>
> I am hoping that someone can help me figure out what might be going on with this mom and baby. Baby was born full-term 7# 3oz. At 1 month, 9# 4oz, at 2 months was 10# 4oz. At about 3 1/2 months mom noticed baby very fussy and began spitting up a lot. Went to see doctor at 4 months and weight was 9# 9 oz. Dr sent baby for tests: ultrasound on stomach, thyroid, and other bloodwork which did not find anything wrong. Zantac was prescribed along with adding powdered milk based formula to expressed breastmilk. Mom reported after one week baby lost weight even after keeping everything down (do not have weight from that visit). Mom told to add hypoallergenic formula, 1 scoop to 2 oz of her milk. after 1 week weight gain observed of 9 oz. Mother contacted me to evaluate feeding. Baby now 4 3/4 months weighing 10# 8.6 oz (weight gain of 6.6 oz from 9 days previous). baby transferred 2.4 oz from one breast and did not want other side. Observed baby squirming, fussy, pulling back indicative of forceful letdown. Baby did better in upright position, tried laid back position but did not like.Mom really does not want to give any formula. Suggested 1 breast per feed for up to 3 hour block of time, lots of skin-to-skin, and smaller more frequent feeds ( Dr had suggested 5-6 oz feeds with 1 scoop formula every 3-4 hours). Concerned about mother's supply at same time so told her to pump other side when baby feeds. Had asked mother if she changed anything in her diet and she said no, but when asked about milk she said that she does have a history of a milk allergy but has milk twice daily. Suggested to eliminate all dairy and soy for 3 weeks. Spoke to mom 1 week later and baby had lost 4.6 oz. . She said that Dr advised to feed all formula and she wanted to wait 2 weeks to see if things improved. She eliminated dairy and soy, but doing both sides/feeding, giving 2oz supplements after feeds (restarted formula 1/2 scoop for 2 oz). Dr called in GI specialist and plan to test stool sample. She wanted her milk tested at Milk Bank: 1 sample 24kcal, another 30 kcal. So she knows her milk has sufficient calories. My question is, was it possible that mom had oversupply issues at first and baby was getting too much lactose which then irritated the intestines causing the reflux? If it was a milk allergy, wouldn't it have manifested itself sooner? Before this problem arose, this mom had also using an electric double pump averaging 2 times at home and one time at work to collect milk -had to do more pumping at home since there were issues at work (this was discussed further). This mother really wants to continue breastfeeding and is now being told that formula is the answer. Anyone have any ideas? Would appreciate your thoughts!
>
> Esther Gillett RD, IBCLC
> Columbus, Ohio
>
>
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