Neonatal Galactorrhea - Milk production in Newborns (Witch's Milk)

Neonatal galactorrhea occurs in up to 6% of term newborns and is usually secondary to transplacental transfer of maternal estrogen. These hormonal effects (maternal estrogens and endogenous prolactin) lead to palpable breast buds in approximately one-third of all term newborns. Males and females are equally affected. In most cases, the breast enlargement and galactorrhea begin to subside after the second week of life in males and 2 to 6 months in females.

                                       Milky fluid draining from the nipple in a newborn

Infants with neonatal breast hypertrophy may be predisposed to infections (mastitis or abscess) possibly incited by repetitive manipulation of the enlarged breast bud by a caregiver.

The differential diagnosis includes early mastitis with purulent nipple discharge.

Management:
Treatment is not necessary unless infection is suspected. Parents can be reassured that this is a normal finding, and followup to resolution should occur at routine well child care visits.



Clinical Pearls:
1. Classical presentation includes the presence of clear colostrum-like secretions in newborns with hypertrophied mammary tissue without erythema or tenderness. Persistence of enlarged breast buds beyond 6 months of age should prompt follow-up with a pediatric endocrinologist.

2. In an older child, galactorrhea may be the presenting sign of hypothyroidism or pathologically elevated prolactin levels.