Can I just take a second to scream?  UGH!!!!!
I just finished talking with the pediatrician about the baby with the dark
green stool.  Allow me to fill you all in on the history a little more.

September 7th Mom came to office and was concerned about baby's sudden
fussiness and the way he was acting at the breast and in general.  On
observation of a feeding I really felt like he was acting like he had an ear
infection or something like that.  I am not a doctor and I did not look in
his ears but I did suggest that she call the pediatrician and have him
looked at to rule out any illness.  (she sees military doctors)  The doc
that saw baby (I'll call Dr. W.) said that the baby was fine, no problems at
all maybe he is teething, basically told them to go home because baby's get
fussy sometimes.
   The next week they came to my office because the problem was continuing.
I really could not see any reason other than illness for the baby's actions,
certain positions seemed more comfortable for baby and baby really would not
lay back at all without screaming, appeared to me that baby must have an ear
infection.  Again suggested mom call ped.  This time her regular
pediatrician was on (DR. D.) Dr. D said to mom "why did you wait so long to
bring him in if he has had these symptoms for so long, he has a horrible ear
infection."  She informed him about the visit with Dr. W. ... Dr. D puts
baby on antibiotic.  Baby gets rash (and I think some GI stuff but can't
recall exactly) from antibiotic so they switch to a different antibiotic.
Baby takes full treatment of antibiotic.  Baby started having these stools
at some point during all of this and as I said before when mom first told me
about them, without me seeing them myself, I thought that it was most likely
the illness and meds etc.

A week ago baby went to Dr. W for a recheck from the ear infection and to
recheck weight gain. Mom told Dr. W about the stools and the continued
fussiness.  Doc said it was normal, and that baby might be teething, and
they should start the baby on cereal to help with the weight gain.
However... when babies are seen for sick visits they do not weigh them
naked! They only weigh naked on well baby checks. They strip them to diaper
only and don't even check to see if it is a dry diaper.  Mom did not really
want to start cereal because she feels baby is not ready for cereal yet and
that there really was something wrong, that the doctor was not listening to
mom.

 Not satisfied that things were going well, and with a baby who is still
often fussy,  mom came to me on Monday to get her baby's weight checked.
Baby was down 1 ounce from last Thursday's weight.  I gave mom info on
starting solids from various sources and suggested that she do some things
for the teething also. Now, all this time I have noted that the baby is
nursing about 8-10 times a day and on test weights has been consistently
averaging 3-4+ ounces each time.  Usually these observed feedings are what
mom would describe as either not as good - average compared to his feedings
at home.  Mom has increased appropriate fats in her diet, cut out dairy,
evaluated her own diet and we have talked about good nutrition, all of which
mom seems to have been watching carefully.  She has one child in all day
kindergarten the other is 4 and at home and dad is very supportive and
involved in caring for the children.
     Recheck on weight on Wednesday (2 days) the baby had gained 2+ ounces
from Monday.  Mom had increased number of times baby was nursing by giving
him 15- 20 minute break after he seemed satisfied and then getting him to
nurse more.  She said dad tried to give the baby cereal and on Monday baby
took a  couple of baby spoonfuls but refused it on Tuesday.  They did not
try again.

NOW FOR YESTERDAY:   Baby is down from Wednesday's weight about 1 ounce.
Overall, baby weighed 11 # 8.5 ounces on September 2 and 11# 7.6 ounces on
October 7.  I saw the diaper... as described before... I advised mom call
pediatrician and ask for baby to be evaluated.  The pediatrician called her
back while we were still in support group and even with my description (mom
talked to pediatrician and told her that I recommended they have the baby
evaluated) The doc (Dr.W) said they could see the baby next week, but that
it was not unusual for baby's to have these kind of stools, and that the
weights have been fine according to their chart.  Mom was insistent but Dr.
W would not see them.  Mom has many times stated that she does not trust Dr.
W because of the whole ear infection situation and because she feels like
she does not listen to her concerns at all.  I remained supportive but also
politically correct because while I think that Dr. W is a Bozo, I would
never share that with a client. in my mind when I saw the stool I was
thinking CF, but I thought they would be frothy or fatty.... Also, it did
have a metallic smell, an odd odor that I just can't put my finger on.

I just saw Dr. W in the hall, I stopped to talk to her about this patient,
she said to me... ...Whatever you said to that mother really had her upset
and got the family started calling all around last night, you really upset
them....... In fact she would not really let me get a word in at first.  I
tried to keep it about the baby's stools by saying, " I have seen a lot of
green stools, but I have not ever seen anything like that.  It was about a
half a cup or more of dark blackish green  liquid stool with the consistency
of ketchup and had this odd smell like aluminum foil or something metallic"
But Dr. W kept it about me...... well what you did was really get them
worked up, now they are convinced that something is wrong and would not let
up last night, she said she started to tell them to go to the E.R and let
them really get upset because then they would have to wait 3 hours or more
to get seen.....  She went on and on about my judgment and "whatever you
said to them"   Finally when I could take no more, I said...  Actually, mom
has told me several times that she has been upset with the fact that she
feels something is wrong with her baby and that her concerns are not being
addressed by you.  I have been supportive of your plan of care, and giving
mom support with feedings.  I told mom that even I thought that the stools
she described were explained by the events that had gone on before but that
I was surprised that he continues to have them over 10 days later(after
antibiotics complete) and that this stool was not what I was expecting, and
you would want to know . I told mom that if the doctor has a look at the
stools, she would be able to determine if it is normal or if it  warrants
further evaluation. .....
         Dr. W finished our talk by telling me that the baby's weight has
been fine and there was no reason at all to feel that the baby had anything
wrong. She also said that she thinks that maybe mom does not have enough
volume of milk or fat in her milk, she has seen this happen before to people
who successfully nursed other children, suddenly their milk does not have
enough fat and the babies do not gain weight, but they do start to gain when
they get formula. Dad called last night and was angry and insistent so mom
is bringing the baby in to see Dr.D today in clinic, and once he talks to
them and tells them everything is normal maybe then they will calm down....
I said that I was glad they were able to get an appointment sooner than next
week because I know that it will make mom and dad feel much better.

And... I did not trip Dr. W. as she walked away...


Pam Price IBCLC, CBE
Lactation Services Coordinator
Women's Health
Trident Health System
9330 Medical Plaza Drive
Charleston, S.C. 29406
(843) 824-5013 office
(843) 728-9640 pager

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