Dear Sharon,

Fussy baby x 3 hours in pm sounds like colics,  Whatever worked for 1 day
probably will not work in long run and baby may revert back to previous
behavior after 1-2 days.  Infrequent stools at this age doesnt
necessarily mean that baby not getting enough.  It is normal for older
babies to have decreased stool frequency with age.  Tremendous variations
between babies: from 2-3 per day to 1 every 2-3 weeks.  Docs always want
to do something about it.  Moms unaware that that stool pattern is normal
variant usually blame all fussyness on infrequent stools.  Would avoid
dilating baby's anus.  Not necessary since the tightness is probably
voluntary.  Dilating will only cause fissures and baby to be in pain and
go even less and fight more.

About lactose intolerance: to not confuse with cow's milk allergy or some
people say intolerance.  Lactose is present in breast milk no matter what
mom eats.  So giving her lactase or restricting her diet will not do any
good.  It is very rare to have congenital lactose intolerance.  Everybody
has diminished tolerance to lactose with age.  Ususally begins in young
adult ages.  Some babies may take in more lactose than they can digest:
ie frequent short feeds (high foremilk and low fat) but these babies in
addition to beeing fussy,and hungry,and gassy they usually have frequent
rather than infrequent stools.  I have used lactase drops on moms nipples
before feeds with some relief for those babies.  Also you may have some
transient lactose intolerance after an episode of diarrhea (usually lasts
for 2-3 weeks max).

In this case would probably reassure mom, see no need for formula and
observe BF to make sure baby is milking breast effectively and getting
plenty of milk.

Hope this helps.

Maryelle
Little Rock