I have permission from the mother to post for further information. I first met this lady when her baby was 6 weeks old. Until this time she had breastfed exclusively, every 3 hours and had a very settled and content baby. Suddenly, at 5 weeks the feeds became hourly with the baby crying inconsolably in-between feeds. He stooled 8-10 x/24hrs and gained higher than average weight. Having ruled out over supply, over active MER, I thought perhaps a lactose overload and suggested she fed from the same breast for a period of 3 hours. 

A few hours after the consultation, the baby was very distressed so the parents had him checked at the hospital. A chest x-ray (baby was snuffly) and abdominal x-ray revealed all was normal and the paed confirmed what I had said, a lactose overload. So for the next 24 hours the family fed from one breast for a period of 3 hours with some improvement until after only 12 hours of slight improvement, baby was back to crying in-between feeds and inconsolable. In desperation, the mother expressed and bottle fed with EBM but crying continued. In further desperation, the parents fed formula for 24 hours and the baby stopped crying, fed 3 hourly and was the calm baby he was before he hit 5 weeks of age. 

The same pattern occurred when her eldest son reached 5/6 weeks. Her paed told her the baby was lactose intolerant and gave them a lactose free formula. When baby was introduced to breastmilk, crying started again. Consequently, weaning commenced and the baby settled on a regular formula (with lactose!).

This mother is under the impression that her milk is bad for her babies but is desperate to breastfeed. For her and the family, pumping before each feed to reduce lactose content is not really a realistic option. Has anyone a suggestion to help this dyad? 

Paula Miller IBCLC
Dubai

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