Carol asks about a five week old baby, excellent weight gain, with reflux
and oversupply issues.  The question about whether it is or is not "severe"
reflux may be moot.  If the baby is gaining weight,  is not aspirating, and
does not seem to be in discomfort from esophagitis, the frequent spit-ups
are more of a laundry problem rather than a health problem.  This is
usually the criteria doctors use when deciding whether to treat with
zantac, proplucid, reglan, etc.
Aside from all the excellent points you have mentioned, I would encourage
you and the mom to look at her dairy intake and see if there may be a cows
milk protein sensitivity.  There is research showing a correlation between
CMP sensitivities and exacerbation of reflux symptoms, for example,

Eur J Pediatr 1985 Nov;144(4):298-300
Cow's milk protein allergy and gastro-oesophageal reflux.
Forget P, Arends JW
Evidence for cow's milk allergy was looked for prospectively in 15 children
with recurrent vomiting. Whereas radiological
examination showed gastro-oesophageal reflux to be present in all patients,
3 out of 15 children presented an enteropathy
associated with an increased number of IgE plasmocytes in small intestinal
biopsy tissue. These three patients did not improve
with conventional medical therapy but a striking improvement occurred
within 24 h on a cow's milk-free diet. We conclude that
diagnostic confusion between gastro-oesophageal reflux and cow's milk
allergy can occur and that the presence of IgE
plasmocytes in small intestinal biopsy tissue indicates IgE-mediated cow's
milk protein allergy. All cases of "intractable"
gastro-oesophageal reflux should be suspected of cow's milk allergy and
investigated accordingly.

If you visit PubMed and type in Cows milk protein Reflux, you will see
several more studies like this.
http://www.ncbi.nlm.nih.gov/PubMed/

My now 17 month old son had fairly severe reflux as an infant but it was
dramatically improved when I went off dairy.  Unfortunately, even now at 17
months, if I have an indiscretion (a slice of pizza, etc) he will  often
respond by spitting up or vomiting later that evening.  Also, I speak from
personal experience when I say that although to the health provider it may
be "a laundry problem", I clearly remember being that mother with a five
week old, who, after nursing for half an hour, shifted his position on my
shoulder only to have him splat ounces and ounces of beautiful milk all
over the bed, floor, chair, wall.  Clean it up, start all over again.  It
is a despairing feeling for the new mom, even when the baby is gaining
adequately.
Hope this helps.
NancyH
Nancy Holtzman RN BSN
Great Beginnings New Mothers Groups
Boston MA
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