Nicole - posted on 09/24/2010 ( 25 moms have responded )
"I had to stop breastfeeding my baby because he was diagnosed as Lactose Intolerant."
"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 Galactosemia) 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. Also, this is usually genetic and if there is a risk factor (like a parent or other family member who is lactose intolerant), then you would want to be cautious, but it is still quite rare.
Because Galactosemia (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...)
Since I, myself, am a vegetarian, I still consume dairy on occasion (I am not vegan), but I usually (preferably) consume alternatives. I like almond milk, soy milk, goat's milk (is pretty good actually), etc. Goat cheese is awesome, too!!! (Goat's milk is usually far less problematic.) And if you are on WIC and your baby has an intolerance, find out if you can have substitutes to cow's milk.
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)