Hi everyone
I saw a very distressed mother and baby today, and am uncertain how
to help them. She told me a very long story about her daughter's
progress, which I will try to condense here:
Born elective caesarian (previous CS) at term. First 3 weeks fine,
then more and more unsettled - screams for long periods every day,
draws knees up, turns head to one side, becomes unconsolable very
quickly unless held firmly in arms with pressure on stomach. Very
restless sleeper - only sleeps 30 mins at a time, mostly in someone's
arms. Much wimpering, and very restless even when asleep.
Bowels were green, foamy and explosive for first 6 weeks (mother had
oversupply), but then settled to yellow and every 2-3 days. Baby now
12 weeks old. Feeds well, gains weight well, but very unhappy - holds
breath and turns 'blue' if left in pain or crying for more than a few
minutes. Seen by paed who diagnosed reflux on barium meal - tried
cisapride and ranitidine for 10 days with no success (was this a
long enough trial???). Saw a paed gastroenterologist who diagnosed
lactose intolerance (because baby was windy and had a history of
green frothy stools). Told mother to keep breastfeeding and that it
would clear by 6 months (I won't tell you what I thought of that
suggestion). Mother is very motivated to breastfeed, but is exhausted
and is ready to 'give it all away'. There is a history of allergies
in her and partner's families - dairy, peanuts.

Mother is very anxious about her child (had to resus child once after
it stopped breathing after inhaling chloral hydrate prescribed by
paed!!!). They are using a apnoea monitor and baby sleeps in their
bed. Wakes frequently, very restless, cries alot.
I wondered if cow's milk protein intolerance was the answer, and have
suggested she cut all dairy from her diet (she is allergic to
peanuts and already avoids them). I also thought about learned
behaviour in mother or baby. If baby has learnt to react in a
specific way (eg to gut pain caused by original oversupply colic),
then can this continue after the problem has gone. Mother is very
alert to any signal of baby in pain, and I feel she may be
exacerbating her baby's reactions. What do you all feel about this??
I told this mother I would share her plight with the best minds in
the world, and would appreciate any input you have.

Thanks
Fiona



Fiona Coombes MBBS IBCLC               [log in to unmask]
Lactation Consultant, Family Physician
Perth Western Australia