If anyone has time to ponder this case and give me some suggestions, I
would be grateful.

Three and a half month old baby boy.  Born at 8-4.   Weight at eight week
check up, 13-5.   Excellent gain.

Problem:  referred by pediatrician because at 14 weeks, baby weighs 13#, a
weight loss over past 6 weeks.Has been well except for one diarrheal
episode back in mid December. Had several days also of blood in stools.  MD
said to watch and wait and see what happened, and they stopped.  This was
when baby was about a month old.

Mom says:  baby eats every hour, has two bms a day, frequent wets.

What I saw:  Friendly smiling baby, strong who likes to stand up and jump.
Has slight snorty breathing sounds.  Has grown in length, is very bright
and alert.   Skin pale (mom says dad is too).  At breast, latches sucks a
couple of times, snorts and pulls off , reattaches, nurses a few sucks,
snorts and pulls off, all the time vigorously kicking feet and wiggling.
Test weighed before nursing, and after 30 minutes of off and on nursing, he
had taken in 62 grams of milk.  Then had large very foul smelling greenish
bowel movement.

What we tried:  Tried different position, getting baby more upright so
breathing could be easier, deeper latch, breast compression when he slowed
down, using football hold.  Helped a little.  Baby is willing to nurse
anytime he sees the breast.

Mom says:  Baby has always been this way.  Dad is allergic to everything
under the sun. Baby gets red rims around his eyes whenever he nurses.  She
eats no dairy.  She does take prenatal vitamins, and eats a lot of chicken
and pasta, and rice.  Drinks mostly water, cannot tolerate citrus  juices
herself,(goes right through)  but tolerates and frequently eats tomato
sauces.

Suggestions: decrease stimulation when nursing, use football hold and get
baby's head more upright, get deeper latch , consider saline nose gtts. for
congestion before nursing, keep a diary of her diet, stop vitamins and
tomato sauces and products, reweigh on Friday, if no gain, then begin
double pumping after nursing and feed baby hindmilk to increase calories.
Will meet with mom again on Saturday.

Do you think these are early allergic symptoms?  MD wants to start formula
supplementation, but I worry about that option since he already seems to be
showing allergy symptoms.  What am I missing?  Suggestions would be
appreciated. Mom very laid back and relaxed with baby, wants to do whatever
it takes.

Ann Calandro, RNC, IBCLC