I have a sad story to share regarding green stools.  Last Fall I was
supervising nursing students and one was assigned to a community centre to
learn to facilitate and act as a resource person to a group of new mothers
and babies.  I had been unable to get the health department to set up a well
baby clinic which would have been ideal.  One morning I dropped by to see
how the group was going and while I was there a mother who was new to the
group was breastfeeding her six week old and then changed its diaper.  The
baby had been very irritable at the breast and when I saw the diaper it had
a lime green gelatin like stool in it.  This mother did not know who I was
or anything about me.

I could not let this pass so I introduced myself and asked her how long the
stools had looked like that.  She indicated it was recent she had just been
to the MD the day before who said it was the result of her having had a cold
or something like that.  We chatted about her breastfeeding (i wanted to get
a sense of what was going on with this baby) frequency, duration, infant's
output and my first hunch was the baby was not nursing for long enough on
one breast.  Mom satisfied me she had enough milk had pumped on occassion
and was able to get easily 6 oz. which the baby had been given by bottle.
Output was ok babe had been gaining but if my memory serves me correctly she
indicated a slight weight drop.  From where I was sitting the baby did not
look malnourished or dehydrated but this was not a professional consult, she
was quite an assertive mother but seemed interested when I talked about
nursing for longer on one breast.  I also gave her community resources and
suggested she call her MD again if it did not clear in the next day or two.
She did not indicate the baby had been sick just irritable at the breast.

I was a little concerned because in my experience green stools are related
to high volume foremilk feeds, infection and I have seen a very rare
congenital absence of bowel enzymes that produce these types of stools, in
this case the first baby died and the second was diagnosed before birth and
was kept alive for a while being fed on parental nutrition (IV).

Imagine my shock when I heard a week later the baby had died.  During the
week following my seeing her this mother took her infant back to at least
two MD's our local children's hospital and then a children's hospital in
another city. The baby was discharged and died within 24 hours of being seen
in the hotel where they were staying.  Apparently the baby had developed
vomiting and diarrhea and mother had been recommended to feed pedialyte,
formula etc one MD suggested it was allergic to her milk.

The baby apparently died of severe dehydration the coroner had difficulty
getting specimens from the bowel it was so shrivelled up. What I don't
understand is how could dehydration have been missed? They are having an
inquest, I wonder if there was a combination of problems.

I hope for this poor mother's sake they can find an answer she certainly did
everything possible for her baby. Has anyone got any thoughts on this one?

Susan Moxley IBCLC
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