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Subject:
From:
Rick Gagne & Elise Morse-Gagne <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 17 Jan 2003 23:21:00 -0500
Content-Type:
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Jan, this comes very handy.
Do you ever find that transient lactose intolerance due to antibiotics
takes a few days to show up after the end of the course of medication?
I'd like to make up a handout on lactose intolerance for the moms and their
HCPs.  A draft is below.  Jan, is it okay to incorporate your post like this?
Comments, corrections etc., anyone?
Finally, does anyone find that it helps to treat transient lactose
intolerance due to gut damage as if it were oversupply (nursing one side at
a time)?
Elise
LLLL, IBCLC
Bath, NH

DRAFT; PLEASE COMMENT:

Lactose intolerance in the breastfed baby

Human infants are designed to digest lactose, the sugar found in human
milk.  There are two relatively common situations which can make digestion
of lactose temporarily problematic for the breastfed infant.

(1) "Foremilk/hindmilk imbalance"
Foremilk is the first milk the baby gets during a nursing.  It is high in
lactose and quenches thirst.  Hindmilk comes later, is more creamy, and has
a settling, satiating effect.  If the mother's supply is very plentiful,
the baby may have to drink a lot of foremilk to get to the satisfying
hindmilk.  The extra lactose can cause discomfort, gas, and frequent watery
greenish stools.
         The standard recommendation is to avoid switching sides
unnecessarily.  If the mother has been deciding when to switch sides, she
can instead wait for the baby to signal fullness on the first breast (by
coming off of his own accord or falling asleep) before offering the second
breast.  She can also keep the baby on the same side for a whole feeding,
instead of nursing on both breasts at every feeding.  The goal is to
down-regulate the mother's supply to match her baby's needs.  For some
women it works best to nurse on the same side for two or three feedings in
a row, then use the other breast for the next two or three nursings: for
example, the right breast for morning feedings, the left breast during the
early afternoon.  The mother can experiment over a period of several days
to find out what works best for her baby.

(2) "Transient lactose intolerance" or "nuisance diarrhea" caused by
diarrhea or antibiotics
         Both diarrhea and antibiotics can damage the intestinal lining and
cause frequent, watery stools.  This condition will pass in two to four
weeks BAB 282.  In the meantime Jan Barger, RN, MA, IBCLC, RLC, recommends
giving the baby lactase supplements in the form of two drops of Lactaid
before each breast.  If the drops are unavailable, the mother can divide a
Lactaid capsule in four, crush each piece, and just before nursing, mix the
powder from a quarter-capsule with a little water and give it to the baby.

(Refs Lawrence, BAB)

Elise


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