Hi from Central Connecticut.  I have recently been working as a pediatric
nurse practitioner and a lactation consultant (IBCLC) with a private
practice pediatrican's office (2 peds and me).  Since i've been on board,
the number of mom's successfully breastfeeding has increased more than
400%.  My senior pediatrician would like a written protocol re: what to do
when thriving babies (ie usu. babies of mom's with overabundant supply) c/o
bloody stools.  What is the first approach if the  baby has a well exam, a
great weight gain, and no discomfort? As an IBCLC I usu. attribute bloody
stools in a thriving baby with great weight gain (> 1oz/day)in a mom who
offers both breasts/feeding according to the clock to foremilk-hindmilk
imbalance:  I reccomend offering 1 breast per feeding, sometimes even one
single breast for a 3-4 hour chunk of time so that the baby receives less
of the high lactose foremilk.  I am assuming that lactose levels beyond the
babies ability to digest lactose (ie insufficient lactase levels to break
down the high lactose from foremilk overload) can cause GI irritation and
bloody stools.  Do you agree with this?  PLEASE let me know what you do
first, second and third with these babies.  It is critical as one of the
pediatricians favors a totoal dairy-elimination diet for 2w and if no
improvement occurs, an elemental formula and the END OF BREASTFEEDING!!!!!
I usu. recc. no change in diet, only a change in the management of
breastfeeding:  using a 1 breast per feeding or a 1 breast per 3-4 hour
chunk of time.  If this continues beyond what the 4 hour chunk of time per
one breast is able to resolve, I may try dairy elimination.  I usually say
that diet is a very rare contributor to this.  After the 1 breast thing, I
recc. dairy elimination (TOTAL!) for at least 14 days.  Please tell me your
opinions!  Maybe I'm off my rocker.......but it seems wrong to stop
breastfeeding in thriving babies because of bloody stools which the baby
has obviously not been upset about!
PLEASE HELP!  I don't want all these special elimination diets to be
impinged upon well intentioned moms: there are enough obstacles to
breastfeeding already.  But.....I don't want to assure beyond what is in
the best medical interest of the baby!  ALL input appreciated!

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