by Debbi Donovan, IBCLC
My daughter is two weeks old. My wife exclusively breastfed for the first 13 days. Our baby had constant diarrhea the whole time. She was miserable with watery stools and lots of gas. The doctor tested for viruses, etc. and found nothing. Finally, out of desperation, we fed her Similac. She quieted down, slept 'like a baby' and had her first solid stool. We've switched back and forth and it's become obvious. Our baby can't seem to tolerate her mother's milk. My wife eats a bland diet, but this doesn't seem to help. She is very upset and does not know who to talk to. Her doctor doesn't have any answers. Can you help?
Diarrhea is much less common in the breastfed child. When diarrhea does occur, nursing should be maintained in most cases. Allergy to breastmilk is extremely rare. (Ruth Lawrence, MD, 1994)
Normally, stools in an exclusively breastfed baby are unformed, and of pea soup consistency. The odor should be mild. Frequent, loose stools are not uncommon. Some breastfed babies have a bowel movement each time they nurse.
Diarrhea has these symptoms:
*12 to 16 bowel movements in a 24 hour period
*Stools with an offensive odor
*Stools may contain flecks of blood
Observe your baby for other signs of illness, such as lethargy, listlessness minimal output of urine, dry mouth and tongue, non-resilient skin, cool and clammy fingers and toes ... Contact your baby's health care provider if your baby is showing any of these symptoms.
Metabolic disorders, such as primary lactase deficiency and galactosemia, though very rare, can make breastfeeding impossible. If your baby is otherwise healthy and gaining well, your health care provider has probably already ruled out these conditions.
Sometimes a breastfed baby develops watery, green stools and gassiness. This can be caused by a foremilk/hindmilk imbalance. Foremilk is the thinner, lower fat milk your baby receives at the beginning of a feed. It transitions to the hindmilk which is higher in fat. Green stooling and fussiness can result from too much lactose (sugar). High volume feeds are invariably, high lactose feeds. When the excess lactose enters your baby's colon there may be increased fermentation, resulting in her fussiness, gas, and loose, acid stools. If you think this may be playing a part in your baby's loose stools, allow your baby to control the feed. When nursing, let your baby come off the first breast on her own, relaxed and satisfied. You can offer the other breast, though many babies are quite content nursing from one side per three to four hour period. During the first three or four days, as the milk supply is adjusting, express just enough milk from the "unused" or "less used" breast for comfort.
Diarrhea can also be caused by exposure to cow's milk. (Lake AM et al:Dietary protein-induced colitis in breast-fed infants, J Pediatr 101:906,1982) If this is the case, most breastfed babies respond positively to total removal of dairy products from the mother's diet.
If this problem persists, I would recommend working with a Lactation Consultant.