BF Myth: Lactose Intolerance and Reflux

Nicole - posted on 09/24/2010 ( 26 moms have responded )

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"I had to stop breastfeeding my baby because he was diagnosed as Lactose Intolerant."

OR

"My baby has GERD (Reflux) and this has made breastfeeding difficult/impossible."

I will touch on Lactose Intolerance first, since it is most rare. And when I say "rare", I mean RARE. ONLY 47 babies are actually diagnosed with an intolerance to lactose in the U.S. per year. This article (http://thestir.cafemom.com/baby/108659/5...) goes on to say that more people, 150 people to be exact, die per year from a coconut falling on their head.

A baby with lactose intolerance will usually be diagnosed with this condition within the first few days of life. (http://www.breastfeeding.com/breastfeedi...) These babies show signs of distress from the moment they receive ANY milk with lactose. Breast milk OR formula. These signs will be diarrhea, discomfort, bloating, gas, etc. Again, these will be present within the first day of life or within the first few days and, therefore, I would be suspicious of any diagnosis of an intolerance to lactose if the baby/child is diagnosed later and had no signs of problems within the first few days of life. In that case, it is most likely a misdiagnosis. (http://www.llli.org/llleaderweb/LV/LVAug...)

So, what is Lactose Intolerance? Lactose Intolerance (or Hypolactasia-lactase deficiency) is not actually an intolerance to lactose at all. It is a medical condition in which one does not produce enough lactase. Lactase is an enzyme that helps us digest lactose. If someone doesn't produce enough lactase, their bodies can not break down lactose and, therefore, it stays in the intestine and causes gastrointestinal problems. Human infants naturally produce more lactase than adults and, therefore, rare for babies to have Hypolactasia or "lactose intolerance".

There are 3 types of "lactose intolerance": (1) Primary, (2) Secondary, acquired, or transient, and (3) Congenital.

(1) Primary "lactose intolerance" is most common and only affects adults. Since humans start to lose their ability to produce adequate lactase as they mature, adults are more likely to be "lactose intolerance". (http://pediatrics.aappublications.org/co...) (http://www.nature.com/ng/journal/v30/n2/...) (http://www.annualreviews.org/doi/abs/10....)

(2) Secondary "lactose intolerance" is caused by infection or injury to the small intestine, usually during infancy. (This would explain the rarity in infants.) (http://www.aafp.org/afp/2002/0501/p1845....)

(3) Congenital "lactose intolerance" is a rare, recessive genetic problem that presents itself at birth and any exposure to milk with lactose, like breastmilk and formula, causes severe health problems almost immediately. (http://pediatrics.aappublications.org/co...)

Because Hypolactasia (lactase deficiency or lactose intolerance) symptoms are so similar, or mimic, other common ailments/discomforts, these common problems (like colic, normal gas, etc. see: http://www.drjacknewman.com/help/Colic%2...) can easily be perceived as an intolerance to lactose by a very worried parent. Although, it is ALWAYS best to consult a physician or a professional in lactation if you have any concern, you could check out this: http://www.kellymom.com/babyconcerns/lac... or http://www.breastfeeding.asn.au/bfinfo/l...

So, what about GERD (Gastroesophageal reflux disease), GER (Gastroesophageal reflux) or Reflux?

Well, this too can easily be misdiagnosed. Not to mention that even if it is a true diagnosis, Reflux NEVER has to interfere with breastfeeding. Nor does the breastfeeding have to be supplemented with anything like cereal or any type of formula (thickened feeds)! As quoted on Kellymom's page: "Donna Secker, MS, RD in Gastroesophageal Reflux Disease PDF, 'The effect of thickened feedings may be more cosmetic (decreased regurgitation and increased postprandial sleeping) than beneficial.' Thickened feeds have been associated with increased coughing after feedings, and may also decrease gastric emptying time and increase reflux episodes and aspiration. Note that rice cereal will not effectively thicken breastmilk due to the amylase (an enzyme that digests carbohydrates) naturally present in the breastmilk." (http://www.kellymom.com/babyconcerns/ref...)

Reflux is diagnosed by using a parent's description of the symptoms. Therefore, this is how it is sometimes misdiagnosed. Especially once you know the symptoms of reflux: frequent burping or hiccupping, frequent spitting up or non-projectile vomiting, frequent night waking, poor weight gain, difficulty swallowing, sudden or inconsolable crying, arching during feeding, constant nursing, or disinterest in nursing. Most of these things can be common in a normal, healthy infant from time to time. It is the frequency and severity that prompts the worry. Especially in a baby that is not thriving well.

If you have a baby with reflux, it is still possible to breastfeed. Actually, it is more important that you breastfeed! A baby with reflux is easily and commonly met with gastrointestinal problems and because breast milk is designed for human babies and so easily digested, it proves to be so much better for the reflux baby. (http://www.llli.org/FAQ/ger.html)

If your baby has legitimate reflux, there are some things you can do to help prevent or lessen the symptoms while breastfeeding.

LLLI's website says to do these:
1. Upright positioning. By keeping the baby in an upright position both during and after breastfeeding, gravity can help keep the milk from coming back up. Use a sling or front carrier to position the baby at breast level and nurse while standing or walking. Nurse lying down, side by side, with baby elevated on mother's arm. Try feeding in a recliner or reclining on pillows on a bed. Put baby chest to chest with mother, facing in to the breast, head slightly higher than the nipple.
2. Thorough burping. See THE WOMANLY ART OF BREASTFEEDING, pg 58, by LLLI for information about burping baby gently.
3. Small, frequent feeds. One way to do this is to nurse on only one breast at each feeding. As the lactating breast never truly empties, the baby will be rewarded with a slower flow of milk that may soothe a burning throat, but not overfill his stomach. A strong rush of milk may cause the baby to gulp and swallow more air, which can trigger more spitting up.

Keep in mind that spitting up is usually a laundry problem more than it is a medical problem and spitting up in and of itself is NOT a sign of reflux.

The good news:

Most of the time, tummy troubles/colic in the breastfed baby can be linked to two other, much less worry-some, conditions: Foremilk/Hindmilk Imbalance (or oversupply) (http://www.llli.org/FAQ/foremilk.html) or an intolerance to cow's milk protein.

Foremilk/Hindmilk Imbalance is what happens when a mother has an oversupply and/or forceful let-down. This is when the baby fills up on the foremilk and doesn't get enough hindmilk. The foremilk has a lot of lactose, while hindmilk is fattier and the fat helps the baby digest the lactose. If the baby doesn't get enough fat to digest the lactose well, he will have stomach discomfort. (http://www.llli.org/FAQ/oversupply.html) So, it is NOT the lactose that is the problem, it is the absence of the hindmilk. (http://www.kellymom.com/babyconcerns/fus...)

Block feeding http://www.kellymom.com/bf/supply/fast-l... and other breastfeeding techniques http://www.kellymom.com/bf/supply/fast-l... can do wonders for the breastfeeding mother and her baby when dealing with oversupply problems.

Symptoms of Foremilk/Hindmilk Imbalance (oversupply):
* Baby cries a lot, and is often very irritable and/or restless
* Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
* Baby may seem to bite or clamp down on the nipple while feeding
* Milk sprays when baby comes off, especially at the beginning of a feeding
* Mother may have sore nipples
* Baby may arch and hold himself very stiffly, sometimes screaming
* Feedings often seem like battles, with baby nursing fitfully on and off
* Feedings may be short, lasting only 5 or 10 minutes total
* Baby may seem to have a "love-hate" relationship with the breast
* Baby may burp or pass gas frequently between feedings, tending to spit up a lot
* Baby may have green, watery or foamy, explosive stools
* Mother's breasts feel very full most of the time
* Mother may have frequent plugged ducts, which can sometimes lead to mastitis (breast infection)

Do these things sound like what we would perceive as lactose intolerance or reflux??? This is why I am calling these things "myths". Not that they don't exist, just that maybe not as often as we think.

An intolerance to cow's milk protein (http://www.kellymom.com/babyconcerns/foo...) may present itself in the same way. This is when a baby is born with an intolerance (allergy/inability to digest well) to a protein that exists in cow's milk. If a breastfeeding mother has this protein in her diet (by eating dairy products), it does pass through her breast milk and to her baby. This may not be a problem for a baby who can process this protein, but for the baby with an intolerance, this can create gastrointestinal problems.

What to do if you think your baby has an intolerance/sensitivity to cow's milk? Keep a food journal and if you notice your baby has problems on the days you consume dairy, you would need to cut the dairy back from your diet or totally eliminate it. Easy fix! (http://www.kellymom.com/babyconcerns/foo...)

As always, if you have any concerns about your breastfeeding or your baby's health, it is always best to seek the help of professional in lactation or a La Leche League Leader. (http://www.llli.org/WebIndex.html)

MOST HELPFUL POSTS

Heidi - posted on 11/03/2010

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my son has intolerance to milk but then i have a milk intolerance to. i was able to breast feed him.

[deleted account]

This kellymom link (http://www.kellymom.com/babyconcerns/lac...) explains it much better than I did lol.

"Primary lactose intolerance (also called developmental, late-onset or adult lactose intolerance) is relatively common in adults (and more common in some nationalities than others), and is caused by a slow decrease in the body's production of lactase, the enzyme that breaks down lactose (milk sugar). This occurs gradually, over a period of years, and never appears before 2-5 years old and often not until young adulthood. Almost all adults who are lactose intolerant have this type of lactose intolerance, which is not related to lactose intolerance in babies."

[deleted account]

Lactose intolerance is an issue for older children/adults, not babies. That's what Nicole is trying to explain. It's very rare for a baby to be lactose intolerant. Babies diagnosed with *galactosemia* ARE diagnosed in the first few day. Yes, older children and adults can be diagnosed with lactose intolerance, but if a doctor says your newborn is then he/she most likely means baby is allergic to dairy proteins. That's not the same and a milk protein allergy can be fixed by mom cutting dairy and still being able to breastfeed. Hope that clears things up.

Nicole - posted on 10/01/2010

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Yes Jodi, if you had an imbalance with the last baby, there is a good possibility you can have it with the next. Not 100%, but most woman with heavy let-downs or oversupplies usually do with all of their children. I did with all four of mine and I, like you, wish I had known about block feeding earlier, too. I, like Sara and April, had a problem with clogged ducts, so block feeding wasn't perfect for me either. BUT, I NEVER switched sides in the same feeding. This helped my babies to completely empty that breast. And if they were ever cluster feeding and wanted to eat again within 30 minutes or so of the last feeding, then I would offer the same breast again. But any longer, I had to give the other side. I also (for the time we had an imbalance) tried to give every feeding in a position that made my milk fight gravity (laying back, laying down, etc. and NEVER while leaning over). What was one of the worst things for me with having a heavy let-down was how sore my nipples would get because as soon as I would let-down, my LOs would literally bite down (with no teeth, of course) and change their latch to bad just to try to slow down the flow. But, Jodi, the good news: Since you know that this may be an issue with the next one, you will find a routine that will help correct it sooner. Also, most babies and mothers adjust well by 3 months. Start early (if you notice an imbalance) researching those techniques and starting them, so you can correct it early on.



Thank you all for your comments!

April - posted on 09/29/2010

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i didn't know about block feeding either...you believe the nurses and doctors in the hospital when they tell you to switch after 15 minutes...LOL. but i had CHRONIC blocked ducts all the time. probably from "timing" our nursing sessions. Once i stoppped timing and just let him nurse forever and ever on one breast, in addition to offering the same side for several nursing sessions...i stopped having blocked ducts.

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Tina - posted on 07/23/2013

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My son had reflux and my pediatrician was of no help with breastfeeding. I kept saying I thought he had reflux but he kept telling me he didn't. I cut out ALL acidic foods, orange juice, ketchup (tomatoes), nitrates, chocolate, caffeine, etc and it went away. He's almost five and to this day if he eats too late (goes to bed too soon after eating), has hot dogs, sausage, or orange juice too late at night he wakes up coughing and coughing (reflux burning his nasal passages and causing post nasal drip) to the point where he sometimes throws up. Trust your intuition. When nursing, cutting out ANY allergen or irritant can help your baby. (dark greens for gas, or dairy for constipation or stomach issues in the baby). :)

Nicole - posted on 11/10/2010

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And thank you Sara for clarifying the difference between primary and secondary lactose intolerance. Yes, I was referring to Galactosemia in the breastfed infant. This is diagnosed very soon after a baby receives any milk with lactose. Within a few days, usually.



Sorry it took so long for me to reply. The hubby just got transferred and I have been kind of going it alone about 6 days per week and it has taken me a few weeks to get into a routine. Hopefully, we will be moving shortly to be closer to him while he is at work, but we are hanging in until that happens. ;o)

Nicole - posted on 11/10/2010

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Christina, that was a very encouraging story! You have made it through many hurdles to still be breastfeeding! Way to go!

Since your baby was born prematurely, I am not surprised that she had reflux. A lot of premature babies also have immature esophageal function and, unfortunately, this can create some health problems until the esophagus matures.

Thank you for sharing your struggles!

Christina - posted on 11/07/2010

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My Lilly was born @ 33.6 weeks. She was lucky to make it that far as my water broke at 32 weeks. She was in the NICU for 17 days, during that time was mainly fed with a feeding tube as she would not stay awake for feedings. I pumped like crazy to supply with breastmilk and would nurse her everytime I had a chance and she wasn't too tired. I've been exclussively breastfeeding her since the night she was discharged about 4.5 months ago : ) Well she started showing symptom of GERD or GER. She would cry in pain, did not want to be laid down, spit up, cough and gag, hiccups ALL the time and so on. I couldn't get any sleep myself as I was just terrified to lay my eyes off of her as I'd wake up in the night to her gagging. She even choked and stopped breathing once, luckily I knew what to do. Anyways, I had her tested for the GERD and it did come back positive that she had acid reflux. It was instant as soon as we laid her down flat. Her pediatrician tried to get me to give her cereal, well I had also read everything I could get my hands on about reflux, GERD and so on, I refused as I was worried if that came up too it would be so thick and she would end up aspirating and plus it is said it's more painful and she cried so much as it was. Finally the doctor prescribed her Cimetidine (Tagamet) and luckily that did the trick! She still spit up but not as much and was just all over a more content baby! I never noticed any side affects (and believe me I watch her like a hawk lol) I have recently took her off the meds as I was curious if her muscles had strengthened enough yet, well she does spit up more again but doesn't seem to be bothered by it at all...no scary gagging or crying ect. I am looking forward to starting her on cereal as she is nursing like crazy....but we have another month or so to wait. Well...that is all for now, I just felt typy and wanted to share part of my story as it had to do with GERD. Definately do NOT stop breastfeeding! I am glad I am a headstrong person, I knew Lilly could have been suffering much worse had she been formula fed.......and my story ends here....she's squealing at me letting me know she's hungry lol

A - posted on 11/06/2010

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I'm always shocked by how many children have been diagnosed with reflux. My son had nearly all of those symptoms when he was a few months old at one point or another. He hiccuped constantly as a newborn, cried all the time. When he was a couple months older he would fuss while eating, pull away and arch his back. That I now know was from teething. The hiccuping eventually went away and well the fussiness has never gone away but thats his personality...

But the only time my son ever spit up was when I overfed him. and thats only been maybe 6 times his whole life (18 months now).

I can see how people think a child has it...like you said the symptoms are often there anyway for newborns

Jessie - posted on 11/04/2010

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my son was/is breastfed at 15 months old. We didn't discover that he is dairy intolerant until he was 13 months old. we started cows milk after his birthday and he began having diarhea and irratibility and wasn't eating well so I had him tested by his doctor (blood work). He NEVER spit up as a baby or after we gave him cows milk. I mean never, we never even used a burp cloth once with our son. No one believed me when I thought there was something wrong after starting cows milk because he wasn't throwing up. He improved after we switched to soy (and breastfeeding) but there was still something off and he had eczema on his face that would flare up randomly. Took him to an actual allergist (pediatric specialty) and had the milk intolerance confirmed as well as a severe wheat intolerance and mild wheat allergy.

Melysa - posted on 10/31/2010

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as rare as it may be i have a friend with 3 lactose intolerant babies, besides that it is sometimes easier to say lactose intolerant then intolerant of one of the proteins in regular milk my son has to have A2 milk and lactose free dairy as it does not upset him where as regular does i assume it is the enzyme that helps breakdown the lactose that helps breakdown this protein as well, but he was tested for lactose intolerance and he is not, though i would never put him on regular dairy again after seeing the dramatic difference in my son since making a few simple changes to his diet he now looks healthy instead of the sick shadow of life he once looked like despite my best efforts to keep up with his feeding demands i have never had a child that fed so much, and yet stayed so tiny!

Susan - posted on 10/27/2010

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My Husband wasn't diagnosed as lactose intolerance until he was 13 years old. He was fine as a baby and developed an intolerance to lactose. It is called an intolerance and not an allergy for a reason. All his Nephews and Nieces are the same but they did not show any symptoms until 22 months of age. Before that they had no problems with Breast milk, Cows milk or any other Dairy products. it is incorrect to say that if they are not diagnosed within the first to days of life then they cannot be labeled as lactose intolerant. Intolerance are the same with many things. Some people become wheat intolerant at middle age, just like Diabetes can develop when you are older.
My Daughter is most likely to become lactose intolerant as she gets older but for now I give her Dairy products and she is fine with them.

Stevie - posted on 10/26/2010

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My daughter was diagnosed at 5 weeks with Secondary lactose intolerance..after the removal of 20 inches of her upper/lower intestines we had many health issues while she recovered and healed...I reached my breaking point of defeat...knowing that my milk was making her sick...We now buy Lactaid that we crush and add to water or milk. I hyperlactate and that was also a big factor with the dosage...we've consulted her pediatrician, surgeon, and specialists and since the Lactaid works she gets to still breastfeed! Good luck everyone, its not easy but it gets better!

Tina - posted on 10/17/2010

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I cut out dairy for my daughter for her second to seventh month because of her difficulties. She was having gass, constipation, and discomfort. I also cut out citric foods for my son's reflux. Tomato sauce, ketchup, lemon juice, oranges, orange juice, etc. All of those foods cause acid reflux. By doing this for both of my children, neither of them showed signs or had the difficulties they did before I cut the foods out.

Sarh - posted on 10/15/2010

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That is what I meant Nicole. I'm new to the hole lactose and intolerance thing. lol. All sounds the same to me. But thanks for clearing it up.
thanks!

Nicole - posted on 10/15/2010

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Sarh, that doesn't sound like Lactose Intolerance. It sounds like your son has an intolerance to cow's milk protein/dairy. There is lactose in your breastmilk, cow's milk, goat's milk, etc. If your son was intolerant to lactose, he would not be able to receive your breastmilk. It is so common for people to call an intolerance to dairy "lactose intolerance".

I think you are awesome for cutting out the dairy and listening to the needs of your son and continuing to breastfeed through it all! Way to go!

Sarh - posted on 10/13/2010

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My son is lactose intolerant, he was not diagnosed by the pediatrician, but I took matters into my own hands as I was breast feeding and I guess you could say I was playing around or testing things. Example, I cut out dairy because of his gas, bloating, and discomfort, also because my fiancee and MIL are lactose intolerant.
My son's pediatrician continued to dismiss him having GERD, so again I had to take things into my own hands and offered him soupy rice cereal from a spoon, he did excellent w/this and it also helped w/the spitting up (which was CONSTANT!). Finally at his 2 month appointment she listened to me instead of cutting me off w/thats normal before letting me finish. He was taking the Zantac twice a day, but still needed the rice cereal before bed to help illuminate the night time spitting up... I was changing his sheets daily, and you could see the amount of spit up! It was horrible.
Even through all of this discomfort my son started sleeping 7hrs a night at 1 month old and at about 2.5 months old has started sleeping 9-12hrs a night. He's my little fighter!!
He is now 4 months old and we are still breast feeding! :)
He also has thrush, which he has had for at least 3 weeks now (on medication for 2 wks). Still hasn't gone away, I haven't noticed any on my nipples, at first it hurt to nurse him, but I worked through it.

Kelsey - posted on 10/12/2010

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This is exactly what I needed to read today. I have started nursing my son only on one side because it made me more comfortable but I'm glad to know that I may have been doing him some good.

Thank you all ladies. You made me feel much better about nursing my son!

Brandy - posted on 09/30/2010

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This is my 2 week old, I'm glad I know what is going on now and how to take care of it.

Jodi - posted on 09/28/2010

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Sara, I did not know about block nursing at the time, but eventually it just naturally happened as that was easier and made me more comfortable! So I guess it did work, just wish I had known sooner!

Terri - posted on 09/28/2010

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My son was diagnosed with GERD at 2 days old. I was never able to actuly breastfeed, but have pumped since he was born. He is on 2 different medications for it, we have to leave him elevated at all time (bed is at a 25 degree angle, even elevated to change diaper), we also add a thickener to the milk to help keep it down. Its a product called Simply Thick. Just wondered if anyone else has heard of this product or used it?

[deleted account]

Jodi,
Did you try block nursing? I had oversupply and it resulted in foremilk/hindmilk imbalance. I got so many clogged ducts that I was afraid to block feed. I just kept my daughter on the same side until I felt she had thoroughly emptied it. Then we switched sides (this is in the same nursing session). I knew it was working when the green, frothy poos stopped and it went back to yellow.

Jodi - posted on 09/27/2010

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My daughter and I had nearly every symptom of the foremilk/hindmilk imbalance list you stated. We jokingly called her a demon baby (no, I never actually thought she was evil, but I had to use humor to get through her crying spells that would last 5-8 hours at a time!) because she was so colicky, vomitous, a horrible nurser etc etc etc. Her pediatrician diagnosed her with colic and gave me a sheet of tips to try. Thankfully, she is fine now, but it lasted nearly 9 months!
I am pregnant again, what are the chances that, if indeed it was an imbalance, it will occur again? And if it does, is there anything I can do?

Rebecca - posted on 09/25/2010

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My baby was diagnosed lactose intolerant when she was 2 days old, and diagnosed with GE Reflux Disease at 1 week old. She refuses to latch on to breast feed, and unfortunately, I have no milk supply due to a thrush infection left un-treated. These things may be rare, but they can definitely happen to anyone. I never thought it could happen to my daughter, but it is something that is definitely hard to cope with!

Savannah - posted on 09/24/2010

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Awesome research! The part on the lactose intolerance I didn't know that they had to be diagnosed when they are within a week to actually be accurate because when i worked in a daycare there was a 20 month old boy that was diagnosed with lactose intolerance by his ped. when honestly I believe he had a virus! But he wasn't my son so I couldn't really do anything about it and I didn't know this at the time either! But very informative! Thumbs up to you!

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