I am a PNP/IBCLC working with a great pediatrician who is very supportive of
breastfeeding.  He has posed an interesting question that I was unable to
answer and am looking for some insight:  In an exclusively breastfed baby
whose stool pattern has gone through the expected change at a few weeks of age
from frequent smears to infrequent, voluminous stools - he has noticed that
after a few days of not stooling and presumed accumulation of some stool in
the colon, SOME babies become uncomfortable during what is assumed to be a
gastrocolic reflex during the feed.  These babies then arch and pull off the
nipple, strain, and eventually (after several miserable breastfeeds, sometimes
after several miserable days) defecate and become happy nursing babies again
only to gradually become uncomfortable after a few days of "build up".
Theoretically, this makes sense as stooling after/during meals is caused at
least partially  by gastrocolic and duodenocolic reflexes.  These reflexes
result from distension of the stomach and duodenum.  Thoughts?  Feelings?
Thanks, Janna Zempsky, CPNP, IBCLC - West Hartford, CT
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