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Date: | Sun, 24 Jan 1999 00:00:19 -0700 |
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Please help me with all of your wisdom.
Baby boy born 12/5/98. 9# 8 oz at birth. Vaginal delivery. Given soy
formula after feeds for 1st 24h because "he was so big they said he would
have low blood sugar if I didn't give him formula." Formula was
discontinued after leaving hospital. Baby nursed q3h for first few weeks.
First contact 1/2/99. Mom called. Baby was spitting up, very gassy,
gulping and chugging at most meals. Better at night than day time. Baby is
not switched from side to side in the middle of nighttime feedings. Sounded
like oversupply. Suggested two feedings per breast, pump if needed for
comfort only. Call if no improvement.
Second contact about two weeks later. Baby is still spitting up and gassy.
Not gulping as much at breast. Continue to feed one breast every two to
three feeds, consider cutting dairy. Father has "major allergy," and
lactose intolerance according to mom.
Third contact 1/20/99. Baby's stools have turned green all of a sudden
yesterday. Baby is very fussy. Invited her in for consult.
Saw baby 1/22/99. Weight: 11# 8 oz. Palate: WNL. Tongue: normal
wavelike motion on dry finger, extends easily beyond lips. No white patches
on tongue or cheeks noted. Nipples do not show signs of yeast. Urine:
clear, 4 - 6/24h. Stools: varied for dark green to fluorescent green, 6 -
8/24h. Baby is still quite gassy. Mom denies any dietary changes within
the last 5 days other than reducing dairy. Baby has not been left with
anyone else and, until last night, had been given no other foods or fluids.
Mom gave 4 oz formula last night in desperation and stools have a bit of
yellow now. Baby takes pacifier for several hours per day. Attachment was
poor. Baby was held in the crook of the arm and had to curl chin down
significantly to latch to breast. Lots of slurping on the breast.
Attachment corrected to allow for wide mouth. Baby still sucked a bit of
air but not much. Seemed to have good control over the amount of milk
delivered. Took 54cc on first breast by test weight. Baby spit up a bit
and after 10 minutes or so seemed hungry again. Would not settle at first
breast. Moved to second breast. Baby nursed well. He seemed to take less
air on second breast. Total intake from both breasts 94cc. Baby spit up
and was done eating but did not settle well. Mom had lots of dairy during
pregnancy, as well as lots of fruit especially, nectarines, peaches and
oranges. Mom is not eating any of the fruits from pregnancy now. Began to
reduce dairy last week but has not cut it completely. Suggested limiting
pacifier to no more than 5 minutes per day. Feed baby at first breast
unless he refuses then offer second breast. Eliminate dairy completely.
Follow-up phone call 1/23/99. Mom reports baby has been miserable ever
since she brought him in yesterday. Stools are still mostly green with some
yellow. Baby is nursing q11/2h. Frequently nursing for a few minutes
vigorously and then sucking a long time without much swallowing. Suggested
using breast compression to increase fat content of milk. Baby is still
very gassy.
Mom is very concerned that if she "nurses him all of the time now" what will
happen when she goes back to work in two weeks. She seems to be a bit
inconsistent at times with her story.
Question #1: What is causing these green stools?
Question #2: What next?
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