Let-down Reflex

I find this part of breastfeeding (the anatomy and physiology) incredibly fascinating 🤓. The mechanisms that go into breastfeeding are incredible.

The let-down reflex is an integral part but like anything else, there can be issues. Read through this post to learn more about this and possible solutions.

  • Some women feel the let-down reflex and this can feel like tingling, burning, or a feeling of fullness.
  • Some women don’t feel it at all.
  • Most women notice a change in their baby’s sucking pattern as the milk begins to flow, from small, shallow sucks to stronger, slower sucks.
  • The let-down reflex generally occurs 2-3 times a feed or pump. Most women only feel the first, if at all.
  • This reflex is not always consistent, particularly early on, but after a few weeks of regular breastfeeding or pumping, it becomes an automatic response.

Problems with Let-Down Reflex:

  • The let-down reflex doesn’t work perfectly all the time. If you are having trouble with your letdown, it can decrease your milk supply so take a look at these:


  • There are many potential causes for this:
    • Alcohol, caffeine, cold temperature, fatigue, pain, previous breast surgery, smoking.
  • When you have a slow let-down, your baby can get frustrated at the breast (bite down, scream, or refuse to breastfeed).

Encouraging a Let-Down

If you are having trouble with your let-down reflex, here are a few things to try:

  • Pump or hand express a little bit of breast milk before each feeding to help stimulate your letdown reflex.
  • Put the baby to your breast once your milk begins to flow.
  • Place a warm compress on your breasts for a few minutes before feeding time.
  • Massage your breasts gently before and during each feeding.
  • Ensure a good latch or properly fitting flanges
  • Feed or pump in a familiar/comfortable environment away from distractions.
  • Try different methods to help you to relax: calming music, warm shower or a warm washer on the breast, some slow deep breathing, or a neck and shoulder massage.
  • Look at and think about your baby.
  • If you are away from your baby, try looking at a picture of your baby.
  • Avoid smoking and alcohol. Decrease caffeine intake.
  • A let-down is partly a conditioned reflex and is a result of repeated “training.” Remember Pavlov? (And Pavlov’s dogs?)
    • So for breastfeeding, use a “let-down cue” just before you nurse or pump.
    • Ex: sitting down, deep breathing, drinking water). Your milk then lets down in response to baby nursing.

If you have problems with slow or difficult letdowns, try to establish a letdown cue and this will aid in the conditioned reflex. (you’ll respond to the letdown cue regardless of pumping or nursing).

Encouraging a Let-Down while Pumping:

  • Start out in let-down (quick sucks) mode, then once you start to get a letdown switch it to a slower mode (expression mode).
  • Once your milk stops flowing or has slowed down, put it back in let-down mode. Switch back and forth between these modes throughout your pumping session to encourage at 2-3 let-downs.
  • Use warm compresses before and during your pump.
  • Massage your breasts before and during your pump.
  • Try a lactation massager.
  • Relax as much as you can and try and make it as fun as possible.
    • Do something you enjoy while pumping like watch a TV show you’re into, read a book if you can.
    • Cover the bottles with baby socks if you get anxious about milk production when pumping.

Strong or Overactive Let-Down

  • An overactive let-down reflex causes too much milk to flow quickly out of the breast.
  • You may notice the baby pulling off your breast, gagging, coughing, choking, or clamping down on your breast.
  • The baby can also take in a lot of air while trying to keep up with the flow/gulping which can lead to fussiness, gassiness, and colic.
  • Many times if you have an overactive let-down, you’ll also have an oversupply of milk.

Tips for Strong/Overactive Let-Down

  • Express some of your breast milk before you begin.
  • Put your baby to the breast after the first let-down passes and the milk flow slows down.
  • Burp your baby and after each feeding to help bring up any air that he may swallow.
  • Try breastfeeding from only one side per feeding (AKA block feeding).
  • Try the laid back nursing position (so baby is working against gravity).
  • Treat your oversupply if that’s the issue

Dysmorphic Milk Ejection Reflex (DMER)

  • This occurs in a small percentage of breastfeeding women and is a result of dopamine dropping in response to the letdown reflex.
  • The symptoms of DMER include sadness, a sense of doon, agitation, anger, anxiety, panic, dizziness, depression, restelessness.
  • Knowing that DMER is a physiological phenomenon and not something you’re making up is important in being able to get through it more easily.
  • This usually only lasts during the letdown and not more than 10 minutes. Always discuss these issues with your PCP or IBCLC for further management.