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Thread: Help! Blood in stool -- lactose overload/allergy?

  1. #1

    Default Help! Blood in stool -- lactose overload/allergy?

    Hi ladies! I'm new here and hoping you can help shed some light on my situation. I'm feeling beyond frustrated. :-(

    My LO is 16 weeks and EBF. Starting around 8 weeks he started having bloody, green, mucousy stool. It started as a few specks of blood and increased to streaks. The ped said it was a dairy/soy allergy so I cut those out immediately. I noticed an improvement within two weeks but not 100% -- I was still seeing blood every few days and still some mucous. Then I cut out the Top 8 allergens hoping that one of those was causing the continued issues. Nope. The ped sent us to a GI who again said milk protein allergy and to keep out the dairy/soy. She said it could just take more time for the protein to work its way out of my/his system and for his GI track to heal. At that point his stool was very watery and still green (occasionally foamy). I was frustrated so I went to a total elimination diet (only eating rice, turkey, lamb, potato, zucchini, pears) which I have been on for a little over 3 weeks....including Christmas. :-( Still seeing blood and green mucous.

    I should note that LO is a very happy baby. Not fussy, no major gas, not a lot of spit up, he sleeps great and eats well (usually btwn 2.5 - 3 hrs during the day and sleeping a full 12 hrs at night). He has doubled his birth weight.

    After being on all these crazy elimination diets and still seeing no progress I started thinking a little outside the box and questioning my possible oversupply. I had an oversupply initially -- OALD that would cause LO to choke and sputter frequently but he eventually learned to pull off and I would spray into a towel. I regularly pumped 4-5 oz after feeding him. I was pumping once a day to build up a freezer stash. Since the very beginning he has been satisfied with just one breast per feeding so that's what we have been doing. I figured the OS regulated itself since I never felt engorged anymore and LO had gotten a handle on the OALD.

    I was convinced that the blood was food related since it got better after I stopped the dairy/soy. But I also stopped pumping as soon as I cut out the dairy! It was also getting much better before I went on the total elimination diet. Then I decided to pump for a few days to build up a little stash of "safe" milk (I donated all of my freezer stash thinking it was tainted with dairy that LO couldn't handle). After pumping those four days the blood got SO much worse! It also timed up with a sleep regression that caused me to add a night feed for a few night. Again, blood got much worse!

    So, I guess this is long way of saying .... what do you think? Is it a random allergy to rice or pears? Or more likely lactose overload from the OS/OALD? I've started block feeding for slightly longer periods (2 feedings per side) in the hopes that this will help regulate things but we are only on day 3 and so far I'm still seeing green stool but no blood as of today. I would like to stop the extended block feeding as soon as possible as I'm paranoid about losing my supply entirely.

    TIA ladies! I'm feeling at such a loss. Both ped & GI keep suggesting hypo allergenic formula and I'm desperate to BF until a year!

  2. #2
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    Default Re: Help! Blood in stool -- lactose overload/allergy?

    Welcome to the forum and congratulations on the new baby!

    I think you've done some really good detective work here. Oversupply is way more common than allergies, and lactose overload from oversupply can cause blood in a baby's poop. The fact that you saw increased bloody poop after pumping and after baby started feeding more at night is an excellent indicator that oversupply/lactose overload really is to blame. But I do think that your baby's poop issue might be a "little column A, a little column B", because you also saw improvement after you eliminated dairy and soy.

    The really great news here is that you have a basically healthy, happy, growing baby. In that situation, bloody poop is freaky but it's really not a big health concern- when the "whole baby" picture is good, a single weird symptom is merely weird. You can basically just keep an eye on it.

    If this were my baby, here is what I would do:
    1. Switch pediatricians. You might want to go to your local LLL and ask the moms there who they like- who is breastfeeding-friendly, who is good at looking at that whole baby picture, who is not freaked out by minor bloody stool. That way you (hopefully) reduce the pressure to switch to hypoallergenic formula.
    2. Be very careful with the block feeding. It is possible to go too far! So if your baby seems hungry after finishing the first breast, don't be afraid to offer the second side. It's better to screw up your blocks and have a setback in terms of oversupply than to adhere rigidly to your blocks and end up with not enough milk. Again, bloody poop in an otherwise healthy baby is not a big deal!!!
    3. Take advantage of your elimination diet by gradually and systematically reintroducing foods. If you drink a big glass of milk and then your baby has several days of awful diapers, then that is a good indicator that milk really is a problem, and you remove it from your diet again. I personally would start with the least likely allergens and move up to the major ones, but you could certainly do it the other way round.
    4. Brush off the hypoallergenic formula recommendations. Just flat out tell the doctors that you're not going to do that unless they can demonstrate that your baby is actually unhealthy. It's a major intervention and has health consequences for both you and your child. It's something you do when your baby is sick- not growing, not developing as expected.
    5. Consider adding a dropper of baby vitamins or an iron supplement to your baby's routine. This is what I did with my bloody poop baby- I figured that if she was losing iron from an irritated gut, then I should add some back with the Poly-Vi-Sol.

  3. #3

    Default Re: Help! Blood in stool -- lactose overload/allergy?

    Quote Originally Posted by @llli*mommal View Post
    Welcome to the forum and congratulations on the new baby!

    I think you've done some really good detective work here. Oversupply is way more common than allergies, and lactose overload from oversupply can cause blood in a baby's poop. The fact that you saw increased bloody poop after pumping and after baby started feeding more at night is an excellent indicator that oversupply/lactose overload really is to blame. But I do think that your baby's poop issue might be a "little column A, a little column B", because you also saw improvement after you eliminated dairy and soy.

    The really great news here is that you have a basically healthy, happy, growing baby. In that situation, bloody poop is freaky but it's really not a big health concern- when the "whole baby" picture is good, a single weird symptom is merely weird. You can basically just keep an eye on it.

    If this were my baby, here is what I would do:
    1. Switch pediatricians. You might want to go to your local LLL and ask the moms there who they like- who is breastfeeding-friendly, who is good at looking at that whole baby picture, who is not freaked out by minor bloody stool. That way you (hopefully) reduce the pressure to switch to hypoallergenic formula.
    2. Be very careful with the block feeding. It is possible to go too far! So if your baby seems hungry after finishing the first breast, don't be afraid to offer the second side. It's better to screw up your blocks and have a setback in terms of oversupply than to adhere rigidly to your blocks and end up with not enough milk. Again, bloody poop in an otherwise healthy baby is not a big deal!!!
    3. Take advantage of your elimination diet by gradually and systematically reintroducing foods. If you drink a big glass of milk and then your baby has several days of awful diapers, then that is a good indicator that milk really is a problem, and you remove it from your diet again. I personally would start with the least likely allergens and move up to the major ones, but you could certainly do it the other way round.
    4. Brush off the hypoallergenic formula recommendations. Just flat out tell the doctors that you're not going to do that unless they can demonstrate that your baby is actually unhealthy. It's a major intervention and has health consequences for both you and your child. It's something you do when your baby is sick- not growing, not developing as expected.
    5. Consider adding a dropper of baby vitamins or an iron supplement to your baby's routine. This is what I did with my bloody poop baby- I figured that if she was losing iron from an irritated gut, then I should add some back with the Poly-Vi-Sol.
    Thank you SO much for the response! I agree, I think it's a little bit of both. Probably a dairy intolerance and a bit of an oversupply that was aggravating the situation.

    We've now had 3 blood free, non-watery poops so I feel like I'm on the right track. The number of BMs has decreased in the past few days as well -- he used to go up to 5 times a day and now we are down to just 2 in 24 hours, which I'm taking as a positive sign that the milk is taking longer to digest and not going straight thru him. Today is Day 4 of the extending block feeding (2 feedings on each side - ordinarily he usually just does one breast anyway and is satisfied and has been gaining well). I'm no longer feeling engorged at the end of the block so I think things are evening out. How much longer should I continue the extended block feeding? I want to make sure my supply has regulated but I don't want to lose too much milk! So hard!

    Thanks again for the response!

  4. #4
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    Default Re: Help! Blood in stool -- lactose overload/allergy?

    We've now had 3 blood free, non-watery poops so I feel like I'm on the right track.
    Excellent! Just don't be too shocked if you suddenly get a series of yucky-looking diapers. This sort of thing can and often does come and go!

    The number of BMs has decreased in the past few days as well -- he used to go up to 5 times a day and now we are down to just 2 in 24 hours, which I'm taking as a positive sign that the milk is taking longer to digest and not going straight thru him.
    This may seem like I'm insisting on a very fine point, but if a baby is growing normally, then the milk is not going straight through him. He may be pooping frequently, but that doesn't mean he's not extracting nutrition from his meals.

    How much longer should I continue the extended block feeding?
    The "when" questions are the hardest to answer, because the answers will vary so much based on the individuals involved and the unique circumstances. I personally would go by feel. Do long blocks when you feel like you have a lot of milk and when you feel like your baby is satisfied with just one breast. Do short blocks or even double-sided feedings when you feel like you're low or baby wants more. A lot of moms find that they have more milk at certain times of day- for instance, overnight or first thing in the morning- and less milk at others, particularly later in the day. When I was block feeding, I had to do very long blocks in the morning (2-3 feedings in a row) and very short blocks or no blocks at all come evening.

  5. #5

    Default Re: Help! Blood in stool -- lactose overload/allergy?

    Quote Originally Posted by @llli*mommal View Post
    Excellent! Just don't be too shocked if you suddenly get a series of yucky-looking diapers. This sort of thing can and often does come and go!
    Yup, just got a big mucousy one with little flecks of blood (so small you wouldn't notice if you weren't looking but of course I am). It's hard not to feel completely discouraged. I feel like if I could just get to a baseline I could figure out if there really is an allergy/intolerance but it's just not happening. Could the OS be causing mucous as well? Or is that clearly an indication of an allergy?

    My husband suggested that I just start pumping and try giving LO bottles for a few days see if that corrects the issue. Then we would know for sure that it's the OS causing the bad diapers. (He has taken a bottle before and we haven't had any nipple confusion issues, just fyi.) I'm tempted to give this a try since it would at least help answer the question about whether it's an allergy or OS, but I don't want to get myself stuck in a situation where I have to continue pumping exclusively.

    I should probably mention that the diet is driving me bonkers. It's been almost a month on nothing but potatoes, turkey, lamb, zucchini, pears, rice and quinoa. Every time I see a good diaper I start dreaming about adding foods back in. I can do it but it's just tough.

    This may seem like I'm insisting on a very fine point, but if a baby is growing normally, then the milk is not going straight through him. He may be pooping frequently, but that doesn't mean he's not extracting nutrition from his meals.
    Good to know. The GI said that watery stool was no good since it was basically coming out the same way it went in. Honestly, I'm a bit let down that neither the GI nor the pediatrician even asked about oversupply as a possible issue given how long we have been struggling with the bloody stool (2 months almost). We are moving in the next few weeks and I'll be looking for a new pediatrician anyway so there's that.

    The "when" questions are the hardest to answer, because the answers will vary so much based on the individuals involved and the unique circumstances. I personally would go by feel. Do long blocks when you feel like you have a lot of milk and when you feel like your baby is satisfied with just one breast. Do short blocks or even double-sided feedings when you feel like you're low or baby wants more. A lot of moms find that they have more milk at certain times of day- for instance, overnight or first thing in the morning- and less milk at others, particularly later in the day. When I was block feeding, I had to do very long blocks in the morning (2-3 feedings in a row) and very short blocks or no blocks at all come evening.
    Any signs to look for to know that my supply has gone down too low? Right now LO seems full after just one breast so if he starts looking for the second should I worry about my supply? I am able to still easily hand express immediately after he's done (I've been checking to make sure I'm not running dry).

    Thanks again for the help! This is such a journey!

  6. #6
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    Default Re: Help! Blood in stool -- lactose overload/allergy?

    I totally understand the desire to get to a baseline. But I think you have to accept that it might not happen. According to my pediatrician, proctocolitis peaks in the 3-5 month age range- which is not very long in absolute terms, except that we're talking about babies whose entire lifespan is measured in months. It was certainly my experience that I saw more bloody poops around 3-4 months than thereafter. Gut irritation can also be persistent, so accept that you may be doing everything right and yet still be seeing bloody poops.

    The other thing that I think you have to accept is the idea that allergies are really hard to pin down. Even when your kid is diagnosed with an allergy, you are still groping in the dark. Okay, so my kid is allergic to X- now what? Can I have X? Can she have X if it is in baked goods? Can she touch X? How about a surface that X was on? Okay, it's been a few months- how careful do I need to be now? Etc. So don't feel like you have failed just because you haven't pinpointed something which may be extraordinarily difficult to pinpoint.

    I don't think anyone knows whether or not mucous is a definitive sign of allergy. I mean, you will see that assertion made over and over again, but I don't think there's any scientific basis for it. I personally don't see why mucous has to mean allergy, especially considering that mucous in the stool is a symptom of lactose intolerance in adults!

    Your husband's suggestion to give bottles for a few days will only hurt, not help. Here's why:
    1. If the baby's bloody/mucousy stool is being caused by lactose overload from oversupply, it will not matter how the milk is delivered. Bottled milk and straight-from-the-tap milk will both have the same lactose-enriched composition. Fast letdowns are a symptom of oversupply but do not in and of themselves cause poop issues.
    2. Taking the baby off the breast for a few days means relying on the pump, and pumping could set back all the block feeding work you have done to manage your oversupply.
    3. Taking the baby completely off the breast means taking the risk that he will decide that he prefers bottles. Even babies who have happily gone back and forth between bottle and breast can abruptly decide that they prefer the ease of bottlefeeding. This seems like a big risk for relatively minor gain.

    Of course the diet is driving you bonkers!!!! I'd love to out the pediatrician and GI doc on your diet and see how they like it. This is why I hate hate HATE the prevailing approach to bloody stools, which emphasizes depriving moms rather than looking at that "whole baby" picture and taking an expectant management approach- that is, expecting that if baby is otherwise healthy and growing, everything will likely work itself out and the only thing you need to do is watch, wait, and intervene only if things start going really wrong.

    I think the best thing you can do with the block feeding is to really watch the baby and his diaper output. If he seems satisfied after a single breast, great. But if he still seems hungry, don't be afraid to offer the second breast. Block feeding is an art, not a science, and you should expect to get it right some days and wrong on others.

  7. #7

    Default Re: Help! Blood in stool -- lactose overload/allergy?

    Well, shoot, that's discouraging. Grr. Everything I've read says to keep with the block feeding and the elimination diet until the poops return to "normal" .... if I never get back to normal does that mean I'm such on this darn diet forever and a day? Haha! I guess I will just start adding back in low allergen foods slowly and see if I get a MAJOR difference. I guess if we are still talking about small specks of blood occasionally that wouldn't necessarily indicate a positive reaction.

    Oh a related note -- any suggestions for needing to pump while block feeding? Obviously I'm hesitant to pump at all after what it triggered last time, but I have a job interview next week and will be away from LO for most of the day. I only have about 16 ounces of frozen milk but we will be traveling to another state for the interview and staying in a hotel and I wont be able to keep the milk frozen long enough for use while I'm away. Whats the best way to pump to avoid revving up my supply again? A few minutes after each feed? Only doing one side at a time? I need to have enough milk to leave with DH for the day but I don't know how to go about it at this point. TIA!!

  8. #8
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    Default Re: Help! Blood in stool -- lactose overload/allergy?

    I am wondering if you and your doctors have gone over the protocol for allergic proctocolitus in a breastfed baby? http://www.bfmed.org/Media/Files/Pro...ish_120211.pdf

    From what I am gathering, your baby is entirely healthy except for the blood in the stools. While I understand it is worrying, I am not sure this warrants as much concern as you are all going through. To me it sounds like things improved noticeably when you eliminated dairy and soy and started block nursing. But nothing else has made much difference. This makes it sound to me that one or both of those things helped and nothing else is necessarily needed. If your baby was ill or gaining poorly it would be different.

    As mommal notes, Block feeding reduces milk production. So you only 'do it' until the milk production calms down. This should not take long, so the current suggestion is to practice block nurse for NO MORE THAN one week. If you do it for too long, you risk lowering production too much.

    Also, block nursing (while it is going on) is likely to increase fast letdown, so actually may act to increase lactose 'overload.' Why? Because the blocked breast goes a long time without being nursed from, and when that happens, there is a ton of milk stored in there when baby nurses. This is another reason to stop block nursing as soon as it has done its job (reducing production, which you will tell by how YOU feel more than poop look) so you can go back to more normal, very frequent, nursing. Frequent nursing cuts way down on fast letdown/lactose overload. In fact frequent nursing is sometimes all that is needed. You can always block nurse again if needed.

    I would also suggest reading the following about block nursing: http://www.nancymohrbacher.com/blog/tag/block-feeding This IBCLC wrote one of the premier lactation consultant textbooks, plus this article reflects the more current thinking on block nursing.

    and will be away from LO for most of the day
    If you are only going to be gone most of one day, you may already have all you need. 16 ounces would be enough for a 10-15 hours separation. If you want a little more, I would suggest pump ONCE a day no more than 2 ounces at a time. If that will not give you enough, add a more sessions only as needed. I would not suggest pumping directly after baby nurses, as this would lead to a more 'empty breast' and that is what you are trying to avoid if the goal is to lower milk production. But this is a fine point, so if it is only convenient after a session ok. Just not too often! Once or less a day would be ideal.

  9. #9
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    Default Re: Help! Blood in stool -- lactose overload/allergy?

    Everything I've read says to keep with the block feeding and the elimination diet until the poops return to "normal" ....
    Yikes, that's not the greatest advice! As Maddieb said, block feeding is not something you do long term (except perhaps in unusual circumstances of severe and long-lasting overproduction). And it's also focusing too hard on the poop. I mean, yeah, all parents are fascinated by their infants' diaper output... But what you read makes perfect poop the stand-alone goal. What about the baby producing that poop?! If he's happy and healthy, then you're probably doing a lot more right than you are wrong!

    if I never get back to normal does that mean I'm such on this darn diet forever and a day?
    Yes, until he goes to college and becomes the dining hall's problem.

    I don't think you need to be on this diet forever and a day. I think you're taking the right approach by adding back the low allergen foods, and seeing if anything changes. If you continue seeing small specks of blood, I wouldn't consider that a change or an indication to cut foods again.

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