Expert: ruth kraft - 8/8/2009

Question
I just read a question/answer posted on Oct 4 2008 from Lee about her baby having blood in her stool.  Her case sounds exactly like what my 6 week old baby is going through.  A week ago, I saw some streaks of blood in my baby's stool and have been carefully monitoring her stool.  Since then she has had days where there are some streaks in 2 or 3 bowel movements and other days where there isn't any at all.  My baby is also content, although she does strain sometimes while having a bowel movement and has some explosive BM as well. The most important difference between situation and mine is that my baby wasn't gaining any weight during the first three weeks of life and therefore, we have been supplementing with some formula milk.  I already have a child who breastfed for 8 months, so I'm pretty sure the technique is right. (I think the problem lies in that she falls asleep while eating, therefore only eating foremilk and not getting to the hindmilk.  Is that possible?)  Our doctor advised us to supplement with formula since she wasn't gaining.  In her fourth week she put on 200 grams supplementing with an average of 120ml per day.  At 5 weeks she only put on 90 grams and started with the blood in her stool.  I read the article in kellymom.com... I don't have oversupply, but is it possible that she isn't getting to the hindmilk?  Could my milk lack fat, calories, or just simply not be adequate?  Could she be having a late reaction to the formula milk?  Could the blood in her stool be related to the fact she hasn't gained weight?  When does something I eat finally reach my breastmilk?  I'm obviously lost, I'd really appreciate some help. I asked the doctor about the possible allergy to the cow protein, but he responded to me with the possibility of her being lactose intolerant.  Those are two different things, aren't they?

Answer
Ok... lets see.... the basics after reading your situation is that I would like you to see a lactation specialist in person to see if the baby is nursing effectivly. It could be many things, a short frenulum, not a perfect position, theres alot going on that I would want to confirm in person. So I suggest you find someone who you can visit that knows real breastfeeding issues. You can also go to www.LLLI.org and find someone who can see you for free. Or, I know of someone who does Skype counceling via internet for nursing, but I know she charges . although it isnt expensive...  So to answer your questions the best I can... It is possible that she isnt getting enough hind milk, but I doubt that is the problem. There is too much going on here to be a hind milk issue.  Usualy hind milk issues are figured out because of green diapers and really fussy babies.  My suggestion in the mean time is to pump milk to build your supply back up so that you arent supplimenting with formula and giving only breastmilk. yes, I think it could be that she is having a reaction to the formula. And yes, lactose intolerance and milk protein allergys are different. In fact, at a recent conference I went to , the newest information says that lactose intolerance in babies isnt possible, that it has to be a milk allergy. thats why the incidence of milk issues is with those that are formula fed. AS we dont make the same protiens as cows. No, I am not aware of any instance where your milk would lack fat, nutrients or anything your baby needs.  I think the blood in her stool is more likley the formula than anything else. Something you eat usually gets to your breastmilk within a few hours.  depending on the food....

again , because of the nature of the issue I want you to continue to see your doctor and follow up with a specialist of breastfeeding in person. If you can pump the amount of milk to increase your supply and give the baby the pumped milk, it will have greater nutritional value than the formula and maybe stop the stool issues and she should still gain weight.

Best of luck! I hope that helped!
Ruth Kraft
www.honoringwomen.com