Lynn - to answer your last question first, the short answer is Yes, I've 
heard of this test (for reducing substances) way too often -many of the GPs 
in Harare would do a stool test, then pronounce "lactose intolerance" and 
put the baby on to a soy formula.   Soy contains no lactose because it is 
not an animal milk.  But approx 40% of babies who exhibit symptoms of cow 
protein sensitivity, which is what I think these babies were showing, ie to 
protein not to the sugar in the milk (in this case to cow's milk proteins 
in the mother's diet) can also become allergic to soy. The "symptoms" you 
describe were often mentioned too - baby gaining weight well, obviously 
having good intake, but described as "drawing legs up and screaming".  When 
I was able to actually observe this, what I saw was a baby who was not 
necessarily in pain, but angry.  It's a question of what you "see", or how 
the baby's distress is interpreted, since they can't actually tell us.

I think you have "fixed" the problem already, actually.  You mention that 
mom eats 5-7 servings of dairy per day, so you red-flagged it.  If this was 
my client I'd also suggest absolute elimination of all bovine proteins 
(that's all dairy and all beef and all foods containing any quantity of 
those items) - and expect symptoms of continued distress in the baby for 
about three weeks, but the most important thing is to keep on exclusively 
breastfeeding.  Bovine proteins can be expressed in the mother's milk and 
can damage the infant gut, making it temporarily lactose intolerant.  The 
trick is to reduce exposure to bovine proteins, rather than give up 
breastfeeding!   IME, if the mom was diligent about eliminating bovine in 
her own diet and continued to offer the breast very often to comfort the 
baby (these babies often want to suck a lot for comfort, which is what I 
think stimulates something of an oversupply - ie oversupply is another 
symptom, not a cause) then after 14 - 20 days the baby miraculously becomes 
calm and almost a different baby.

I think it is more difficult to persuade the mother that such strict 
modification of her own diet is necessary than it is to fix the problem for 
the baby.   I used to do an extremely painstaking history in order to 
attempt to show the mother that bovine proteins were almost "poison" to her 
baby.  Often there would be a mother who actually hated milk on its own 
(disguising the taste with something) or craved it, drinking pints every 
day.  And maybe antibiotics for either herself or baby in the last few 
weeks.  And somewhere in the family would be eczema, asthma, hayfever, 
showing that there might be a family history of risk to dairy products and 
beef.

Best wishes.  Please let us know what happens, if you can.

Pamela Morrison IBCLC
Rustington, England.

At 05:05 26/11/2005, you wrote:
>Date:    Fri, 25 Nov 2005 21:10:01 -0600
>From:    Lynn Carter <[log in to unmask]>
>Subject: "lactose intolerance"
>
>Yeah, same song, zillionth verse.
>
>I am working with a mom who initially presented as having a 12 day old 
>baby who was lactose intolerant.  I checked to make sure it wasn't 
>galactosemia.  Baby has abundant yellow seedy stools, gains 1-1.5oz per 
>day, and has several daily episodes of drawing up the legs and 
>screaming.  Sure sounds like mild oversupply to me.  Previous child was 
>bottlefed EBM plus lactaid, and mom just can't keep up with that regime 
>for this baby, which is why she called me.  In addition, Mom eats 5-7 
>servings of dairy per day, so I red flagged that.  We talked about 
>switching sides q3-4 hours and cutting out the dairy.
>
>So why the diagnosis?  Because her pedi did a "stool residue test" which 
>showed that the stool had "way to much lactose left in it."
>
>Mom sort of believes me, because I described to her what she would be 
>seeing if her baby were truly intolerant of the chief carbohydrate in her 
>milk!  She was nervous to restart bf (had weaned to soy) bc she was afraid 
>of hurting baby's tummy.  I told her gently but directly that weaning a 12 
>day old had far worse consequences than a few days' sore belly.
>
>So my question is, have any of you heard of using this stool test with a 
>bf baby?  And is there some standard for how much lactose should be in the 
>stool?  And why is this test appropriate for a baby who appears to be thriving?
>
>Lynn in MO USA

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