4 mo old cries in pain while nursing at the breast. On the bottle is
uncomfortable, but better and on pacifier is very happy. 100% breastfed. Mom
works hard to get baby fed. Saw 3 pedis and finally got a referral to pedi
gastroenterologist who said reflux and put baby on Zantac. Somewhat better
but it has only been a couple of days. The mother is a very dedicated
breastfeeding mother. Any ideas?
Annie Furie, RN, IBCLC

My gut (heh, sorry) instinct would be DAIRY.  Has mom tried a serious dairy
elimination diet for two full weeks?  I'd suspect she'd see improvement.  I
am really a believer that dairy in the moms diet may cause irritability,
discomfort, and fussy feeding behaviors in babies that have a Cow's Milk
Protein sensitivity.
There is also a link between  CMP allergy and GastroEsophageal Reflux.

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=4076244&form=6&db=m&
Dopt=b which says:

Cow's milk protein allergy and gastro-oesophageal reflux.

Forget P, Arends JW

Evidence for cow's milk allergy was looked for prospectively in 15 children
with recurrent vomiting. Whereas radiological examination showed
gastro-oesophageal reflux
to be present in all patients, 3 out of 15 children presented an
enteropathy associated with an increased number of IgE plasmocytes in small
intestinal biopsy tissue.
These three patients did not improve with conventional medical therapy but
a striking improvement occurred within 24 h on a cow's milk-free diet. We
conclude that
diagnostic confusion between gastro-oesophageal reflux and cow's milk
allergy can occur and that the presence of IgE plasmocytes in small
intestinal biopsy tissue
indicates IgE-mediated cow's milk protein allergy. All cases of
"intractable" gastro-oesophageal reflux should be suspected of cow's milk
allergy and investigated
accordingly.

That would be my best guess.
Runner up would be asking more questions to see if it could be a possible
foremilk/hindmilk imbalance or overactive letdown...
color/smell/consistancy of stools, weight gain history, fussy/gassy
behavior, etc.   Interesting because baby seems more comfortable when milk
given in a bottle, maybe less of a lactose load in the milk that way?

My money is still on the Dairy, though.

NancyH
Nancy Holtzman RN BSN
Great Beginnings New Mothers Groups
Boston MA
mailto:[log in to unmask]
http://www.great-beginnings.com

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