I am working with an  couple with a 9 week old baby girl, growing beautifully
and otherwise well, who has had crying, cramping, explosive thin, green
bowels and periodic episodes of blood in the stool.  Anal fissures have been
ruled out.  Pedi referred to me prior to ref. to pedi gastroenterologist
because his nurse told him she knew of 2 other similar cases I'd counseled .
 During consult we discussed the idea of one-breast-per feed regimen to avoid
over consumption of fore-milk (recently discussed in posts on this subject--
ref. to LANCET article by Woolridge and Fisher.)  Anyway, though doubtful,
parents tried this since mom has lactose intolerance and colitis and is
anxious for baby to have easier time than she has had.

  Things have improved some.  Crying and colicdramatically better, stools no
longer full of green mucus after 2 weeks of this type feeding.  However,
there are still sporadic episodes of blood specks.  We are looking at dairy
and peanuts in maternal diet.  Mom ate lots of both esp during 3rd trimester.
 There was no blood for 5 days, then some appeared after mom ate sev. power
bars containing nuts and powdered milk.  Blood again after 3 meals where
pop-and-bake buttermilk biscuits were consumed.  This baby looks to be pretty
sensitive and even a little 'hidden' dairy is enough to do it.
 Interestingly, 1st episode of blood in diapers occured after a binge on
payday candy bars (peanuts and caramal -- no choco.) Sometimes there is more
than just one problem going on when babies present with severe gi probs.
despite being breastfed..  Managing the lactose over-feeding helped calm down
this infant's irritated gut. As there is also good clinical evidence that
Bovine IgG can be the culprit in colic in breastfed infants I always figure
its less invasive to infant to investigate  maternal diet than it is to
embark upon GI tests and formulas.  If doctor insists on weaning (which tends
to be the first thought) I send the Woolridge and Bovine IgG articles and
bargin that mom at least be encouraged to pump and dump so that she isn't in
a relactation situation if baby worsens on formulas or parents can't afford
"hypoallergenic" formulas.

I also always look for some improvement from changing things.  If there isn't
any, prob. a look see by the pedi GI  is a wise idea.   BTW, I once heard
someone say that reflux should be investigated when babies wake up from a
deep sleep and immed.begin screaming in pain.  In my exper. babies with
severe reflux don't like eating much no matter what feeding method you use,
and don't grow well.  Is this what the rest of you see?
Barbara Wilson-Clay, BSE, IBCLC
Austin, Tx  (priv. practice)