Witch's milk or neonatal milk is milk secreted from the breasts of some newborn human infants of either sex. Production of neonatal milk by infants usually resolves itself and does not require treatment unless it is caused by an underlying condition or medications. It is thought to be caused by the exposure to an elevated level of estrogen to infants during pregnancy Its production also may be caused by certain medications. The composition of neonatal milk is similar to maternal milk for most of their components except for fats and one type of antibody.
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. Pre-term infants under the gestational age of 34 weeks did not secrete milk as observed in one study. Complications such as mastitis and abscesses are associated with breast massage of the neonate's breast.
The name witch's milk originates from ancient folklore It has varying originations including the central nervous system (CNS), the immune system, mammary glands, and uterus. Development and introduction of any of the following contributes to its production as well: thyrotropin releasing hormone (TRH), estrogen, and dopamine antagonists. Connecting to the pituitary gland via the infundibular stalk, is the hypothalamus of which is the primary regulator of prolactin production. The serum levels of prolactin are typically low in males and non-lactating females, inhibiting possibility for breastmilk production. In the cases that the serum levels of prolactin do become high in these individuals, the phenomenon galactorrhea is to occur.
Witch's milk pathophysiology
Hyperprolactinemia
Witch's milk, or neonatal galactorrhea, in newborns is primarily caused by hyperprolactinemia - abnormally high level of prolactin hormone. Please note that galactorrhea and hyperprolactinemia physiologies are independent of one another. 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.
Prolactinoma
A tumor originating in the pituitary gland is one cause of galactorrhea. However, the breast area may become red, tender, or swollen, which is an indication that an infectious complication may have risen. It is believed that such infection occurs when bacteria from the skin enters into the breast. Additionally, Staphylococcus aureus causes about 85% of cases encounter. However, other bacteria such as gram-negative enteric bacteria, anaerobes, and Group B Streptococcus can be the cause of the neonatal mastitis. The clinical presentation of mastitis can manifest has painful, swelling, and an abscess can form after 4 weeks. Mastitis can occur in one of the breast but in some cases it can occur in both breasts of the neonate. Treatment can be done by using an aggressive course of antibiotics if treated right away and upon diagnosis, which was shown to be 50% effective.
Case studies and reports
Hormone
A 13-day old male infant with bilateral breast enlargement from birth accompanied with recent development of witch's milk presents to the outpatient facility. Upon physical examination, the infant was found to have normal vitals such as heart rate and body temperature. In addition, blood tests, ultrasound, and physical examination found no evidence of complications such as breast abscess. Therefore, the patient was diagnosed with giant mastauxe. Breast enlargement and witch's milk found in this patient was believed to be caused by either the exposure to estrogen during pregnancy or the reduced estrogen exposure postnatally. Neither the patient nor the mother took any medication that could contribute to the infant's breast development. Prior to their presentation to the outpatient facility, the mother did attempt chest manipulation trying to reduce the breast size. 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.
Cultural interpretations
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. Across Europe, neonatal lactation was called "witch's milk", "Hexenmilch" and "lait de sorciere", and it was accused of being a potential source for witchcraft.
Some communities believed that women who has sold their souls to Satan in return for mystical powers would persecute babies by sucking their mammary glands and leaving "witches' marks". This sinister association led to widespread fear and superstitions surrounding the condition of Galactorrhea. Milk would often be used as a ritual offering in various other societies as well including Mesopotamia, Egypt, India, and Europe. In Egypt specifically, milk was rarely consumed by adults but as in the case of early Mesopotamia, was drunk only by children or used in religious ceremonies because of how scarce milk was. However, when the milk came out of so-called "unnatural" places, it was either seen as divine or satanic.
The cultural interpretations of witch's milk vary significantly across different cultures, influencing how parents address the condition when their child has galactorrhea. 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 attempt to prevent the development of large breasts, which are considered inappropriate before the age of marriage. This practice, rooted in cultural beliefs and superstitions, contrasts with modern medical advice which strongly discourages such actions of squeezing the milk out of the breasts because it increases the risk of infections such as mastitis. Making an effort to understand the cultural interpretations behind conditions such as galactorrhea can help bridge the gaps in care that many minority groups face when compared to their white counterparts considering that cultural competence from healthcare staff has been shown to improve general healthcare system quality.
Comparison to adolescent galactorrhea
"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. 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.
In contrast, adolescent galactorrhea occurs in teenagers and involves the production of milk in individuals who are not pregnant or breastfeeding. The causes of adolescent galactorrhea are varied and can include multiple factors. A common cause is hormonal imbalances, particularly high levels of prolactin, a hormone produced by the pituitary gland that regulates milk production. Excessive prolactin can lead to milk production even when it's not warranted. Certain medications can also play a role; for example, antipsychotics might disrupt dopamine regulation, resulting in elevated prolactin levels. Similarly, antidepressants and some antihypertensives can have comparable effects.
Disorders affecting the pituitary gland, such as prolactinomas (benign tumors that produce too much prolactin), are another potential cause. Hypothyroidism, characterized by an underactive thyroid gland, can also lead to higher prolactin levels and contribute to the condition.