Hi fellow Lactneters

I have permission to post a client’s case in hopes that someone here has additional information for us.  

The baby is 10 weeks old and I saw them a couple times early postpartum for basic latch help and pumping help (her choice).  Good latch, good supply, happy baby.  They have been exclusively breastfeeding and weight gain was great. Last time I saw them was at 4 weeks, and all was well a week later when I followed up, except a couple of green stools, no other symptoms.  The mother emailed me yesterday and told me that her baby is showing signs of severe food allergy.  At about 6 weeks (4 weeks ago), stools turned consistently pesto-green, and he developed a skin rash.  Then 2.5 weeks ago, stools turned to frothy green, continued rash, and nasal congestion.  Since then they have had a couple of pediatrician appointments and the baby has lost weight (down about 7 oz in 2.5 weeks).  I saw them today, and their baby had lost 3 oz in 3 days, currently 11 lbs 7 oz).  Mom eliminated dairy about 4 weeks ago, and is now off of gluten, corn, eggs, soy and nuts (!!) as of a week ago.  They saw their pediatrician today, who considered admitting the baby, but instead referred them to a gastroenterologist (seeing tomorrow), and instructed them to switch the baby completely to Nutramigen formula, mixed to 24 cal/oz, 30 oz a day.  She was instructed to pump and save her milk.  The baby had blood and stool samples taken and no occult blood was found in the stool, pH is normal.  Blood work included tests for salmonella, shigella, campylobacter, Yersinia entero, vibrio, and EHEC/Shiga toxin, all negative.  The only outlier was alkaline phosphatase at 346, normal range <138. Baby is also slightly anemic (inability of lactoferrin to do its job?).

To top it off the family has plans to take a cross-country trip to Boston on Thursday this week for a 10 day stay.  I am very concerned about this trip, as this baby is in a fragile state.  I would greatly appreciate any information you can offer about this case, and whether there could be a zebra lurking here.  Can the baby see an allergist to be tested for his specific allergies, if that is, in fact what is happening?  Obviously that parents are very concerned and scared, and are devastated that their baby cannot be breastfeeding.  They are committed to breastfeeding and hoping to get back to it once the cause of baby’s troubles is discovered.

Many thanks,
Tanya Powell, IBCLC
SF Bay Area

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