Brenda writes:

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 ~~~
Does baby have any sign of breathing issues: stridor, sternal  retraction,
SSB dysrthmnia ( that's my description, not a condition),  breath-holding
while feeding, etc that might make the different flow rate of  human milk more
of a challenge to deal with in some physical way? Usually babies  handle
human milk better, but there's always an exception for some  reason.   I
sometimes say if it goes down more out of control,  it's more likely to return.
Does it happen when baby is nursing head above belly  significantly, almost
sitting, or leaning forward down to breast? Does it happen  if baby is not
moved for at least 20 minutes? Also, this might sound weird, but  I would let
the baby feed with some absorbent material around him/her to catch  the
returning milk, then take it off, and weigh the baby. If it's workable,
weighing before the feed, weighing after the feed but before the vomiting, and
then again after ( with the towel removed and the baby not "wearing" any milk
either") might tell you what small or large portion of the milk is not
staying  down. Sometimes it looks like baby is losing the entire feed  because of
 the way liquids "spread out", but we find out it's a small portion and
baby is  still getting a decent feed. Any possible dietary issues? Just
musing...

Peace,
Judy




Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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