Breastmilk intolerance?
by Debbi Donovan, IBCLC
Q:
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?
A:
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.
