Maryelle (especially!) and other netters:
   Need your input on this dyad. 5 month old boy whom I have seen in the
past, with a history of vomiting and colicky behaviour at any time that mom
tried to introduce formula. First time was a soy formula. Mom went back to
exclusive BF, and problems resolved. Baby is gaining well, nurses well, is
content.Mom went several months, then returned to work. She pumps for the
time she is away from baby, but has sensitive nipples, and really does not
enjoy pumping, so wanted to try one bottle of formula while at work.She tried
one bottle of Good Start each day. This week, baby has regurged (has a
minimal to moderate reflux normally) breastmilk several times with blood in
it. Mom can express no blood, tho she did at one other time have this happen
when she had a cracked, bleeding nipple. Nipples are fine now. She also
states that stool is much darker color this week. Baby acts fine, sleeps
fine. Consider:
   1) mom has intraductal bleeding? (but can express none)
   2) baby has esophageal or gastric bleed?
With the history, mom thought she should try Nutramigen rather than another
milk based formula, with which I concur, if she wants to use formula.  She is
fine with understanding of GE reflux being normal, but the blood concerns
her.
Recommendations?  Thanks!

Denise Mollenkopf, RNC, IBCLC
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