What's her creamatocrit before, during and after breastfeeding - if available? Someone with gall bladder issues - you might wonder about fat absorption.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Jaye Simpson, IBCLC
Sent: Thursday, July 30, 2009 10:56 AM
Subject: Complicated case - need input - long
Hi all,
Well, I have a case that I am working on that I think is actually way outside my expertise! I'm kid of enjoying the challenge actually. I have not yet seen baby in person but will do so in the next couple days. I'm going to try and give the details as concisely as possible: (I have permission to post)
Baby born 2-11-09 weight 7'3" (3450 gm?)
Current weight as of 7-23 11'5" (5430gm?)
Weight gain over this time period avgs out to about .5 oz per day - EXCEPT that in tracking the weight gain baby is NOT gaining appropriately at all.
From day 5 to 15 she put on 20 ounces - mom supplemented with a little ABM - perhaps 2 ounces per day. Avg gain - 2 oz/dy
After day 15 weight gain dropped to .5 oz through the next 2 months (thru 4-13-09).
4-13 / 6-12 weight gain dropped to .3oz/dy
6-12 / 6-26 weight gain dropped more to .16 oz/dy
6-26 / 7-23 weight gain up to .3oz/dy
Points of interest: Baby had yellow seedy stool for first 3 weeks. Stools then became dark brown and much more firm - this lasted several weeks. Mom reported this as being 'constipation'. Mom took citrus out of her diet and stools became looser and went to lighter brown - mom reports them as "light-medium brown diarrhea like", foul smelling (smells like "poop" not like breastfed stools) - never went back to yellow seedy. She asked Dr about it and he said no big deal - but she has been concerned. (she feels seriously blown off here)
Plenty of nursings per day. Plenty of wet diapers (pale yellow urine - heavy wet). Several stools per day - 3-4 per day or more. Baby started spitting up excessively until mom took most dairy out of her diet in May (3
months) and this reduced baby's spitting tremendously. Baby seems happy and satisfied after nursing.
Dr concerned about weight gain in June and sent mom to a ped. Nutritionist who wanted baby OFF BREAST and to be fed 1tsp of nutramigen powder in bottle of breastmilk each feed. Nutramigen suggested due to possible lactose intolerance. (mom refused to follow this advice)
Points of interest re: Parents:
Dad has Von Willebrand's syndrome (not ruled out in baby yet)
Dad has ulcerative colitis and history of GI issues
Mom has history of GI issues, dairy issues, gall bladder and appendix removed, wheat intolerant, odd side effects to meds, herbs, etc, history of allergies ranging from foods to pollens, molds, prenatal vitamins, calcium supplements, etc. Mom is not taking any meds or herbs that would reduce supply.
My suggestions to her:
Get baby tested for: Von Willebrand's, Celiac disease, blood in stool (due to possible injury to gut from ABM supplementation, mom wheat intake, dairy allergy causing bleeding in intestines due to possible von willebrand's),
Mom: test for Celiac - elimination diet NOW - absolutely NO wheat, gluten, dairy, citrus. Get mom and possibly baby on Probiotics now to help heal gut (this is not my specialty so I am looking for any information to help with this particular issue). Rent a scale in the process to do pre/post weights with baby's feeds to look at true intake at breast to rule out actual lack of intake issue. Change Docs if Ped won't do testing or blows her off again (gave referrals to a few who would listen and test).
Am I missing anything here? Am I on the right track? I think I am.but wanted to get more input. I know something is really not sitting right here.the weight gain, the stools, the smell, the history - doesn't quite smack of a true breastfeeding issue to me but something else that breastfeeding may be getting blamed for.
Please respond privately and to the list. Thank you for ALL input and help!
Warmly,
Jaye
Jaye Simpson, IBCLC, CIIM
Breastfeeding Network
Sacramento, CA
www.breastfeedingnetwork.net
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