Hi Rob,
Thanks for your comments about my comments. ;-)

>"Re Rob's case of the fussy baby, this has several characteristics of
>a baby with gastro-oesophageal reflux - possibly mostly silent reflux
>(which feels like heartburn): hates to be lying down, particularly to
>feed; squirms and screams at the breast; wants to feed frequently,
>etc. It sounds also like the whole situation has over-stimulated the
>mum's supply"
>
>Reflux is an idea but why did he do better with the formula feeds?

If the baby was held in a more upright position to bottle-feed, he
may have less trouble with pain while feeding (if he has silent
reflux). I think your original post mentioned that the baby did
better with bottle-feeding EBM as well, so this would be consistent.

>I agree wiht the over supply.
>As to his hating to be lied down, maybe reflux but maybe just a human baby.

True. I suppose I assumed that this may become evident even if still
being held, eg cries when laid horizontal on mum's lap but OK when
held vertical.

>
>>Mom is driving herself crazy trying to eliminate multiple foods from her
>>diet.
>"I wonder if she is doing this well enough, and for each food, long
>enough, etc to give any good clues. If baby is only 3 weeks, then
>there hasn't really been time to determine, for example, whether
>dairy products are a problem. This is further complicated by her
>feeding cow's milk formula to the baby. In fact cow's milk would be
>my first bet here as there have been studies that found a
>relationship between cow's milk protein sensitivity and reflux in a
>high proportion of babies with reflux."
>
>I can agree with the elimination of cows milk from mom's diet but I
>wouldnt give it more than a week to have an effect.

Some of the anecdotal reports (I think from Lactnet in the past)
indicated that for some people it may take up to 3 weeks to clear a
mother's system, although many others say they see in a difference
much sooner than this.

> Again why did he do better, or percieved better, with cows milk
>based formula?

Short-term, I think you often see a baby settle well from a big feed
of formula, just because it is like a big lump in their stomach that
takes a couple of hours to digest. Sort of zonks them out, bit like
we feel after a big Christmas dinner (actually probably more like
your Thanksgiving dinner - you know, turkey and all that stuff).

If it was casein-based (most modern formulas are whey-based, so this
may not apply here), there is a further aspect that casein is
digested down to morphine-like peptides that further zonk the baby
out. Peter Hartmann talks about this and points out that a popular
casein-based formula here in Australia has been advertised as good
for 'hard-to-settle' babies. That's because of the caseinomorphins
(spelling may be out!). Makes sense when you think about *what* the
cow's milk was originally designed for - to keep the calf quiet and
asleep, hiding in the grass, while mother cow goes off to graze for a
few hours. Not very applicable to human babies, though!

>There is only one article I know of with the CMP reflux link.

The ones in my database are:

Iacono G et al, 1996, Gastroesophageal reflux and cow's milk allergy
in infants: a prospective study. J Allergy Clin Immunol 97:822-27

Cavataio F et al, 1996, Clinical and pH-metric characteristics of
gastro-oesophageal reflux secondary to cow's milk protein allergy.
Arch Dis Child 75: 51-56

Hill DJ & Hosking CS, 1997, Emerging disease profiles in infants and
young children with food allergy,  Pediatr Allergy Immunol 8 (suppl
10): 21-26

I haven't gone back to check exactly what they say - just used my key
words to find them.

>
>"However, as a first step, I would recommend a chiropractic check.
>Neck vertebrae out of alignment can be a major cause of reflux
>symptoms."
>
>Youre not really suggesting a praticing Osteopathic physician refer
>to a chiroprator are you?
>At risk of starting a war, we manipulated first.

Oh sorry, I hadn't realised the ramifications of what I wrote. Blame
it on ignorance! I don't think we have osteopathic physicians in
Australia (or not many, if we do). It would sound like an oxymoron to
most Australians, unfortunately. We have nearly all conventional
medical doctors *plus* chiropractors, with few of other types of
practitioners. Conventional doctors hardly ever communicate or refer
to chiropractors (political 'enemies' as I understand it), so it can
get tricky sometimes. I really still don't understand how all the
different disciplines and types of practice work in the US. Please
accept my humble apologies.

>
>" And then perhaps pursue the possible food sensitivities,
>and attempt to control the oversupply. This may need more than one
>side per feed, especially if the feeds are frequent - rather try
>using a set time period per side, eg 3 or 4 hours."
>
>I'm going to call mom today based on this and other who agree with
>the over supply, maybe even have her pump 60 cc of so before feeding
>then stay single sided.
>I'm cautious about the diet elimination without good reason. I think
>this is teling a mom "Its your milk and you falt b/c of what you
>ate" for a condition that is self limited.

Certainly I agree that it is best to try the simple things first -
controlling the oversupply. However, in my experience, I find that it
is useful for the mum to think about *why* the oversupply has
occurred to this extent, and it *may* be diet-related, it may be
birth-experience related or may be neither of these. Some mothers are
so paranoid about 'not enough milk' (often pushed by others around
them) that they go overboard in stimulating a supply to the extent
that is becomes an oversupply.

I am usually counselling the mothers as a voluntary Breastfeeding
Counsellor on the phone, or as a private practice LC, and may only
ever have one conversation with that particular mother, so I tend to
be focussed on trying to get the mother to consider all the most
likely possibilities, so she can go away and work out for herself
what may be impacting her and her baby to create the distress. If the
mother thinks it may be diet-related, I strongly encourage her to
seek professional help with any elimination diet.

I hope this clarifies some of my comments, which I must admit I tried
to make very brief on Lactnet.
******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
******************************************************************

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