The congestion makes it sound as if baby is aspirating during feeds.  This could be due to fast flow or due to oral anatomy issues or both.  I would want to see and hear baby at the breast and with a bottle to determine how baby is coordinating suck, swallow and breathing.

I wonder about the pacifier.  Often babies whose moms have oversupply want to suck more than they need to get a good feed and will happily take a pacifier.  I would want to know if this baby is able to hold onto a pacifier because the pacifier refusal and difficulty at the breast and with a bottle suggests to me that he could possibly have challenges beyond oversupply.

Has the baby been assessed for tongue and or lip-tie?  Does he ever have milk come out of his nose?  Does he squeak or click during feeds?  If you have an appropriate scale, it would also be informative to do a before and after weighing to determine intake.

Laid-back breastfeeding www.biologicalnurturing.com is very helpful for managing flow.  I would start with this as it is the least interventive and can also address many difficulties.  If oral anatomy is normal and baby is gaining very fast, I would also consider full-drainage and block-feeding.

http://www.internationalbreastfeedingjournal.com/content/2/1/11

This does reduce supply, so I would want to be sure that baby can transfer milk well without an oversupply.

Laura Spitzfaden, LLLL, IBCLC

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