This sounds like a baby who might be helped by mom taking pancreatic
enzymes, as mentioned by Dr. Newman in _The Ultimate Breastfeeding
Book of Answers_.  Trying it seems unlikely to cause harm, in any
case.

LLLI's _Breastfeeding Answer Book_ says this (3rd edition, 2003, p. 133):
"Research has documented that food proteins can pass whole into human
milk.  Cow's milk (Sorva 1994; Clyne and Kulczycki 1991), egg (Casas
2000), and peanut (Vadas 2001) allergens have all been isolated in
human milk.  Although for most babies exposure to these food proteins
does not cause a problem, for allergic babies, reactions sometimes
occur.  Although an elimination diet helps in many cases, it can be
difficult, as a mother may need to severely restrict her diet to get
results.  As an alternative, some doctors recommend that mothers stop
breastfeeding and feed their babies hydrolyzed or elemental cow's
milk formula.

"A new, simpler treatment is now available when allergic
breastfeeding babies react to foods in the mother's diet.  Using a
digestive enzyme taken by people with cystic fibrosis to help break
down fats, proteins, and carbohydrates, the mother takes two
prescribed Pancrease MT4-strength tablets with each meal and one with
each snack (Schach and Haight 2002; Repucci 1999).  The effect is to
break down food more thoroughly in the mother's digestive system, so
that the offending food is less likely to pass intact into her milk.

"In one study on this treatment at the University of California at
Davis, 16 breastfeeding mothers began an elimination diet starting
with dairy, soy, nuts, strawberries, and chocolate and began taking
the Pancrease as directed.  In 13 of the babies bloody stools
resolved and colic symptoms decreased while the mothers continued to
breastfeed.  Although this treatment shows promise, more studies are
needed with a control group as well as a treatment group to better
evaluate the efficacy of this new option."

The citations for Pancrease use are:
Schach, B. and Haight, M.  Colic and food allergy in the breastfed
infant: is it possible for an exclusively breastfed infant to suffer
from food allergy?  J Hum Lact 2002; 18(1):50-52.

Repucci, A.  Resolution of stool blood in breast-fed infants with
maternal ingestion of pancreatic enzymes.  J Ped Gastro Nutr 1999;
84:353-60.

On a personal note, my first child had a pattern similar to what you
describe for this baby -- he gained extremely well at the breast (a
pound a week in the early weeks) and all seemed great until one day
there was frank blood in his diapers and he began spitting up
copiously and constantly.  It took me awhile to figure out that a
strict elimination diet (dairy) was the solution for us.  It sounds
as if this dyad has a more severe situation, but I was struck by the
parallels.

Warmly,
Margaret
LLLL
Longmont, CO

>I have read the archives regarding bloody stools but this is a really
>severe case. Any ideas to help this mom would be most welcome. This mom
>nursed her first for over a year no problems except a bit of oversupply.
>This baby was doing really well. born at 8#10 and up to 16# by 2 months.
>Soon after that suddenly had an extremely bloody stool and began throwing
>up - he was unable to tolerate any feedings.
>  He was hospitalised for about 10 days on IV and whenever any kind of milk
>was reintroduced the fussyness and bleeding started again. Stool samples
>tested negative for any known viruses. The ped used the label breastmilk
>colitis.
>  He went home for a few days on neocate and then back into childrens
>hospital for another 10 days. Baby still looks quite chubby in spite of
>having only gained about 3 oz in the last month. This mom can't believe
>shes unable to nurse her baby - she has been pumping now for a month and
>is getting pretty fed up but says she will continue if there is any hope
>of returning to nursing her baby. She is Vegetarian and has taken out of
>her diet all dairy, soy, peanuts and tree nuts and eggs. Baby sees a
>Gastrenterologist this week.  Any words of wisdom??

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