hello all,
permission to post 
31 year old mom, G2P2, baby girl born sept-16 @ 38 weeks/ spontaneous labor/ epidural/ no complications/ birth weight 7-5. no antibiotics for mom in labor or after. mom currently on non-rx PNVs, not taking any other meds. hx- had milk supply issues with first baby after went on estrogen contraception at 6-8 weeks and was supplementing by 4 months and struggled with  bf for several more months.

ped dx'd baby with  reflux during newborn exam in hospital. has been on axid 2x/day since 3 weeks of age. (mom's first baby- now 20 months-  was dx'd with reflux too, he did have projectile vomiting, this baby does not). not alot of spitting up but mom says baby acts uncomfortable if not in upright position after feeds, makes gurgling, refluxy noises during sleep. has to sleep in swing or bouncy seat. switching from axid to prevacid because mom doesn't think the axid is working at all.

exclusively bf from birth until yesterday, when mom took baby to ped for concern about stools- "poops all the time: every time she nurses and more/ over 10-12x/day" (not counting "wet farts")- "watery, explosive, yellow, very liquidy, they look *acidic, like they burn* " and that baby screams most times when she stools. describes diaper rash that ped thought looked a little yeasty, mom has been using "triple paste" which when I looked at the container seemed to just be zinc oxide although it says it's "medicated"- maybe I missed other (antifungal?) ingrediants? and ped gave mom rx for topical nystatin for baby's bottom which mom hasn't used yet. 

weight at ped yesterday (oct-22) was 10 pounds (not naked- wearing onsie and dry diaper). diaper change in office- ped saw the stools, says they are too watery. mom reports that ped "tested the stool for allergies" (I asked if she was sure that's what ped checked for, named a few bacteria etc, nope: "allergies"). ped told mom to cut out dairy, soy, spices, and tomatoes from her diet. clarification: "decrease, don't have to completely eliminate but cut down a lot" (??huh?!) and to, firm up the stools, to substitute 2 nursings a day with similac isomil advanced soy formula (yes you read that correctly, mom cut out dairy and soy but give baby soy formula). ped conveniently had a sample to give mom :-). dad fed baby one bottle 11pm that night, took 3.5oz. 

mom called me this afternoon (oct-23) because she doesn't want to give any more formula, says baby has been fussy and crying all day (which is not her normal behavior); has only stooled one time since the formula: today at 7am (it's now 6pm)  (I wanted to see how "watery" the "before" diapers were, she was dry and we had dig diapers out of the trash from that morning or the day before so the liquid had all absorbed; but otherwise they did look normal to me, like mustard and cottage cheese. I noticed some odor- like when a baby is on an antibiotic-- does axid give an odor to urine/stool? mom pointed to .one and said "that one was all liquid" (still had about a quarter's worth of curdy material).
 mom says baby hasn't nursed well since the bottle (mom felt engorged once today, says baby not nursing frequently enough, long enough, or getting enough out before falling asleep). mom says baby's bottom does look improved, probably since she hasn't been stooling so frequently and that she's had a chance to "air out" her bottom between diapers (unable to before because baby usually stooled *during* diaper changes too).  the little redness/bumps she had did look yeasty to me. 
I didn't get to look at baby's tongue but moms says yes she did notice a thick white coating on tongue this am. 

no signs of oversupply/ overactive let down. 
I reassured her about normal frequency and consistency of breastmilk stools. mom says these are much more "watery" than her first baby's and that he only stooled q4-5 days from newborn on (before she started formula). reassured her every baby and every baby's poop is different. we discussed that if mom eliminates dairy, it's total, not just decrease (will be very hard to mom to give up, she consumed a lot of milk, cheese, and yogurt all day every day) (ped did tell mom not to expect results for 4 weeks).... discussed probiotics.... 

what further questions do I need to ask her? what suggestions do you all have? 
thank you all,
vicki hayes rn ibclc in brunswick ga

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome