As a way to reintroduce myself as I post so  infrequently, I want to say 
thank you for all the words of wisdom over the  years. I am a hospital based LC x 
10 years and have learned much over the years  reading what others have had to 
say. My practice and views on issues have grown  because of this list. That 
said, I received a call from a mother who gave me  permission to share her 
dilemma in order to find a solution.
    This woman is a G3L3 who had breast reduction surgery in  1994. She went 
from a 32EE to a B cup. She attempted BF with her 1st child 6 yrs  ago and due 
to weight loss issues had to supplement that child beginning around  6wo. She 
did not attempt to BF #2 but is trying with this child who is now  4mo.She is 
seeing milk in this baby's mouth after he feeds but he still acts  hungry 
afterwards. She supplements him with soy formula now after most BF. The  question 
is not one of supply. This baby vomits after every feeding and always  more 
volume and sooner if was just a BF without supplement. She told me she had  a 
friend who is a LLL come to her to observe a feeding who concurred with her  
that the baby did BF well with swallows and the latch looked good but he did  
appear hungry after that feed. She started pumping soon after birth with a  
Symphony for 3 weeks. She now has a Avent. She gets nothing by pump regardless  if 
she pumped after or in place of a feed but she can always get a squirt with  
hand expression.
     This baby BF well after delivery ( a scheduled  repeat c/s). Day #3 she 
started to supplement with Lactofree(both her and her  daughter are lactose 
intolerant and she thought that would be the formula of  choice) He then soon 
started vomiting after feeds and she switched to  Nutramigen. The vomiting 
continued and then looking more like corn syrup. She  turned to soy after that. The 
vomit is usually clear but sometimes  "chunky".
     She is taking only prenatal vits and More Milk  Plus at this time. Upon 
recommendation by the ped, she is now on a dairy  elimination diet to rule out 
a dairy allergy as the cause of the baby's  vomiting. She is eating turkey, 
rive, peanut butter on apples, salad with  cashews with balsamic vinegrette 
dressing. Baby does not appear distressed as he  is about to throw up. She says 
he looks like he is going to burp and then volume  issues forth. If he gets the 
supplement, then he throws up about 1 hour later.  She currently puts him an 
upright position after feeds and the head of his bed  is elevated.She tried 
probiotics with Karo syrup in his formula at peds  suggestion but that did not 
change anything. She still adds Karo syrup to the  formula since he stools only 
with rectal stim which she does every other day  with a return of a pebble of 
stool.
    She was given a prescription for Zantac the she has  filled but not used 
since she has had friends whose children have had bowel  problems after 
staring its use.
    She will be coming to see me at weeks end as she wants  to have pre and 
post feed weights to decide if "BF is worth it" since the  vomiting is always 
worse with just BF. I Her ped does not feel it is reflux but  I feel she should 
persue another conversation with the ped as this  situation is not normal. 
    I was wondering if anyone has any suggestions or ideas  as to what might 
be going on with this child. I recommended avoiding all nuts  and shared with 
her the concern of cross sensitivity of soy with other  allergies. I believe 
she told me that she took the probiotics as well when she  was giving them to 
him.
 
Thank you,
 
Allyson Michaels RN, IBCLC
Charlottesville, VA



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