I saw a mom today with such an incredible MER, that the baby struggled through
3 suck/swallow/gasp cycles each second!  She has already been trying most of
the standard "overactive letdown" tx's: one breast per feed, nursing while
walking (tough with this 16 lb 3mo old), pumping before feeds) and still
becomes engorged several times a day.  Baby is huge.  I recommended trying
cabbage compresses, weaning down the pumping to allow those suppressor
peptides to act, taking the baby off after the first few sucks until the
spraying subsides, and nursing with baby upright in a sling-type carrier.
Baby did seem to handle the flow better this way.  I also advised her to see
her physician to rule out the possibilities of hyperthyroidism or prolactinoma
(she has very prominent eyes and frequent migraine headaches, though no heat
intolerance or anxiety/panic feelings).  Baby is 'clicking', breaking the
suction with her tongue as she lifts it againt the nipple every few sucks.  Am
hesitant to mess with her as this is adaptive in this situation- reducing the
milk flow a bit.  Mom reports baby chews sometimes, so we worked on the latch
to improve tongue placement.
        Is there anything further that can be done to help this mom and baby?
Thanks,
Catherine Watson Genna, IBCLC