Glossary

Term · Feeding Your Baby

delayed onset of lactation

Also: delayed lactogenesis II, late milk coming in, late milk supply start

When milk does not come in fully by about three days after birth. It has many possible causes, and a lactation consultant can assess it.

In plain words

Delayed onset of lactation means full milk production starts later than usual. Normally milk comes in around days two to four after birth. When it has not come in by about 72 hours, it is called delayed. The breasts may stay soft and the milk may stay thin, like . Causes include retained placental tissue, a long or surgical birth, large blood loss, diabetes, obesity, thyroid problems, and some conditions that affect breast tissue. Many mothers still build a full supply with frequent feeding or pumping. A can help check the baby's intake and the breasts. Feeling worried is common. A delay is a reason to get support, not a sign that breastfeeding has failed.

The deeper version

Delayed onset of lactation, defined as failure of beyond 72 hours, is associated with , maternal obesity, diabetes, , , hypothyroidism, retained placental fragments with sustained progesterone, and reduced glandular tissue after breast reduction. Dewey and colleagues (Pediatrics, 2003) reported delayed onset in a substantial minority of first-time mothers in a US cohort and linked it to excess neonatal weight loss and suboptimal feeding. Neville and Morton (Journal of Nutrition, 2001) described the endocrine switch that governs onset, with insulin signaling required for differentiation. The Academy of Breastfeeding Medicine treats delayed onset as a reason for close intake monitoring. Controversy concerns whether early worsens or helps later supply, and how to separate true insufficiency from normal variation.

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Sources

  • Dewey KG et al. — Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics, 2003
  • Neville MC, Morton J — Physiology and endocrine changes underlying human lactogenesis II. Journal of Nutrition, 2001

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