Hello

I followed the discussion about blood in the infants' stools as related to
allergies with interest.  Not only did I have a mother calling me with the same
problem around that time but I also suspected tht this could induce some red
flag reactions in some hysicians who might not consider allergy as a cause.
Now I have a LLL Leader calling me to talk over some situations because a new
pediatrician at her hospital has managed two infants in a way that has the OB
nurses, the mothers, and this Leader feeling uneasy.

Two questions:

1. A 7 wk old infant with history of good, uneventful birth, good weight gain,
mother and infant in good health has had blood clots in the stool.  I had
always thought of the blood seen in the stool as perhaps streaks or spots, as
opposed to clots.  The family practice physician talked to this peds ( a
single, childless, female) about management and the ped. dr. said that
something in the milk is affecting the baby and took her immediately off of
breastmilk.  Mother is pumping and has been told to feed nutramegen (sp?) in
the meantime.  THe family practice doc wants to know if there are any articles
about blood in the stool due to allergies.  The baby's father has several.  We
discussed blood in the stool of an exclusively bfd infant and allergies but
'clots' put me off.  Could there be that much blood loss that there would be
clots (I don't know of what size.)  Other  than the discussion here on LACTNET
are there any articles, clinical reports or studies on this?  Or are we being
typical clinicians and finding this out emperically and sharing it without
writing these cases up (no insult intended - but we know that knowledge spreads
faster sometimes by word-0f-mouth rather than the printed word : 0).  I'm just
hesitant about the the seemingly larger amount of bleeding going on but think
that it might indeed be allergy.

2.  This same pediatrician has just hospitalized a baby whose jaundice had
peaked at a 20 bilirubin.  It has been slowly resolving, not increasing at all,
but slowly decreasing.  Now this doc is telling the mom that the baby isn't
gaining enough and that something is wrong with her breast milk.  This 11 day
old is two ounces shy of her 8lb. 4 oz. birthweight and stooling three times a
day, and voiding ok.  The Doc says three xs a day is not enough,  that she has
to stop bfg and give the baby formula FOR MORE CALORIES and has admitted the
baby and inserted an NG tube.  The mother is pumping 2-4 oz. every time and
seems to have no problem with supply.  This doc has been talking to a
neonatologist and wants to due a barium study!!!   The baby looks good, acts
well, has been gaining weight but the doc wants the baby fed with abm until the
birth weight is regained.  Is anyone else's ire rising!!??  The mother is
refusing to transport the baby for this test and is very frustrated with the
doc but young and not so knowledgable about babies.  Neither is this doc,
huh??!!  I read to this Leader about the caloric content of human milk and
suggested the nurses ask to have both Riordan/Auerbach's  book and Lawrence's
available at the nurses station for reference - maybe this doc would actaully
pick one up someday and use it!! Any comments and ideas for education welcome.
By the way this doc claims to be pro bfg but tells mom to wean at six months
and give the baby a cup not a bottle and writes discharge orders stating that
mothers should not sleep with their babies.  Sounds like she is trying to
manage every baby so that it never has bottle mouth cavities, doesn't get
attached to bottles and keep them as a toddler, doesn't die of SIDS or being
"overlayed" - has and I'm just trying to be nice and give her the benefit of
the doubt.  Sounds like she doesn't ever want anything bad to happen to a baby
in her practice so instead she's doing all the damage herself by over treating
and testing and being so aggressive.  YIKES.


Mardrey
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