I sent my post to Maryelle Vonlanthen and she OK'd my
sharing her responce.
Original case was:

> > I saw a 2.5 month old baby today who for the past month has reflux post
> > feeds and between feeds, either white milk like or clear. No
> > AM pre-feed reflux and no fussiness or wheezing with reflux. Weight gain
is
> > 25 grams per day in past 14 days.
> > I've talked to mom the past few days b/c of brownish more explosive
stools
> > and increased gassiness with odor. No history of other foods
> > or formula, was briefly on multivitamin with Fl (I didn't do that).
> > Baby was colicy big time in past but is improving. Mom has eliminated
cow's
> > milk from her diet.
> > Exam remarkable for a heart murmur suspect innocent vs VSD.
> > Small amt of stool in rectum was heme negative yellow/brown color.
> > At breast baby arches and pulls away early in feed.
> > My thoughts are resolving
> > 1.gastroenteritis tx continue breastfeeding
> > 2. benign reflux tx with gravity
> > 3. overactive let down tx express before feeds and/or feed reclining.
> > 4. refer peds cards
> > I also told this mom I think not only did her bay have a GI bug but if
she
> > had done as friends suggested and put him on soy formula he'd
> > be in the hospital with an IV. I told her she can ask her soy pushing
> > friends what they think of the lack of nucleic acids, the
> > phytoestrones and aluminum in soy and of course ifs terrible taste.
> > Any other ideas?
> > -Rob
> > PS Are you on lactnet again? Lots of good GI stuff lately

Maryelle's responce:
>Sounds like you've got the right idea.  Consider checking for C >diff in
> case this does not resolve and if mom or baby had antibiotics since birht.

> I sometimes look at lactnet but so much stuff dont always have time.
> MV

OK course the bab'y diarrhea cleared. He still refluxes asymptomaticlly. As
I explained (in detail) to mom, So he refluxes.
-Rob




Rob Cordes, DO, FAAP, FACOP
Wilkes Barre, PA
mailto: [log in to unmask]