This may be a complex problem.  One of the recommendations that often is
given to mothers whose babies vomit or regurgitate a lot is to give the
baby frequent short feedings.  This is interesting and works for bottle
fed babies reasonably well.  However, it shows how you cannot take the
bottle fed baby as the model for the breastfed baby.

It has been my observation over many years, that breastfed babies rarely
vomit or regurgitate while on the breast.  It does occur occasionally,
but only very occasionally.  Even the biggest spitter uppers wait until
they are off the breast before ralphing.  The probable reason for this
is that even with non nutritive sucking, there are likely ripple-like
contractions of the baby's esophagus which seem to prevent
regurgitation.  Thus, a more rational approach would be to keep the baby
on one breast, for as long as the baby wants until he pulls off by
himself.  This will give any milk in the stomach a chance to go on to
the small intestine, and result in much less regurgitation, and thus,
better weight gain.

If this does not work, perhaps thickened feeds might work.  But why
formula in the bottle, why not breast milk?  Why not just pablum after
breastfeeding?

Jack Newman, MD, FRCPC

Jack Newman, MD, FRCPC