A baby who has blood in the stool at this stage of the game is likely to
have some sort of colitis. While it is highly unlikely that an infant is
allergic to his own mother's milk, it's possible. Severe colitis in the
neonatal period (which is when this baby had the onset, right?) suggests a
metabolic disorder, or a significant intolerance to something in the
mother's milk.

When the onset is during the neonatal time, cow's milk protein in the
mother's diet (Lake, Whitington, &  Hamilton, 1982; Shmerling, 1983;
Wilson, Self, &  Hamburger, 1990) is a likely cause of infant colitis.  The
doctor may be suggesting weaning if he read a study (Pittschieler, 1990)
that concludes that colitis clears up when breastfed babies are weaned and
instead given hydrolyzed casein formula. However, in my opinion, that
particular study doesn't really "prove" much, because as nearly as I can
glean, it did not address the mother's diet. More importantly, if you look
at another study (Anveden-Hertzberg, Finkel, Sandstedt, &  Karpe, 1996) it
appears that eliminating the dairy from the mother's diet brought marked
improvement in the breastfed babies.

Let me caution that we can't automatically "blame" maternal consumption of
dairy products for the bloody stools without a full-blown assessment. Other
possible causes, including maternal antibiotic therapy (Harmon, Burkhart, &
Applebaum, 1992) should be ruled out by the physician.

GI is not my strong suit here, but unless there is some strong and obvious
contraindication, I'd try to persuade the physician and the mother to do
the obvious: Try eliminating the maternal dairy first!  Beware, however,
that the mother's level of discouragement may be so high by now that she'll
need significant support to continue, even for one more day.

_____________________

Anveden-Hertzberg, L., Finkel, Y., Sandstedt, B., & Karpe, B. (1996).
Proctocolitis in exclusively breast-fed infants . Eur J Pediatr, 155(6),
464-7.
Harmon, T., Burkhart, G., & Applebaum, H. (1992). Perforated
pseudomembranous colitis in the breast-fed infant. J-Pediatr-Surg, 27(6),
744-6.
Lake, A. M., Whitington, P. F., & Hamilton, S. R. (1982). Dietary
protein-induced colitis in breast-fed infants. J-Pediatr, 101(6), 906-10.
Pittschieler, K. (1990). Cow's milk protein-induced colitis in the
breast-fed infant. J Pediatr Gastroenterol Nutr, 10(4), 548-9.
Shmerling, D. H. (1983). Dietary protein-induced colitis in breast-fed
infants [letter]. J-Pediatr, 103(3), 500.
Wilson, N. W., Self, T. W., & Hamburger, R. N. (1990). Severe cow's milk
induced colitis in an exclusively breast-fed neonate. Case report and
clinical review of cow's milk allergy. Clin Pediatr (Phila), 29(2), 77-80.

>The mother of a 6-wk old has phoned me for an opinion.  She is
>out-of-state, so I can't see her in person.  Her ped Dr is saying that her
>baby has a rare allergy to her breastmilk.  Here's her story--What do you
>think?    Baby born C-sec.  At 10 days pp mom's nipples were cracked &
>sore, so she was put on antibiotics.  Then yeast & thrush developed, so
>the pair went on Nystatin; then mastitis diagnosed, so mom took
>antibiotics 2 more weeks.  Yeast persisted, so mom & baby used Gentian
>Violet for 5 days.  The entire time baby was supplemented with Similac.  5
>days ago  (baby is 6 wks now) Baby had blood in stool and has been very
>irritable .  After blood in stool appeared Dr. changed formula supp to
>Nutramagen and then told mom to stop giving breastmilk to baby.  Dr. is
>saying that baby probably has a rare allergy to protein in mom's milk. ???
>I have trouble believing that!  Especially since all those drugs in such a
>young baby could be causing intestinal irritation.  Mom returns to ped Dr.
>this am.  Blood in stool is clearing up, so Dr. will likely say it because
>of stopping breastfeeding.  Mom wants to continue nursing , but is afraid
>to go against Dr. advice, and she's afraid that yeast & breast problems
>could re-occur.
> What do you think?


--
Marie Biancuzzo, Perinatal Clinical Nurse Specialist
[log in to unmask]
Resources to simplify breastfeeding management are available at
http://www.wmc-worldwide.com

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