I have an interesting mom-baby pair in my practice. I first met the mom shortly after she weaned her previous child at around 9 mos. That little guy had been followed by my partner from birth. He was exclusively breastfed for about the first 3-4 mos, but was always slow to grow and hovered right at or a little below the bottom of the growth chart. Partner encouraged supplementation and early solids (don't get me started), and baby did not grow any faster with these interventions. He also had developmental delay, which became more evident around the time I started caring for him. Thorough work-up revealed that this baby had suffered a left middle cerebral artery stroke somewhere along the line - perhaps even prior to birth. He is now receiving early intervention services, and doing quite well - walking with a limp, talking well for age, and appears to be compensating well. He is still small, although quite healthy, hovering around the 3rd percentile for weight and height. Mom has some feelings of regret and anger over his weaning, since it turned out he had a medical issue not related to her breastmilk likely causing his slow growth. This was the issue that led her to switch to me as a provider. Mom has a new baby now, about 2 mos old. Baby was born at 38 weeks, spontaneous labor and delivery, 6 lbs 9 oz. She has had adequate growth from birth, averaging about 1 oz a day, and at 2 mos was 10lbs 14 oz. She is exclusively breastfed. From birth, she nursed well and frequently. Starting around 2-3 weeks of age, mom says baby is irritable at breast several feedings a day. She arches her back, cries, and will latch and suck briefly, then cry again. Mom describes her letdown as forceful this time around (wasn't with first baby) and baby is heard gulping and sputtering especially at morning feedings. Baby is more irritable, and spits up a lot more than first child did (no projectile or large volume vomiting though) Some times of the day, baby is happy and content, and nurses eagerly and happily, though. At around 5 weeks, baby started to have most feeds be difficult - arching, crying, refusing to latch, than rooting desperately, sucking briefly and crying again. Stool output decreased around this time, too. At this point, I wasn't certain exactly what the problem was, but mom was worried most that baby was arching and refusing to eat, and then spitting more than her other child. We talked a lot about options for treatment, and after careful thought, we decided to try a trial of Zantac. Baby then slowly improved over the next week, and started to nurse happily again. Stools picked back up to nearly every feeding also. At 9 weeks (2 month visit) mom reported that for the last few days baby had been back to refusing to nurse sometimes, and arching her back and crying again. We weight-adjusted her Zantac dose again, and will see how this works. After all the recent discussions here, though, I've discussed with her trying an elimination diet, too, and she is thinking about trying to eliminate dairy and see if her symptoms improve. So what do you all think? One of those rare, true refluxers? Another issue and the Zantac timing was serendipitous? The mom doesn't really want any diagnostic tests at this point, and since baby is growing well, I can't disagree with her. Thought I'd think it out loud here though, and see if there were any other prevailing opinions! Thanks in advance! Jennifer Tieman Family Physician Mom to 4, including my toddler nursling Caroline Rose *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html