I wonder if there might be a clue as to why this baby spits up after
breastfeeding, in the type of bottle nipple being used.  Besides the flow of
the bottle, check the baby's seal on the bottle nipple, versus the breast.
I agree that overactive letdown might be the problem, but I also wonder if
it could be that he is swallowing more air at the breast than with the
bottle, for some reason.  I would think this would be more likely to be the
case, if this mom is using one of the best bottle nipples, like the Avent.
I guess it could also be that the baby has developed a wierd way of sucking,
that results in less swallowed air with the bottle nipple, than the breast.
Since the baby is willing to take the breast, maybe stopping the bottles and
only having suckling at the breast for a few days, and just dealing with the
spitting up, will give the baby a chance to figure out how to handle the
breast better.  I would keep a good eye on urine output during that time, to
make sure the baby is keeping enough milk down.

I have seen the reverse problem in adopted babies who were spitting up alot
from bottles, but did much better at the breast.  My Thomas was one of
those.  He had been on the standard nipples hospitals use, before I got him,
at 15 days old.  The wonderful NICU nurses who had taken care of him, and
lavished attention on him, sent several pictures home with him, including a
couple of the messes he made after being fed a bottle.  I was expecting a
real spitter, but he never spit up more than a tiny bit, breastfeeding with
the Lact-Aid.  However, when he got an occasional bottle, most of it came
back up all over whoever was feeding him.  I think the problem was that he
swallowed more air with the bottle, because his mouth didn't get a real good
seal around it.

Aloha,
Darillyn

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