Some patients go to a headache center, where a team of healthcare professionals coordinates a patient’s pain management program.

Nurse educators may also work with patients to instruct them how to keep a headache diary and identify migraine triggers.

Additionally, babies who are having problems handling mother’s overactive/forceful letdown should not be introduced to a bottle too soon. Because the flow from a bottle nipple will be less forceful than mother’s letdown, baby may develop a preference for the artificial nipple and this could increase the chances for breast rejection and nursing strikes.

My son weaned early, due in part to my part-time return to work, the bottles of expressed breast milk he received, and the fact that he fell into the category of babies who couldn’t pacify at the breast without milking it. However, my daughter has been entirely different. Perhaps it’s a combination of her strong will and the newfound knowledge I’ve received from La Leche League. Regardless of how we have arrived to the two-and-a-half-year mark of successful breastfeeding, I am grateful for the chance to overcome a minor obstacle and that I was able to provide my children with a wonderfully adequate abundance of breastmilk.

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However, in cases where the overactive/forceful letdown is more severe and is causing nursing difficulties for mother and baby, there are a few solutions that may help remedy the situation.

One solution I favored really helped me and my two nurslings, especially in the early months when overactive/forceful letdown was more of a problem because my abundant milk supply had not adjusted — nor had my babies grown accustomed to the spray of milk during my letdown. I decided to let gravity assist my endeavors by using an “uphill” nursing position. Lying on my back, I would lay my nursling across my front side. Baby could latch on with surprising ease in this position, and I found that gravity helped to control the strong spray of milk during my letdown. Also, baby could more easily come off of the breast if the flow became too strong and too fast because he/she could control his/her head a bit easier from that position.

Mothers who have more extreme cases of powerful letdown will often take the baby off of the breast when the letdown starts, catching the overflow of foremilk in a clean towel or cloth, then return baby to the breast when the flow slows, allowing baby to feed on the hindmilk as long as baby wants (using no clock or timer).

It is not uncommon, especially in situations of overactive/powerful letdown, for babies to feed only on one breast per nursing. Nursing baby from one breast could help prevent baby from being overwhelmed by milk. Feeding on one side each feeding will help reduce mother’s milk supply until it meets her baby’s demands. However, it is important that mother monitors baby’s intake by making certain that baby has at least six wet diapers in 24 hours. If the number of wet diapers drops below six, mother should go back to using both breasts at each feeding. Typically, however, most women with overactive/forceful letdown have no trouble satisfying their infants’ hunger needs by feeding one breast per session.

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Babies who breastfeed from their mothers with an overactive/forceful letdown can exhibit a number of symptoms and reactions. The extremity of overactive/forceful letdown will usually determine whether or not an infant’s reactions or symptoms are numerous and obvious, or barely noticeable.

Overactive/forceful letdown in the early days of breastfeeding, once an adequate milk supply has come in, will typically cause a nursing infant to choke, sputter, and gasp during nursing. Because this can increase the amount of air baby takes in during each breastfeeding session, baby will often become gassy, fussy, and even colicky. He/she may become frustrated at the breast, especially once letdown occurs. Some babies are so upset by the forceful letdown that they begin refusing the breast and go on nursing strikes.

In cases where the letdown is extremely forceful, as the baby swallows gulps of air, baby will consume and become “full” on foremilk, forgoing the hindmilk. The foremilk, which is watery and much lower in fat and nutrients than the hindmilk, combined with a stomach filled too quickly, causes stomach pain and gassiness.

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Five years ago, when my son came into the world, my firstborn, I knew that I would breastfeed him. I was equipped only with information provided to me by the hospital where I delivered. While the information was enough — barely — to get me started breastfeeding my son, it didn’t allude to the more common problems, such as sore nipples, engorgement and… yes… overactive letdown.

Fortunately, my overactive letdown probably ranges a four or five on a scale of one to ten — one being minimal, ten being extreme. Common sense led me to realize that my letdown had to be quick and strong, because my son could empty a breast in under ten minutes, all the while choking, gasping, and sputtering between huge gulps of milk and air. Although he only took one breast per feeding, he gained weight so quickly that his pediatrician questioned if I might be feeding my six-week-old son cereal! (I wasn’t.)

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However, what we rarely hear are stories about mothers whose supplies are so abundant that their milk letdown is almost too forceful — so “overactive,” in fact, that their babies have difficulty adjusting to this plentiful milk supply. This is a condition known as “Overactive Letdown,” “Forceful Letdown,” or “Overabundant Milk Supply.”

Overactive letdown is more common than most mothers know. It often goes undetected — until one day you may hear someone comment about how her letdown is so powerful that it almost hurts her, or that her baby nearly drowns in the river of milk pouring from her breast. You might realize then that you, too, had a similar, milder, or even more extreme case of overactive letdown. The condition’s fair amount of anonymity is probably due to a frequency of milder cases of overactive letdown, rather than cases which are so extreme that the mothers suffering with overactive letdown experience nursing strikes from their babies, who can’t seem to keep up with the abundant supply or quick letdown, and inevitably grow frustrated at the breast.

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Signs and Symptoms
fever, chills and headache
fatigue or confusion
loss of appetite, nausea or diarrhea
warm, flushed skin
increased heart rate
What to Do
Call a doctor for emergency advice.

If a doctor is not available, call 911 or go to an emergency facility. Antibiotics may be required. Watch for signs of septic shock, a common side effect.

The signs are rapid pulse and breathing, fainting and possibly confusion or coma. If the symptoms of septic shock appear, call 911 or go to an emergency facility immediately.

Use a standardized extract. Because current Food and Drug Administration regulations cannot guarantee the purity of St. John’s wort sold in the United States, Counts recommends using brands from German manufacturers, which produce the herb under pharmaceutical conditions. The American Botanical Council lists Kira and Quanterra among U.S. brand-name equivalents of German products.

Be aware of possible side effects, such as increased sensitivity to the sun and minor gastrointestinal irritation.

Do not attempt to treat major depression with St. John’s wort. See your doctor immediately if you have symptoms of severe depression, such as crying spells, feelings of hopelessness, sleep disturbance, panic or suicidal thoughts.

Whether your staff requires certification depends upon what the primary preparation is. The more respected certifications (ACE, ACSM, AFAA) require a certain body of knowledge. Richard Seibert, director of special projects for the American Council on Exercise, feels that certifications are beneficial for part-timers who don’t want to pursue a formal four-year degree program and for those people with educations that didn’t provide the specific knowledge required (e.g., aerobic certification for someone with a kinesiology background). In addition, for people finding themselves attracted to a specialty after their career has started, certifications offer a great option. For example, ACE has specialty areas such as senior programming, nutrition, program management, etc. A degree plus certifications illustrates a strong desire to be successful in the industry.

“I feel over-qualified for starter positions” is the sentiment from students who have failed to gain experience while obtaining their degree. Quatrochi feels that students should be working in starter positions while going to school. A 10-credit internship is required at his school and can often lead to full-time positions, but if a position doesn’t exist at the internship site, extra experience helps differentiate a candidate from other graduates.

Following are some suggestions offered from both schools and employers to help create a more compatible fit between graduates and employer needs:

University instructors could help their students be prepared for any position by keeping themselves abreast of news in the industry. They should also be emphatic with students about getting experience while in school, more than an internship, paid or volunteer.

Students should collect a portfolio of service. They should solicit inquiries from the community so that they can obtain more detailed experience. Working at health fairs, hospital events, speaking at community groups, writing for local papers, etc., can all be included in a portfolio that will impress future employers (and give students a realistic idea of the types of people they will most likely be working with when they graduate).

A frustration of students after they graduate is the question of where they go after they become manager of their department. Management of the full facility is not in line with the clinical or technical coursework that most studied and want to pursue. Many move to other fields. Those who enter the field later in life as a lifestyle choice (after working in other industries) are more likely to stay in the field because they are less motivated by financial objectives and more motivated by lifestyle choice and a desire to “help people.” Employers should consider these seasoned candidates as a real treasure.

Graduates complain that clubs hire people who “just look good” in a leotard or workout clothes and complain when they receive the same pay as those without the education. If students get work experience while in school, they may be able to move to higher paying positions when they graduate and should look for businesses that support hiring trained staff.

Hiring degreed individuals offers more credibility to businesses. As the population ages and the focus of membership becomes older, more sedentary, with specific, possibly age- or disease-related, problems, a health/fitness business will only survive if the staff are able to safely assist the members, work with physicians and keep people motivated. In addition, community organizations and financial sources (banks, lenders, investors, sponsors) will be looking to work with educated individuals who can write well, speak well and provide a quality presentation.

A balance of personality, skills, experience and maturity will help determine if a candidate is right for any particular position. Once hired and trained, it is up to the business to work with their staff on a continual basis to keep the members happy and motivated, which will lead to high staff and member retention.

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Robert W. Patton, a professor of kinesiology in the health promotion and recreation department at the University of North Texas, says that the major deficiency in professional preparation institutions is that faculty are hired as exercise scientists into a tenure system requiring data-based publication in nationally recognized refereed journals. Outlets for publication of exercise science research abound in comparison to those for practical research in the club industry. This perpetuates exercise scientists rather than health fitness practioners in higher education. It also creates a chasm between what is needed in the health fitness industry and what is offered in colleges and universities.

Patton feels that licensure for the industry is a necessity and would put teeth into the kind of competency and expectations that health fitness professionals must have. Once this happens, institutions would have to develop proper curriculum, he says.

William Stone, of Arizona State University, conducted a survey recently of club managers and directors, and discovered that a deficiency in school programs is in the area of general business skills. On the undergraduate level, Arizona State offers a B.S. degree in exercise science, which is offered as an academic course as part of the college of liberal arts and sciences, and is designed for students moving on to medical school or other degree programs.

A bachelor’s degree in exercise and wellness prepares students for many things and takes a broad-based approach. Students can obtain a bachelor’s degree only or go on to a master’s or doctoral program. It is the master’s graduates who are prepared to work in corporate/worksite, commercial/private, community-based programs, medical, clinical, sports medicine programs or become entrepreneurs (personal trainers). Their activity experiences include fitness-oriented activities, as well as organization, promotion and business skills.

Master’s graduates get better jobs and focus more on management. The focus of their study has been on behavioral and psychological changes, leadership and management skills, exercise testing and prescription, and electives in nutrition, counseling, computers, etc.

Paula Potter, general manager of the Airport Club believes universities need to realize and teach students that they will be dealing with a public that is not as fit as those people in the program. Students need to learn more empathy for the general population and develop stronger motivational skills to keep members exercising, moving and eating right at whatever pace they can.

Gainsboro has found that technically oriented people are not always “up” people, adding that, “The audience will dwindle if you don’t make them feel good.”

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