Blood in the stools of 2 very young babies: case studies

The attached photo is, in fact, the bowel movement of a baby who had late onset decreasing milk supply and flow (see link below).

What doctors don’t know about breastfeeding. Two very young exclusively breastfed babies present at the emergency department with blood in their bowel movements. Doctors’ diagnosis “cow milk allergy” in both cases. The information about the cases, comes from a lactation consultant in one case and the other from a midwife.

Baby #1: Four days old, admitted to hospital with blood in bowel movements. Necrotizing enterocolitis ruled out, bowel rest and antibiotic regime initiated. Gastrointestinal specialist pushing for formula with the theory that newborn allergy to milk protein. Initial bowel movement is passed at 22 hours of age. Other three at 25, 26, and 27 hours of age. These appear transitional stools. Blood in third stool minimal with dark green, fourth more brown-orange with more blood, and last one prior to referral yellow orange with increased red. Mother does not complain of nipple pain and no obvious nipple wound is seen.

Comment: Cow milk allergy? Very unlikely, though pediatricians, as a group, seem to love this diagnosis, the love of which is boosted by frequent formula company advertising. Blood in the bowel movements is not rare with late onset decreasing milk supply and flow, but this diagnosis does not fit here because it is usually seen in older babies (6 weeks of age to 4 months, typically, though occasionally is seen in babies as young as 3 weeks of age).

The first and most logical thing that could/should have been done before the baby is admitted to hospital, before an IV is started, before the baby is taken off the breast and put on formula? Test the baby’s bowel movements with the Apt test. I used to do this test in the tiny lab in the emergency department where I was a staff pediatrician. This very simple and rapid test tells you whether the blood in the bowel movements is due to the mother’s blood or baby’s blood. It can be done on the baby's vomit also.

At the baby’s age of 4 days, chances are it’s mother’s blood, either due the mother having “rusty pipe syndrome” or the baby having swallowed blood during the birth (It is unlikely that a damaged nipple could bleed so much that blood would appear in the baby’s bowel movements, though in such a case the Apt test would still show the blood is mother’s). And after my suggestion to do the test on the baby’s bowel movements, it turns out the blood is, in fact, mother’s blood.

Why the epidemic of cow milk allergy in exclusively breastfed babies? Because formula company advertising has convinced pediatricians (and family doctors) that cow milk allergy is common, and the answer is "special", but unnecessary formula at high prices, and the end of breastfeeding. At many pediatric conferences, there are formula companies pushing cow milk allergy as a common problem in breastfed babies. At some conferences the formula company representatives give lectures, not just breakout sessions, but to the entire conference attendees, on… cow milk allergy and their special formulas.

Baby #2: Baby born at term is 2 days old, healthy and was able to breastfeed well, but had a lot of bowel movements in the first hours after birth. Eventually there was blood in his diapers after 24 hrs. X-rays showed air bubbles in the bowel wall. He had been diagnosed with a possible cow milk protein allergy. Baby is still in the NICU, they are giving him fluids via IV, and baby has now been put on "special" formula. Mom has been advised to stop breastfeeding for 3 months and eliminate any dairy and soy products from her diet before attempting breastfeeding again.

Comment: Air bubbles in the gut wall are a diagnostic sign of necrotizing enterocolitis, a diagnosis I suggested and that was accepted by the treating pediatrician. Why this baby who was born at term should get necrotizing enterocolitis is not clear, since it is usually occurs in premature babies, who are receiving formula feeds. Exclusive breastfeeding usually protects against necrotizing enterocolitis in the premature baby. The initial diagnosis of cow milk allergy boggles the mind. And how did the pediatrician come up with a diagnosis of cow milk allergy in a 2-day old? And even when the right diagnosis was made, they were still telling the mother not to breastfeed for 3 months. Do they really believe the baby will take the breast after 3 months? Do they care?

Please consider buying and recommending my new book: What Doctors Don’t Know About breastfeeding

Print version and ebook version on Amazon:?https://www.amazon.com/dp/B09WC2HCC6

Print version on Praeclarus site:?https://stores.praeclaruspress.com/what-doctors-dont-know-about-breastfeeding-by-jack-newman-and-andrea-polokova/?showHidden=true

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