Rachel,
I think one of the biggest mistakes many LCs make is to think that they must normalize these kinds of 
scenarios as a way to defend breastfeeding. The fact that the family did not detect additional food
allergies until after six months could account for the baby being behind the curve, so to speak. Often 
bleeding resolves with cow milk elimination, but other symptoms continue that are missed, such as 
abnormal stooling patterns, poor growth, eczema, ear infections, poor sleep patterns, hyper-sensitivity, 
"baby acne" and other rashes and of course little interest in solids. 

It is likely that this baby will continue to to develop further allergies unless both mom's and baby's guts 
are healed. This baby may well be deficient in fat-soluble vitamins and zinc as well. I would take a full
history on mom and her nutritional profile (I do this with all of my clients anyway). I would be concerned
about her milk, too, since it is likely that her own health is compromised. After all, the baby can only have 
the same antigens as the mother at birth. So, I always have moms increase anti-inflammatory nutrients, 
especially essential fatty acids, alkalinizing foods and certain vitamins and minerals. 

Heal the mother, you heal the baby. 

Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network, LLC

Need input on a case for which I have permission to post, please reply to
the list.
The child is just over a year and a half, weight 8150 g, length 75 cm (just
below 18 lb, and 30 inches).  Exclusively BF for first six months by his
mother, who has long and good experience breastfeeding her other children,
singly and tandem.  She went on dairy-free diet from seven weeks because of
bloody stools in baby, which resolved and never returned.  Weight gain at
low end of normal until six months, thereafter about sixty grams/month
(about two ounces).  Rest of family (both parents and all siblings) are
above average in size.  

He currently breastfeeds twelve to fourteen times a day.

Specialists have checked for every possible condition that could be
associated with failure to thrive (including lymphoma, leukemia, cystic
fibrosis, metabolic disorders, endocrine disorders, anemia, celiac disease,
all major organ functions, gut fat absorption), and there were no abnormal
findings.  Other food allergies were discovered so now mother and child are
not eating dairy, egg, corn, wheat, soy, peanuts or anything containing
gluten.  Mother well informed about diet, prepares own food and child has
good appetite.  He is developmentally entirely normal, if not precocious,
for example he is out of diapers.  Has never had a GI illness since the
bloody stools in the first few weeks of life, and has always breastfed
without difficulty, no choking, gagging, spitting up, ever.

During two periods, one year apart, since he began weaning foods, he
reverted to exclusive or near-exclusive BF for some weeks.  Both times, he
gained more weight than he normally does on a diet including solids, and
grew in length. 

His slow growth is the focus of concern from parents and his doctor.  Since
no pathology has been found in the child, and despite the fact that his
growth has been noticeably more rapid during the two periods when he was
getting more breastmilk than usual, the composition of her milk has come
under suspicion, and the pediatrician is interested in measuring the fat
content, if a place can be found to carry out such an analysis.  

I am not familiar with the procedure.  How should the milk sample be
collected?  Should she collect one sample from each breast, or should they
be pooled?  Is there a time of day that is preferable, or should she perhaps
collect several, at different times?  And, does anyone know where one would
have milk analyzed for carbohydrate and protein content, should this come
up?  Once the result is back, what are the reference values and limits of
normal?

And, if anyone has anything to add, some stone that has been left unturned,
please post about that too.  I am open to the possibility that we are
dealing with a person whose growth rate is not mainly nutritionally
determined, and I would hate to see a good diet be sacrificed in the name of
boosting his weight for the sake of weight alone.  

Rachel Myr
Kristiansand, Norway



 





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