I hope I am not simplifying this situation too much. You said the main sup
was Enfamil Lipil. I have seen some nasty stools from this brand and type
of ABM. Thick green stools are certainly something not uncommon with this
brand. I have also seen lots of loose stools while babies are on Lipil.

Just my observation. Could it be possible to try an "old fashioned" non-AHA
ABM if supps are needed and see if the child improves?

You didn't mention any symptoms of OER so I am assuming it is the ABM,
unless the baby is being taken off of the breast before he is able to get
to the hindmilk, which if he tires easily, could also be a contributing
factor. How is mom's Ejection and how often are feedings? Could this,
perhaps be a foremilk-hindmilk imbalance issue, in addition to, perhaps the
ABM issue? Could efforts be made to increase hindmilk for this baby (ie
pumping off some foremilk before feeding when possible ect) be tried?

Mary Jozwiak IBCLC, RLC, LLLL, AAPL
Private Practice

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