I agree with everyone who has suggested that this baby needs a complete workup. Here are a couple of things I would try in the meantime. Trying to estimate how much this baby is getting during feedings. Either with a test weight or by pumping after a feeding and then pumping under similar conditions the next day instead of a feeding a looking at the difference...by similar conditions I mean approximately the same time of day with approximately the same amount of refill time between feeds for breast....If you think mom is oversupplied and that is contributing to this, then baby may be overeating. Some babies have no sense of their limits or just can't tolerate the amounts they are ingesting. Recently I was told by one mother who gave her baby expressed breast milk once a day in a bottle, that if they put 3.8 oz in the bottle the baby did fine but anything at 4 or above the baby would spit up large quantities... If this baby is gaining weight well and throwing up constantly that would be another pointer in the direction of overeating. Babies ingesting smaller amounts and throwing up huge amounts stop gaining well. How long are these feedings lasting? Some moms of older babies don't understand that if their baby begins to struggle after just a little while on the breast that the baby is actually signaling that they are done and the feeding is over.

Another thing that might help diagnose what is going on is to offer this baby about  2.5 to 3 oz in a bottle and see how he does. Same amount of vomitting? More relaxed feed? If baby does well on bottle, then I would try a nipple shield on the breast to slow the flow down and possibly make the feedings less scary for baby. I have seen nipple shields reduce reflux...actually I have often seen it in the reverse direction. Baby is able to nurse without shield and now mom reports more refluxing.

And for any digestive issues I do always recommend an antiinflammatory diet...how hard can it be to eat brown rice and blueberries and apples and salmon etc etc for a week or so...If mom notices an improvement then I have them slowly add back in their wheat, corn, soy nuts etc etc...I ofen find this a much quicker and more focused appoach than removing foods one at a time which can drag on forever. I did this for two months to figure something out about my own body...if I can do it, anyone can...there is nobody on this planet who likes to eat more than I do.


This is one of those cases that I would love to know what the end result turns out to be...It is frustrating when these scenarios get posted on LN and then that is the last we ever hear. If this baby gets a diagnosis of some kind it would be wonderful if we could all hear about it, to help guide us in the future!

Kathy Lilleskov RN IBCLC

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