A friend of mine asked a question concerning her cousin's 5 week old baby who is breastfeeding.  Reportedly using a nipple shield for inverted/flat nipples, goes to breast readily, then after feeding proceeds to vomit.  When she gives the baby formula, he keeps it down.  I was at a loss as to what to tell her.  It is not projectile vomiting (asked about pyloric stenosis).  Baby will do this when given breastmilk with the bottle also.  Baby is growing, healthy.  Mom is pumping, but is getting frustrated thinking it isn't worth it if baby is not going to keep it down.  I have not seen or worked with this couple, but they did come in last week for a consult with one of my (daytime) colleagues, unsure what was recommended.  Any possible suggestions for me to pass on that maybe weren't explored during consultation?  Thanks in advance!  Brenda Enfield RN, IBCLC

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