Witch's milk
Witch's milk or neonatal milk is milk secreted from the breasts of some newborn human infants of either sex.[1] Production of neonatal milk by infants usually resolves itself and does not require treatment unless it is caused by an underlying condition or medications.[2] It is thought to be caused by a combination of the effects of maternal hormones before birth, prolactin, and growth hormone passed through breastfeeding and the postnatal pituitary and thyroid hormone surge in the infant.[3]
Neonatal milk production occurs in about 6% of newborns with age from 0 to 12 weeks. Within the age range, infants age 0 to 2 weeks were found to have the highest occurrence. Compared to those who did not have neonatal milk production, infants who did had larger breast nodules.[3] The consistency of neonatal milk is estimated to be quite similar to maternal milk.[4] Its production also may be caused by certain medications.[5][6] In extremely rare cases neonatal mastitis may develop but it is unclear if it is related to neonatal milk secretion.[citation needed] Blood from the nipples is nearly always benign and frequently associated with duct ectasia; it should only be investigated when it is unilateral.[7]
Cultural interpretations
[edit]The term "witch's milk" comes from ancient folklore that stems from the 17th century belief that the fluid leaking from a newborn's nipple was a source of nourishment for witches' familiar spirits.[8] Across Europe, neonatal lactation was called "witch's milk", "hexenmilch" and "lait de sorciere", and was accused of being a potential source for witchcraft.[9] Some would even go to the extent of "milking" infants with this condition of Galactorrhea in order to prevent a witch coming to collect it.[9] It was thought to be stolen from unwatched, sleeping infants.
There is also a religious interpretation behind the significance of witch's milk. In the 1500s in England, milk was symbolically linked with nurture and purity, and was particularly associated with the Virgin Mary.[9] However, when the milk came our of so-called "unnatural" places, it was either seen as divine or satanic.
The cultural interpretations of witch's milk, however, vary across different cultures. For instance, in India, there is an age-old practice in place where mothers would squeeze the swollen breasts of infants that contained witch's milk in an attempy to avoid large breasts, which are considered inappropriate before the age of marriage.[10]
Contributing factors
[edit]Hyperprolactinemia
[edit]Witch's milk, or neonatal galactorrhea, in newborns is primarily caused by hyperprolactinemia,[11] which results from the decline of maternally transferred estrogen in the neonate, stimulating milk production. Maternal estrogens are essential for developing a newborn's mammary glands during pregnancy. These hormones cross the placenta and stimulate the growth of breast tissue in the fetus. After birth, the levels of maternal estrogens fall quickly since the placenta is no longer supplying these hormones. This rapid decrease can disturb the newborn's hormonal balance.[10] Consequently, the baby's pituitary gland may increase the production of prolactin, a hormone that triggers milk production. This condition, called hyperprolactinemia, can cause the newborn’s breasts to produce milk, a phenomenon known as "witch's milk." Usually, this milk production is temporary and resolves as the baby’s hormone levels adjust. However, in some cultures, the tradition of manually expressing this milk based on cultural beliefs can worsen the condition, resulting in prolonged breast enlargement and milk secretion.[12]
Prolactin
[edit]In breastfeeding, pituitary hormone prolactin vary throughout pregnancy and in different lactation conditions.[13] Prolactin, produced by the pituitary gland, is essential for initiating and maintaining milk production. Its levels increase during pregnancy to prepare the breasts for milk production and remain high after childbirth to continue supporting breastfeeding. Issues related to abnormal lactation, such as inadequate milk supply or galactorrhea, an excessive milk flow not linked to childbirth, are also explored. Fluctuations in prolactin levels can significantly influence these problems. By analyzing prolactin levels in various lactation situations, insights are provided into how changes in prolactin affect milk production and overall lactation health. This emphasizes the importance of understanding prolactin's role for better diagnosis and management of lactation issues, offering valuable information for treating both normal and problematic lactation cases.[13]
Antidepressants
[edit]A rare case of infant galactorrhea associated with maternal use of antidepressants is has been reported.[14] A 3-month-old infant developed nipple lesions and milk production. Initially, the condition was thought to be an infection due to excessive handling. However, repeated episodes prompted further investigation by a mastologist, who suggested that the galactorrhea could be linked to the mother’s antidepressant medication, specifically sertraline and quetiapine. Although these medications are generally considered safe during breastfeeding, they can still affect the infant. This case highlights the importance of considering this rare but possible side effect when diagnosing persistent galactorrhea in infants. It underscores the need for thorough monitoring and assessment of potential drug impacts on infants, particularly when common explanations for symptoms do not apply.[14]
Other medications
[edit]Medications are a significant cause of hyperprolactinemia and galactorrhea. They can disrupt the normal regulation of prolactin by either inhibiting dopamine, which naturally suppresses prolactin secretion, or by directly stimulating the release of prolactin. Opiates are among these medications. They can elevate prolactin levels by inhibiting dopamine release, reducing the dopamine-mediated suppression of prolactin, thus leading to increased prolactin levels and possibly causing galactorrhea. The use of opiates by mothers during pregnancy or breastfeeding can transfer these drugs to the infant, potentially leading to neonatal galactorrhea, also known as "witch's milk."[15]
Comparison to adolescent galactorrhea
[edit]"Witch's milk" and adolescent galactorrhea are both forms of abnormal milk production, but they differ significantly in terms of age group, causes, and management. Witch's milk occurs in newborns and is typically due to maternal hormones that cross the placenta during pregnancy. These hormones can stimulate the infant's mammary glands to produce milk, a condition that is relatively common, affecting about 5% of newborns.[11] Witch's milk is usually self-limiting and resolves within a few weeks as the maternal hormones dissipate from the infant's system. Parents are advised not to express the milk, as this can stimulate further production, and no specific treatment is generally required.
Complications
[edit]Witch's milk can last about 6 months then usually resolve on its own.[16] However, the breast area may become red, tender, or swollen, which is an indication that an infectious complication may have risen. These complications include mastitis, cellulitis, and breast abscesses.
See also
[edit]References
[edit]- ^ Devidayal MD (November 2005). "A male infant with gynecomastia-galactorrhea". The Journal of Pediatrics. 147 (5): 712. doi:10.1016/j.jpeds.2005.06.026. PMID 16291370. "full text" (PDF).
- ^ Leung AK, Pacaud D (August 2004). "Diagnosis and management of galactorrhea". American Family Physician. 70 (3): 543–550. PMID 15317441.
- ^ a b Madlon-Kay DJ (March 1986). "'Witch's milk'. Galactorrhea in the newborn". American Journal of Diseases of Children. 140 (3): 252–253. doi:10.1001/archpedi.1986.02140170078035. PMID 3946357.
- ^ Yap PL, Mirtle CL, Harvie A, McClelland DB (March 1980). "Milk protein concentrations in neonatal milk (witch's milk)". Clinical and Experimental Immunology. 39 (3): 695–697. PMC 1538139. PMID 7379333.
- ^ Paturi B, Ryan RM, Michienzi KA, Lakshminrusimha S (May 2009). "Galactorrhea with metoclopramide use in the neonatal unit". Journal of Perinatology. 29 (5): 391–392. doi:10.1038/jp.2008.246. PMID 19398999.
- ^ De S, Taylor CM (January 2007). "Domperidone toxicity in an infant on maintenance haemodialysis". Pediatric Nephrology. 22 (1): 161–162. doi:10.1007/s00467-006-0263-7. PMID 16960712.
- ^ Weimann E (March 2003). "Clinical management of nipple discharge in neonates and children". Journal of Paediatrics and Child Health. 39 (2): 155–156. doi:10.1046/j.1440-1754.2003.00118.x. PMID 12603810. S2CID 34248317.
- ^ Potts M (1999). Ever Since Adam and Eve: The Evolution of Human Sexuality. Cambridge University Press. p. 145. ISBN 978-0521644044.
- ^ a b c Maude I (28 November 2019). Close To Goodness, Close to Sin: Cultural Meanings of Milk in England between 1500 and 1650 (B.A. thesis). University of Nottingham. Retrieved 2024-07-25 – via Midlands Historical Review.
- ^ a b Dayal D, Soni V, Jayaraman D, Sindhuja L, Sachdeva N (September 2016). "Cultural gynecomastia in the 21st century India: "Witch's milk" revisited". Pediatria Polska. 91 (5): 472–475. doi:10.1016/j.pepo.2016.04.010. ISSN 0031-3939.
- ^ a b Peña KS, Rosenfeld JA (May 2001). "Evaluation and treatment of galactorrhea". American Family Physician. 63 (9): 1763–1770. PMID 11352287.
- ^ Calzada León R (2003-04-01). "Pediatric endocrine diseases in pre-Hispanic Aztecs". Journal of Pediatric Endocrinology & Metabolism. 16 (4): 487–494. doi:10.1515/JPEM.2003.16.4.487. PMID 12793600.
- ^ a b Friesen HG, Fournier P, Desjardins P (September 1973). "Pituitary prolactin in pregnancy and normal and abnormal lactation". Clinical Obstetrics and Gynecology. 16 (3): 25–45. doi:10.1097/00003081-197309000-00005. PMID 4590323.
- ^ a b Gomes ÉB, Nogueira CT, da Silva Gomes AL, de Albuquerque Oliveira A, Guimarães MR, Belchior HO, et al. (2024). "Galactorrhea in infant induced by maternal antidepressants use: case report". Brazilian Journal of Case Reports. 4 (3): 30–34. doi:10.52600/2763-583X.bjcr.2024.4.3.30-34. ISSN 2763-583X.
- ^ Bruehlman RD, Winters S, McKittrick C (December 2022). "Galactorrhea: Rapid Evidence Review". American Family Physician. 106 (6): 695–700. PMID 36521467.
- ^ Jean Bertrand KA, Rose NK, Franck LG, Célestin BA, Ibrahim T, N'gouan Constance BU (2022). "Mastitis and breast abscess in newborns and infants". African Journal of Paediatric Surgery. 19 (4): 238–240. doi:10.4103/ajps.ajps_92_21. PMC 9615954. PMID 36018205.
| Source |  | |
|---|---|---|
| Types | ||
| Products | ||
| Containers | ||
| Topics | ||
 | This medical sign article is a stub. You can help Wikipedia by expanding it. |