A fast letdown can cause babies to choke, cough, or become fussy at the breast. To manage this, try nursing in a laid-back or 'reclined' position so the baby feeds against gravity, which naturally slows the flow. Alternatively, side-lying feeding can also help the baby control the milk stream better. If the baby is still struggling, burping them in the middle of the feed or using a nasal drop to clear any blockages can also help reduce spit-ups and improve comfort.