Thank you to everyone who has posted about the 6 week old baby who was vomitng once or twice 
after each nursing...

The Dairy question:
The mom already had herself on a mostly dairy free diet and I requested dairy free meals for her 
from the hospital, which they seemed more than happy to accomodate...how dairy free are they? I 
don't know...I mentioned going off beef to the mother after it was mentioned on the list

The test weighing question:
After my first consult with the mother (before the baby was hospitalized) I did send the mother 
home with a milk intake scale...I also brought her a pump the next evening for her to pump once 
during the baby's longest stretch of sleep...she was able to stop all formula supplementation 
because it became immediately clear that she was producing and the baby was transfering more 
than enough breastmilk the baby just wasn't able to keep it down...but the mother did notice the 
vomiting was worse after formula feeding so she had even more reason to withdraw formula 
supplementation...

To be honest after one visit with her I had a high degree of confidence that there were no milk 
production problems in the mother so I told her she could stop formulation supplementation as 
long as the scale continued to corroborate it (I sent the scale home with her to corroborate) I also 
called her pediatrician's office and the nurse practioner consulted with the pediatrician and they 
both OK'd this....

The follwing day I gave her a pump so that she could say "I get 70 ml per breast" to those who 
would be skeptical of the scale...

We took the scale and the pump to the hospital, and I visit with her daily, trying to be there during 
rounds. At first there was a collegial atmosphere between myself and the attending whom I know 
to have breastfed her own children. The problem was the attending and residents looked like deer 
in the headlights when we reported the information we were collecting from the scale. Everything 
we said to them about milk intake and loss through vomiting as well as his weight gain pattern on 
and off formula- it was exactly the same- seemed to go in one ear and out the other. At one point 
when I was not at the hospital one of the residents instructed the mother to pump and bottlefeed. 
She did this for a few feedings but the baby vomited more after bottlefeeding at which point the 
mother refused to do it anymore.

I am not sure if the attending and the resident assigned to the mother still doubt her production, 
or if they just wanted to thicken the feeds and didn't think they could thicken breastmilk because 
of the amylase. They  wanted the mother to move to exclusively formula feedings thickened with 
rice cereal. When they wouldn't relent on this point things got pretty heated. The baby was a slow 
gainer before and after her was supplemented with formula but he did not start vomiting until 
after he was started on formula. They seemed not to be able to processes this information.

When it was clear they could not deviate from their one and only tool in their tool box- thickened 
formula feeds I asked to have a pediatric gastroenterologist see the baby. I thought this was going 
to be the first type of dcotor we were going to see in the hospital and I know full well if the baby 
had been exclusively formula-fed a pediatric GI doctor would have been called in on the first day 
not the 5 th day. They just have no faith in breastfeeding and it did not matter one little bit that 
we weren't asking them to have faith- we were proving that breastfeeding was not to blame with 
the scale and pump.

Luckily the pediatirc gastroenterologist did not take the baby off the breast. She changed the acid 
reducer and is having the mom pump 2 1/2 ounces from one side, mix it with cereal, and feed it 
to the baby with a bottle and then she is allowed to nurse the baby as he wishes. The baby has 
gained two ounces in under 24 hours.

Now I am trying to prepare for what is ahead. 
If the baby's problems are something anatomic...can I expect the baby to gain without further 
difficulty...will the baby get constipated on the cereal...will he gain slowly because cereal is 
displacing breasmilk from his diet?

Will there be respiratory problems now that there is cereal in the reflux?

If the baby was refluxing due to allergy can I expect allergic symptoms to now appear in his lower 
GI...now that he can actually keep the food down?

Things like this are running through my mind and anyone who has had a similiar experience any 
input they can offer would be greatly appreciated.
Jen O'Quinn IBCLC

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