Low Milk Supply: Symptoms, Types, Causes and Treatment

Breastfeeding is often described as a natural and rewarding experience for new mothers and their infants. However, for some, low milk supply can become a significant challenge, affecting confidence, infant nutrition, and the continuation of breastfeeding. Understanding the symptoms, types, causes, and evidence-based treatments of low milk supply is crucial for mothers, families, and healthcare providers. Let’s explore this important topic in depth.

Symptoms of Low Milk Supply

Recognizing low milk supply early can make a significant difference in both maternal well-being and infant health. Many women worry about not producing enough milk, but distinguishing real from perceived insufficiency is essential.

Symptom	Infant Behavior	Maternal Indication	Source(s)
Persistent crying	Frequent fussiness	Perceived low milk	5 6 7
Poor weight gain	Infrequent wet diapers	Delayed breast fullness	5 7 9
Lethargy	Poor feeding patterns	Sore nipples	6 7 9
Less stooling	Short/distracted feeds	Delayed lactogenesis II	5 6 7 9

Table 1: Key Symptoms

Understanding the Signs

The most commonly reported sign of low milk supply is persistent infant crying, especially after feeds. Mothers often interpret fussiness or frequent feeding as a sign of insufficient milk, though these behaviors can have other causes 5 6 7.

Infant-Related Indicators

• Poor weight gain: Infants who do not regain their birth weight by 2 weeks or who do not gain 20–30g/day may not be receiving enough milk 9.
• Infrequent wet diapers: Fewer than 6 wet diapers per day after the first week is concerning 5.
• Lethargy or poor feeding: Babies who are too sleepy to feed or who do not seem satisfied can indicate a problem 9.

Maternal Clues

• Perceived insufficient milk: Many mothers discontinue breastfeeding due to self-doubt rather than objective low supply 5 6.
• Delayed breast fullness: If breasts do not feel full or do not leak, some mothers suspect low supply, but this can be normal as breastfeeding becomes established 9.
• Sore nipples or delayed milk “coming in” (lactogenesis II): Pain and delays can impact supply 6 9.

The Role of Perception

A crucial aspect is the difference between perceived and actual low milk supply. Research shows that many women stop breastfeeding due to perceived insufficient milk (PIM), though objective measures may not confirm this 5. Infant cues, such as crying or frequent feeding, are often misinterpreted, fueling anxiety and early weaning 5 6.

Types of Low Milk Supply

Low milk supply is not a one-size-fits-all phenomenon. By recognizing different types, mothers and providers can better tailor support and interventions.

Type	Description	Onset	Source(s)
Primary	Physiological or anatomical	Early postpartum	9 12
Secondary	Induced by external factors	Any time	9 12
Perceived	Belief vs. reality gap	Early/late	5 6 7
Temporary	Due to modifiable issues	Episodic	9 12

Table 2: Types of Low Milk Supply

Primary (True) Insufficiency

Some women experience true, physiological low milk supply due to congenital or acquired conditions:

• Insufficient glandular tissue: Rare, but results in breasts with limited ability to produce milk.
• Hormonal imbalances: Such as Sheehan’s syndrome (postpartum pituitary gland failure) or thyroid disorders 9 12.

Secondary Insufficiency

Most cases are secondary, where external factors impact production:

• Ineffective milk removal: Poor latch, infrequent feeding, or supplementing with formula can reduce supply 9 12.
• Maternal illness or medications: Some medications, postpartum hemorrhage, or breast surgeries can interfere 9.

Perceived Insufficiency

This type is driven by maternal perception rather than actual low output. Studies show that up to 35% of women who stop breastfeeding early cite perceived insufficient milk, often based on infant cues rather than objective measures 5 6 7.

Temporary or Situational Low Supply

• Stress, illness, or fatigue: Temporary dips in supply are common and usually reversible 9.
• Growth spurts: Babies may feed more frequently, making mothers believe supply is low when it’s simply increased demand 9.

Causes of Low Milk Supply

Understanding the root causes of low milk supply is essential for effective management. Causes can be multifactorial—ranging from hormonal to behavioral, medical, and even psychological.

Cause	Mechanism/Impact	Source(s)
Hormonal imbalance	Disrupts milk synthesis	2 3 4
Obesity/metabolic	Inflammation, disrupted fatty acid transfer	3 4 10
Poor breastfeeding	Ineffective latch, infrequent removal	5 7 9 12
Early supplementation	Reduces demand, thus supply	6 7 12
Psychological factors	Maternal confidence, support	6 7 12
Medications	Some suppress or disrupt lactation	2 9

Table 3: Causes of Low Milk Supply

Hormonal and Endocrine Factors

Milk production is tightly regulated by hormones—primarily prolactin, estrogen, and progesterone. Disruption in these, whether from endogenous problems (like pituitary insufficiency) or exogenous sources (hormonal contraceptives, obesity-related hormonal shifts), can impair lactation 2 3 4.

• Obesity and metabolic issues: Women with class 2+ obesity, insulin resistance, or gestational diabetes are at higher risk for low milk supply. Chronic inflammation linked to obesity disrupts the transfer of essential fatty acids into milk, further compromising supply 3 4 10.

Breastfeeding Practices

• Infrequent or ineffective milk removal: Milk production operates on a supply-and-demand principle. If milk is not regularly and thoroughly removed, the body reduces production 9.
• Poor latch or positioning: Can lead to inadequate drainage and reduced stimulation 9 12.

Early Supplementation

Starting formula or bottle-feeding too soon reduces the baby’s demand on the breast, which in turn decreases supply. This is particularly problematic if introduced in the first weeks postpartum 6 7 12.

Psychological and Social Factors

• Low maternal confidence: A key predictor of perceived insufficient milk. Lack of support from family or healthcare providers can worsen this 6 7.
• Stress and fatigue: These can temporarily suppress milk letdown and reduce supply 7 12.

Medical and Surgical History

• Postpartum hemorrhage: Can damage the pituitary, leading to hormonal deficiencies 9.
• Breast surgery: Previous reductions or augmentations can impair glandular tissue 9.
• Medications: Certain drugs, especially those with hormonal effects, can suppress supply 2 9.

Infant-Related Issues

• Poor suck: Premature or ill infants may have weak sucking reflexes 9.
• Oral anomalies: Tongue-tie or cleft palate can hinder milk transfer 9.

Treatment of Low Milk Supply

The good news is that many cases of low milk supply can be improved with the right approach. A combination of behavioral, medical, and psychosocial interventions proves most effective.

Treatment	Approach/Description	Source(s)
Frequent feeding	Regular, effective milk removal	9 12
Lactation support	Education, counseling, support groups	5 12
Galactagogues	Domperidone, metoclopramide, herbal remedies	11 14 10
SPEOS therapy	Endorphin, oxytocin massage, suggestion	13
Address causes	Treat underlying medical or behavioral factors	2 9 12

Table 4: Treatment Options

Optimizing Breastfeeding Practices

• Frequent and effective milk removal: Feeding every 2–3 hours, including at night, and ensuring proper latch are foundational steps. Pumping after feeds may further stimulate production 9 12.
• Skin-to-skin contact: Encourages more frequent feeding and helps with letdown 12.

Lactation Support and Education

• Professional counseling: Trained lactation consultants can address concerns about latch, positioning, and confidence.
• Support groups: Peer support increases rates of successful relactation and breastfeeding continuation 5 12.

Galactagogues (Medications to Increase Milk Supply)

• Domperidone: Shown to moderately increase milk supply, particularly in mothers of preterm infants or when non-pharmacological measures fail 11 14.
• Metoclopramide: Less robust evidence and higher risk of side effects compared to domperidone 11.
• Metformin: Preliminary studies suggest possible benefit in women with insulin resistance, but more research is needed 10.
• Herbal remedies: Evidence is lacking for efficacy and safety, especially in vulnerable populations 14.

Alternative and Adjunct Therapies

• SPEOS Method: A combination of endorphin stimulation, oxytocin massage, and suggestion therapy has shown promise in increasing milk supply in postpartum women 13.
• Addressing psychological barriers: Building confidence and correcting misconceptions play a significant role, especially in cases of perceived low supply 5 6 7.

Treating Underlying Causes

• Medical intervention: Managing maternal health conditions (thyroid disorders, diabetes, hormonal imbalances) is essential 2 3 4 9.
• Correcting infant feeding difficulties: Addressing issues like tongue-tie or prematurity can improve milk transfer 9.

Relactation

With appropriate support, even mothers who have stopped breastfeeding can often resume, especially if intervention starts within six weeks postpartum. Success rates are highest with early, intensive counseling and support, regardless of whether medications are used 12.

Conclusion

Low milk supply is a complex, multifaceted issue with physiological, behavioral, and psychological components. Key takeaways include:

• Symptoms are often based on infant behavior and maternal perception, not always on true supply 5 6 7 9.
• Types of low milk supply range from primary (physiological) to secondary (external factors), and perceived insufficiency is common 5 6 7 9 12.
• Causes include hormonal imbalances, metabolic issues (especially obesity), ineffective breastfeeding practices, early supplementation, psychological factors, and certain medical conditions 2 3 4 6 7 9 10 12.
• Treatment focuses first on optimizing breastfeeding practices, providing education and support, and, when needed, using medications like domperidone. Addressing root causes and providing psychosocial support are equally important 5 9 11 12 13 14.

In summary:

• Most mothers can overcome low milk supply with the right guidance and support.
• Early intervention—especially within the first weeks postpartum—is critical.
• Addressing both the physical and emotional aspects is key to successful breastfeeding.

Empowering mothers with accurate information and compassionate support is the cornerstone of overcoming low milk supply and achieving breastfeeding goals.