
Address contributing factors: Manage maternal conditions such as hypothyroidism or anaemia, ensure proper maternal nutrition and hydration, and counsel on lifestyle modifications including avoiding smoking and excessive alcohol
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Additional Considerations
Assess infant factors: Evaluate for ineffective suck due to congenital conditions (e.g., cleft palate) that may reduce milk transfer
Recognise normal lactogenesis: Decreased breast fullness after the initial weeks is common and not necessarily a sign of low supply
Encourage proper breast emptying: Express milk after feeds if necessary to stimulate further production
Monitor weight gain: Infants should return to birth weight by 10–14 days and gain 150–200 g/week (0–3 months), 100–150 g/week (3–6 months), and 70–90 g/week (6–12 months)
Educate on avoiding disruptive practices: Strict feeding schedules and unnecessary bottle top-ups can interfere with the supply-demand cycle
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Notes
Maternal anxiety about low milk supply is common and often unwarranted if the infant is gaining weight appropriately
Regular follow-up is essential to monitor weight gain, wet nappies, and overall feeding progress
Multidisciplinary support from lactation consultants and breastfeeding counsellors can optimise outcomes
Emphasis on maternal self-care and family support is vital, as stress can adversely affect milk production
