This is a picture of a baby having a feeding problem. All that vomiting 
is not normal, and could be due to pyloric stenosis, especially if the 
baby has been exposed to formula (formula increases the risk...).

Generally overactive MER occurs due to overproduction of milk. The 
breast is so full, it shoots out milk with some force, so that the baby 
has difficulty with the flow. Almost always, these babies gain very 
rapidly, usually around a pound (450 g) per week, and have green, 
mucousy stools from rapid intestinal transit time. Baby is usually fussy 
and miserable.

There are many conditions that can masquerade as OMER (overactive MER): 
babies with tongue tie may have a harder time coordinating their 
swallowing, and may choke, aspirate, and spit up. Babies with dysphagia 
(difficulty swallowing) due to anatomical or neurological reasons will 
have difficulty with a normal MER; and babies with cardiorespiratory 
issues will have increased effort or frequency of respiration (or both), 
leaving less time available to inhibit respiration for swallowing. These 
babies will gulp rapidly so that they can take their next breath.

A careful evaluation during feeding now that the milk production has 
increased will help you to decide which issue is most likely and design 
your care plan accordingly.

And if baby is having such a hard time keeping large feedings down, I 
agree that mom can try much shorter, more frequent feedings.
Catherine Watson Genna, IBCLC, NYC

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