This situation was described to me this evening by another LC, Judy Oakney, a
hospital-based RN of many years' experience.
Baby girl is now 4 mos old.  Normal vag birth, has always nursed well, is
gaining & growing, has general good disposition, no jaundice, normal yellow
stools.  At 2 mos was treated w/antibiotics for bronchitis.
At 3 1/2 mos, mom saw little specks of bright blood in baby's stools.  Ped
looked at baby's bottom (no other exam), said baby is allergic to mom's milk &
sent them to a Ped G.I.  The GI agreed, said it was 'allergy to protein'.  GI
also noted anal fissures on baby but said that was NOT the cause of the blood in
stools & took a stool culture. GI also took mom off all dairy, citrus, beef,
fish, peanuts, & chocolate (but not  mom's 3 cups of coffee/day).  Mom can eat
chicken, pork, veggies, & non-citrus fruits.  After 2 wks on that diet, stools
still yellow but are 2/day instead of 4/day, & very 'liquidy'.  Baby is now
fussy at breast but still growing.  Stool culture came back & mom reports GI
said the 'good bacteria had gone bad' & gave a new antibiotic prescription for
baby.  Mom says there is more blood now, after 2 wks of diet, but GI had said he
expected it to get worse before it got better.  GI also said he would put baby
on Nutramagen if baby didn't improve after 3 wks of Mom's new diet. Mom said she
made no changes in her routine or diet prior to the appearance of the blood &
fissures.  There are no known food allergies in family per mom's queries of
relatives.  Judy has suggested Mom get 2nd med opinion.  Mom wants to continue
BF & is afraid to call GI w/current status.  She knows he will say to use
Nutramagen.  Also today, baby threw up after a feeding; it was yellow like the
stools, no blood, no mucous.  Mom thought it was bile, but Judy told her since
stomach was full from feed, not empty, it wasn't likely to be bile.  Mom works
part-time but takes baby with her & has given only a couple of bottles of EBM,
no abm.  No other info on poss inside-out cause of anal fissures.  No info to
suggest an outside-in cause of fissures either.
Any suggestions, observations, details left out?  TIA for your help.
Phyllis Adamson, BA, IBCLC
Phoenix, AZ
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