[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.
[13][14] The hormone prolactin has a key role in lactation and breast development in the human body and it is also a functional component of homeostasis.
Development and introduction of any of the following contributes to its production as well: thyrotropin releasing hormone (TRH), estrogen, and dopamine antagonists.
Prolactin has a stimulating effect on alveoli within the mammary glands causing the production of milk that consists of lactose, casein, and lipids.
[15] The anterior region of the pituitary gland, more specifically, houses an increasingly abundant number of lactotrophs (stimulated within the physiology of pregnancy) that synthesize prolactin for secretion.
[17] The serum levels of prolactin are typically low in males and non-lactating females, inhibiting possibility for breastmilk production.
Witch's milk, or neonatal galactorrhea, in newborns is primarily caused by hyperprolactinemia - abnormally high level of prolactin hormone.
[3] The other mechanism states that hyperprolactinemia in neonates after birth results from their exposure to high maternally transferred estrogen level during pregnancy.
Its levels increase during pregnancy to prepare the breasts for milk production and remain high after childbirth to continue supporting breastfeeding.
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.
[16] In pregnancy, the lactotroph production increases through means of cellular proliferation of which gives rise to potential for neoplastic development.
[16] When estrogen levels rise in the placental-fetal circulation, breast enlargement in breastfed infants occurs temporarily but also has the potential to last longer in some cases.
[24] 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.
Prior to their presentation to the outpatient facility, the mother did attempt chest manipulation trying to reduce the breast size.
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.
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.
[25] A 16-day old male infant was treated with congenital heart failure presented with bilateral breast enlargement and witch’s milk.
[12] 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.
[13] 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".
[14] 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.
Since so many cultures may have different customs when it comes to addressing galactorrhea, it is important to talk to the patient about the significance they place on "witch's milk".
When these barriers are not identified, accepted, or understood, it can lead to mistrust, dissatisfaction, decreased adherence, and poorer health outcomes.
[30] 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.
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.
In contrast, adolescent galactorrhea occurs in teenagers and involves the production of milk in individuals who are not pregnant or breastfeeding.
[2] Chronic kidney disease may affect the body's hormonal balance, potentially leading to elevated prolactin and galactorrhea.