A couple of weeks ago I had posted for information on Duarte Galactosemia and
breastfeeding and would like to give an update and also pose a related
question. First of all, baby, who is now almost 6 wks old, has been okayed
to return to breastfeeding. Mom has been breastfeeding for a little over 48
hr. Baby had breastfed intially for almost 2 wks with no symptoms of
intolerance until bloodwork showed low enzyme levels and was weaned to soy
formula; mom continued to pump routinely and store her milk.
First, my question: since starting to breastfeed, baby has been having
problems with regurgitation (was not experiencing this with soy formula). I
spoke with mom on Fri night who reported a few eppisodes of vomiting, some
regurgitation following breastfeeds, often mid feed, where baby would spit up
smaller amounts or "refllux' and swallow this without spitting up. I
suggested feeding hindmilk first (either pumping a bit before feeds or
pumping after feeds and giving via bottle at start of breastfeed) to coat her
stomach and provide thicker substance, burping carefully (was doing), feeding
lying down or semi reclined with baby's head higher than breast, and if
needed to supplement with formula a bit when hindmilk not available. Today,
Sun, mom states has been unable to feed hindmilk first but was seeing
improvement with positioning, and she was breastfeeding first, carefully
burping, giving 1 oz formula and then offering 2nd breast. (It should be
noted that her supply is low, was getting 10-12 oz with pumping-great
considering all the stress this mom's been thru-and baby had been taking
about 20 oz/24 hr). No more vomiting, some spitting up and continues to
regurgitate and swallow it at times.
Could the switch to breastmilk be causing vomiting because baby's GI is used
to thicker substance (formula)? ( Mom and I both realize it could be baby's
reaction to lactose,tho this seems too soon for that according to usual
course with Duarte, and testing on levels of galctose is to be done on Tues)
Could the pyloric sphincter be "stretched" and now that thinner breastmilk
being given, take time to adjust to thinner milk being passed from esophagus
to stomach? Could it be that baby isn't used to lactose? (that was part of
my reasoning for giving more hindmilk) Have any of you had babies that
react like this after return to breastmilk following exclusive formula use?
I've found ped gastro, M. VonLanthen's email so plan to pose this question to
her but just wondered if anyone on this list has seen this response to
breastmilk under similiar circumstances.
Mom's supply isn't up yet and OALD isn't a problem; baby has same response to
breastmilk in bottle. Have also suggested usual post feed positioning of
baby when reflux is a problem. Will post the info I have on galctosemia
testing as think it will be of interest, but this post is too long now.
Thanks so much and docs online who might have a clue please respond.
Barbara Latterner, BSN, RN, IBCLC
Brewster, NY
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