In a message dated 09/20/1999 7:03:03 PM Eastern Daylight Time,
[log in to unmask] writes:
Barbara and Kay (and Lactnetters)
I've worked with 2 moms with enterocolitis this year and a few over the past
years as I'm sure others have. Here are some ideas and stories that might
help.
The first case was a 3 month old with blood in the stool. Mom had been off
major milk products only for a week. Frank blood continued. The blood had
started at 2 weeks of age and only being addressed at this point. Mom was
drinking lots of milk previously. Diapers improved with no milk, but not
100% (still pink).
Based on Joan Fisher's Colitis talk at ILCA a couple years ago, I had mom try
Lact-aid. After so long of a time, I figured the baby's gut was probably not
tolerating the lactose. Joan recommends pumping the milk, treating and
leaving at room temperature, and using that milk at the next feeding. She
found 3 drops to an ounce of milk worked for one of her difficult cases.
The mom I worked with did not have a pump and so we used 12<15 drops into the
baby's mouth before breastfeeding (test-weighing showed an intake of 4 oz).
The very next feeding the blood was gone! When she reduced the dose, the
blood returned. We were using enough to get green stools, not bloody. Joan,
via email, recommended that we up the dose until we got yellow curdy stools
again. Due to cost mom did not do this.
The outcome was unfortunately not as happy as was the use of the lactaid.
The blood persisted in reappearing, despite a meager diet. Baby was
hospitalized and ended up on Neo-cate. At $45 a can, our hindsight wished we
had pumped and treated stronger with the Lact-aid..... (even on WIC she was
spending >$200 on formula)
I've kept in touch with mom. Baby has done well and she is finding the
introduction of solids slow as she watches for reactions. Latest call she
found baby not doing well on white potatoes and sweet potatoes.... things she
was still eating.
So, for your client, Lact-aid would be a can't hurt might help idea. If the
allergen has been eliminated it will probably help. If the allergen is still
in the diet, it may not.
My second case this year did not respond to Lact-aid, though we pumped and
used higher doses. Baby also was put on Nutramigen and blood immediately
stopped. Mom eliminated milk completely. At 5 days reintroduction of the
breast was no problem the first day. Gradually though stools got more like
water and the blood returned. This mom did not have the support and time to
do a multiple elimination diet. She is continuing the Nutramigen with one
breastmilk feed per day. Baby tolerates this much breastmilk fine. If she
weren't weaning, I'd try gradually increasing the breastmilk. (Baby is
tolerating this much milk even though mom is eating whatever she wants).
Another colleague of mine had luck with a "rare food diet". She had mom list
all the things that she normally did not eat every day (or more that once a
week). Those were the foods she had for her diet. Blood resolved and I
think the culprit found was corn.
One of my cases years ago was caught while stools were just green. Baby also
had a low grade fever, rash, and stuffy nose and vomiting. Elimination of
milk, eggs, and citrus got things under control. It took 10 days for the
stools to turn curdy yellow. With blood, it may well take longer.
Well, I better stop here for now..... this is a favorite topic of mine.
Natalie Shenk, BS IBCLC
Findlay Ohio USA
[log in to unmask]
(Kay, I had the pleasure of your company at supper with Diane at ILCA in case
you remember)
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