Well that was a long post (you warned us) to read through, and I was not
following the weight gains/losses exactly, but the gist of the post leads me
to first think of allergy/sensitivity in the infant. Therefore, I would
continue the elemental formula for now, since baby has seen resolution of
many symptoms. I would ask mom to continue pumping regularly while going on
an elimination diet, for sure eliminating dairy and soy, and other highly
allergenic foods like shellfish, nuts, eggs, etc. I think I would also get
her to eliminate maybe some of the herbs, particulary fenugreek, because it
is in the peanut-type family. I would have her continue mostly the
domperidone. Does she even need that? It sounds she has a big stash of milk
so does she have supply problems? How much can she pump? Within a few days
of elimination diet (granted this may be hard due to post-bypass surgery),
resume bf and see what happens. I also wonder about the oatmeal. If the baby
is doing well on the meds, perhaps she can be on just milk feedings,
breastmilk and supp if needed with the elemental. Does she use SNS type
device? This would help to keep baby nursing, if tolerating the breastmilk
on elimination diet.
Also, have mom visit her own doctor or nutritionist to be sure her nutrition
parameters are within normal range. I'm sure a blood test for albumin, iron,
B12 levels can be done. And that she is following the good nutrition
guidelines I'm sure she was instructed on post-surgery. Sometimes years
later, folks become lax about their post-surgery nutrition, and lactation
does put a somewhat increased demand on the body.
The stashed milk and milk she is pumping during the next few days, should be
labeled as possibly containing some offending food, and used possibly later
when baby is older, and has good resolution of symptoms. If that milk is
frozen and placed in back of freezer and away from walls of self-defrosting
freezer, and possibly double bagged, it should last 6 months or more.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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