Breastfeeding: Breastmilk intolerance?

My two-week old daughter was breastfed the first 13 days but had constant diarrhea -- watery stools and lots of gas (her doctor didn’t find anything wrong). Out of desperation, we fed her Similac. She quieted down, slept 'like a baby' and had her first solid stool. We've switched back and forth, but it seems clear that she can’t tolerate her mother's milk, despite my wife’s bland diet. Help!

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

Diarrhea is pretty uncommon in breastfed babies and an allergy to breast milk is extremely rare. Normally, stools in an exclusively breastfed baby are frequent (some babes go at every feeding) and unformed, (they look like pea soup!). The odor should be mild.

Diarrhea has these symptoms:

  • 12 to 16 bowel movements in a 24 hour period
  • Stools with an offensive odor
  • Stools may contain flecks of blood

Watch for other signs of illness, such as lethargy, listlessness minimal output of urine, dry mouth and tongue, non-resilient skin, cool and clammy fingers and toes. Contact your baby's doctor right away if she is showing any of these symptoms.

Metabolic disorders, such as primary lactase deficiency and galactosemia, though very rare, can make breastfeeding impossible. If your baby is otherwise healthy and gaining well, your health care provider has probably already ruled out these conditions.

Sometimes a breastfed baby develops watery, green stools and gassiness. This can be caused by a foremilk/hindmilk imbalance. Foremilk is the thinner, lower fat milk your baby receives at the beginning of a feed. It transitions to the hindmilk which is higher in fat. Green stools and fussiness can result from too much lactose (sugar). High volume feeds are invariably high lactose feeds. When the excess lactose enters your baby's colon there may be increased fermentation, resulting in her fussiness, gas, and loose, acid stools.

If you think this may be playing a part in your baby's loose stools, allow your baby to control the feed. When nursing, let her come off the first breast on her own, relaxed and satisfied. You can offer the other breast, though many babies are quite content nursing from one side in a three to four hour period. During the first three or four days, as the milk supply is adjusting, express just enough milk from the "unused" or "less used" breast for comfort.

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