Has anyone heard of the phrase "reducing substance" and know what it means, as it pertains to breastfeeding? I have an interesting situation with a mom - primip, baby is currently 10 weeks and a whopping 17 lbs. Otherwise very healthy and happy, except that he's always had very explosive diarrhea, as well as excessive intestinal gas. Mom says she doesn't feel he's any fussier than any other baby, and has a marked fussy time from 7-9 pm every evening. When I first spoke with her, she explained that the doctor felt they were dealing with a food sensitivity in mom's diet, and they were in the process of doing a comprehensive food elimination diet (they were currently working on dairy and wheat). After hearing about the baby's prodigious weight gain (can't recall birthweight, but it was "average" - 8-9 lbs or thereabouts) and some of his behaviors - fussing at the breast, pulling off, milk spraying, etc, I suggested that she was dealign with oversupply/not enough hindmilk. I offered the standard suggestions. She called me back a week or so later, saying that staying on the breast for 2-3 hours before switching, etc, seemed to be helping, but he was still having some problems with diarrhea. She also said that she had been off wheat for a good two weeks, and had some pasta the night before, and the next day he was extremely fussy, so she was pretty certain he has a wheat sensitivity.
She just called me back again, saying the doctor left her a 15-minute message on her machine (unfortunately, doctor is now out of town for the next three days). They apparently did a stool sample and the doctor said the baby is missing a "reducing substance" which essentially means he's one of the rare babies with a true lactose intolerance. She stated that the mom's two options were a) pump off the foremilk before EVERY feeding for the rest of the baby's nursing career, or b) wean and switch to soy formula.
I suspect baby is dealing with a transitory lactose intolerance due to the diarrhea and damage to the intestines adn they're still dealing with oversupply. If that's the case, I assume the solution would be to switch to a lactose-free food source for a couple days, allowing the GI tract to heal, then go back to breastmilk? If she did this, could she conceivably pump her milk and add synthetic lactase to it, then offer it to the baby?
I told her that I did not think it was a true lactose intolerance because if it was, her baby would have been FTT from birth, not a robust 17 lbs. To me, this still just sounds like oversupply that she hasn't quite got a handle on yet.
She also mentioned that baby will only go 2 hours on one breast - apparently he's gotten accustomed to the flow and gets quite angry when it's not a forceful spray of milk. She said she keeps him on the first breast for as long as possible, but then when he just won't take it anymore, she'll offer him the other side, at which time he'll nurse contentedly for 2 minutes and fall asleep.
Any thoughts are appreciated.
Kerry Luskey,
Minneapolis
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