dear all,

i have permission from the mother to share this difficult situation with you.
please share your opinions with me.

max is five months old. normal birth, normal course of breastfeeding in the
beginning. his mother returned to work when max was three and a half months
old, and he remains at home in the care of his father. max would not take a
bottle or cup, but takes breastmilk from a spoon, and visits mother at work
during the day to breastfeed. starting at four months (two weeks after the
mother returned to work), max started "fighting" the breast and having
difficulties nursing. he latches on and seems eager to nurse, but then pulls
off, cries, fusses, etc.

in addition to breastmilk max is given rice cereal quite diluted with
breastmilk, and fruit. he is generally constipated (this i find puzzling). he
has not been given other liquids and uses a pacifier "occasionally." the
mother states that she gets the impressioni that max is finding nursing
painful and that is why he pulls away. eventually when he is tired or they
nurse in bed, he will get a full feeding.

his weight gain is good and not compromised or changed since this started.
physical exam has ruled out ear infections. there is no sign of teeth or
teething, and when his mother checked his gums he did not seem sensitive.
there are no changes in laundry, soaps, lotions, etc. no dietary changes for
the mother or for max, although the doctor informed them he needs vegetables
now since he is replacing breastmilk with food (aargh - like squash is
nutritionally significant enough to replace her milk). max seems gassy.

max did not have any signs of colic when younger, but "threw up a lot,"
according to mother. someone told her about reflux, but he doesn't seem to
present any compelling evidence that this is the case. the mother has not had
any signs of mastitits, and, there are no overt signs of thrush that she could
think of when i asked her in detail. there has been no diaper rash.

so in which direction should she go? i am leaning towards allergy - try
elimination diet ideas, especially eliminating everything from max's diet,
then trying eliminating things from hers. also, i think the yeast answer might
apply, and how would everyone feel about suggesting a round of treatment for
yeast?

she doesn't think the psychological/separation aspect is the root cause, and i
agree. i think her statement about max seeming to be in pain is the most
significant.

answer, suggestions, wild ideas - i will take them all. these are the most
difficult/interesting cases.

thanks!

carol b.

ps dr rob . . . it is a slippery slope . . . welcome to the fold brother . . .
we have worked our arcane voodoo on you and you have seen the light!