Dear Denise,

The story you report is very concerning.  This baby definitely needs to
be checked by a pediatrician or a pedi GI. The way I understand the story
is that the baby never did well on soy and now that he is getting cow's
milk he is vomitting blood.  He also has had a change in the color of his
stools to black or darker than nl.

1.  the behavior of the baby on soy suggests some allergic reaction.
Does he also have diarrhea, more emesis or blood in stool? Is there a
family history of allergies (atopic dermatitis or exzema, athsma)?  If
yes it raises you index of suspicion even more.

2.  babies allergic to soy are often allergic to milk and vice versa. So
this would fit this baby's description.

3.  the fact that he vomits blood now that he is consistently getting
cow's milk suggests some type of reaction of his stomach causing him to
bleed.  other things that I consider are
        - if a lot of wretching may have tear wher esophagus and stomach
join (this is called a Mallory Weiss tear)
        - esophagitis fron the reflux is possible but would be uncommon
        - gastritis (inflammation of the stomach) whether or not from an
allergic reaction(this would be high on my list because of the presentation).
        - some type of vascular malformation of the upper gi tract which
would bleed.  (often associated with similar lesions on the skin such as
angiomas and spots on the lips like in Peutz-Jeger.....) this is rare.
        - always possible to have a bleeding duodenal ulcer (have seen it before)

What should be done?
1.  Baby having black stool probably lost a significant amount of blood
so doc needs to see baby to make sure is stable and check blood count
(may be anemic)

2.  Usually if acute we pass a small tube in stomach while baby
anesthetised to actually look at the esophagus, stomach and duodenum and
make the diagnosis.  This is called an EGD or Upper endoscopy.  Takes 5
min in experienced hands and allows you to take biopsies and make
diagnosis (if allergies often time will see eosinophils, a particular
type of inflammation in the stomach).  Also allows you to see esophagus
and rule out esophagitis,.....  Important because all of these conditions
have different treatments and you need to know to pick the right one.

3.  If allergy, agree that patient should be on elemental formula as you
suggested

Doubt the visible blood in the baby's vomiting is related to invisible
blood in mom's pumped milk.  The times I see blood from mom in emesis of
baby is when baby nurses at breast with cracked and/or bleeding nipples.

Hope this helps.

Love this type of ?.  Keep them coming

Maryelle
Little Rock AR