I've been reading with great interest the discussion regarding lactose
intolerance. {Chelle Goodfriend can you see my grin :-) ) Those of you that
know me know that Kittie Frantz once called me the *Queen of Overactive
let-down* (With all the queens here I felt I needed to jump in with a title)
What has been discribed is not lactose intolerance but an overabundance of
free lactose. The infant has an enzyme called lactase, but there is only so
much of it to go around. When the baby has a high volume feeding with lots of
foremilk the lactase is temporarily used up resulting in fermentation of the
lactose thus the gas and bloating. That is why lactaide works. True lactose
intolerance in a newborn in extreamly rare. Allergy to maternal intake of
foodstuffs is also uncommon (boy am I gonna hear on that one). Many many
cases of oversupply syndrome are misdiagnosed as: colic, lactose intolerance,
allergy, gastroesophageal reflux, high needs babies etc.
My clinic has been studying Oversupply syndrome since 1989. It all started
with my belief that breastfed babies don't get colic (I have since learned
otherwise, there are the RARE few who have colic.) We see an improvement in
symptoms within 24-48 hours in 90-95% of our cases. A small percentage are
reacting to allergens (Guess which one is most common? Wrong. It's not milk,
in our population it's prenatal vitamins, then cow's milk.) Another small
percentage are the result of fussy mothers: the kind that won't leave the
baby alone for 2 seconds so he can rest. Less than 1 % have colic symptoms
that cannot be resolved.
Stools range from frequent 8-10 per day to once a week. We even had one that
went 17 days between stools the whole time he was exclusively breastfed 6
months --when he went-he went ;-). It wasn't hard to convince mom to stop the
supossitories and rectal stimulation, they both hated it. It hurts to pass
gass, so if you'll excuse the freudian reference, these kids get anal
rententive. They tighten up their buttocks and push the legs down straight.
Put the baby's legs in the birthing position and the anal sphincter relaxes.
People should not be manually stimulating the rectum with anything, you can
cause a vagal-vagal responce and you have a baby with bradiacardia and apnea.
Here's a bit of what we've learned at our clinic:
1. Oversupply syndrome is probably iatrogenic (I figure the good Lord gave us
two breasts because women have twins). Although we do not treat until the
baby is at least 2 1/2 to 3 wks old. The syndrome usually resolves as
maternal hormone levels fall off between 3-5 months post partum. If untreated
it can result in failure to thrive (See woolridge's article on feed
management.) and breast refusal or nursing strikes.
Anytime you change feed management serial weight checks are a must. We had a
couple babies loose a lot of weight.
2. Symptoms are caused by a combination of factors a. air swallowing: getting
too much too fast. b. high lactose feeds.
3. Changing feedings to one breast per feeding instead of giving both is the
first stage in treatment (If that doesn't work we have other protocols)
Babies have to be well over birthweight at 2 weeks (Usually isn't a problem,
as many of them gain 1-2 pounds per week.
I have a whole list of symptoms for mom and baby and treatment protocols. We
developed a diagnostic tool for clinic use. If there's a lot of interest,
maybe I should send it to Jan  B for the Globe.
Marie Davis