Can our paediatrician be wrong?

[elk4baby]

Hi, (apologies for the long post in advance)

My 10 month old little boy has been having loose stools since... as long as I remember. First, it was the breastfed kind, but when we started weaning the frequency didn't change (about 3-5 times a day) only the colour and smell changed. I thought maybe that's 'just him'.

However, he's growing, and so are his poos! It's on everything! He's in washable nappies full-time, as the disposable ones just have no chance of containing what he's producing. I'm really sick and tired of washing multiple layers of clothes 3-5 times a day, in addition to his nappies. It's literally driving me insane, to the point that I sometimes start to feel a bit resentful towards him . (And I'm a second-time mum, so I've seen my share of big explosive poos, and done the 1000 washes of nappies before, but never was it this bad with my first )

We went to se a paediatrician. He said it was just 'toddler diarhea', happens very often (apparently, I was luck with my first not to run into this). He's put my little boy on formula alone (Pepti-Junior) for five days - no solids, just formula and breast milk. This seemed to have cleared things - his poos were for the first time of normal consistency (could be shaken off into the loo). I thought that were were out of the woods and was kicking myself for not going to see the doc earlier.

HOWEVER, he has started with the loose stools again! I've put him on the formula-breatmilk regime again, but he's still having a dirty nappy about 5 times a day if no more. It's back to the liquid, mustard-coloured stuff, like when he was exclusively on breast milk. We've been at it for 3 days now.... not sure how we'll come out the other end, but I'm starting to doubt my paeditricians diagnosis.

I have a suspicion it may be a reaction to cow's milk. Because during the short time that he had normal stools I just happened not to have any dairy in my diet.

I have asked the paed. about this, he said that it can't be a reaction to cow's milk. That's because if he was lactose-intolerant I'd know about it much much sooner and it's rare anyway. And it can't be to cow's milk protein, as he assured me that human breast milk has exactly the same protein as cow's. Now, this doesn't sound quite right, but he's the one with the doctor's diploma not me...

So... question is, could it really be Cow's Milk Protein Intolerance?! And our paediatrician just needs a little brush up on his science? Or am I making things up here?

I think you are right and the paed is wrong! My DS has CMP intolerance (has had it from the start with reflux and as his father has a problem with dairy I guessed it might happen) and I was on nutramigen and BF with no dairy in my diet and things improved drastically. My DS also has loose stools 3-6 times a day with dairy. My GP decided it was CMP intolerance without any testing etc. and supported the nutramigen on prescription - do you need to find a new doc?

Your doctor is wrong.

Cows milk protein is not the same as BM protein. It's bigger thus harder (or impossible for some) to digest.

Lactose is a sugar - so inability to digest this is not the same not being able to digest cowsmilk.

So ditch the normal formula and any dairy on his diet an demand a referral to a paediatric dietician.

I had similar with ds and dd and both reacted within an hour of being given cows milk to drink. At one point I had ds off all dairy and gluten to stop the constant nappy changes. In the end I discovered that it was cows milk by trial and error. I discovered goats milk formula from 6 months and goats milk from older.

This is without any help from Peads who thought I was another neurotic mother. Dd is still on goats milk to this day but they can both manage yoghurts now with no I'll effects.

My older two had toddler diarrhea, youngest didn't and interestingly the older two weaned at one year and the youngest breastfed for most of his milk until he was three. The middle one did not like cow's milk much and still will not eat cheese or butter at 11!

There is definitely some confusion about re lactose & cow's milk protein. I'm not convinced about cows milk protein getting into your breastmilk from dairy products, surely the proteins would be broken down into amino acids in your digestive system and then reassembled as human milk protein in your milk. different if he reacted to drinking cows milk or formula directly but I'm just going on Higher biology at school. Don't some people (a lot of asian people for example) lack the gene that makes you produce lactase (after babyhood) to digest lactose and that causes digestive upset when they eat dairy as they literally can't digest it.

I was advised to limit fibrous fruit and veg and fruit juice which helped a bit.
In the end I decided very active boys = very active bowel, they never seemed uncomfortable just went often and produced "splats" until they were 4 or 5.
I used washable nappies too so commiserate!

My DS also had reflux and was sick -all-the-time-. Though with weaning this has stopped :)

I've never given him formula before, actually.

The dairy that he did have was baby cereal made on cow's milk at 6.5months and then formage frais. He absolutely loved the Plum organic kind (not the petit filous - very powdery texture) and could eat about 5 at a time :).

wigglybeezer, I do wonder WHAT it is that passes into mum's milk when she eats dairy. If it's not the protein, then some other element surely... ?
Human milk probably contains lactose as well (it's milk afterall), so it's probably not the lactose intolerance.

I've cut dairy from my diet right now. Can I still have soy milk? (love my coffee and tea white and cereal/porridge for breakfast... seriously, it's difficult to picture my diet completely dairy free :()

I think cows milk is one of the few things that has been shown to pass into BM. The protein is different - so maybe bits that pass into the milk are not the same as the human protein. Goats milk is closer to human milk (the protein) hence more tolerated. It happened with DS - I wasn't convinced, cut out dairy anyway and it made a difference. This was then borne out when we moved onto solids - he'd react to dairy and still does. So am now convinced!

The soya milk protein is similar to cows milk -
I remember having soya lattes a couple of times and DS would have green runny poo. Coincidence? I don't know, bit switched to other calcium enriched milk instead.

You have to be careful though of going down the road of thinking everything you eat will impact on baby though - so please see a dietician.

Yes BM does have lactose in it. Also as I understand, lactose intolerance (ie not having the gene) is incredibly rare in babies -
It tends to develop in adults.

Well, both mine and DH's family are from quite 'milky' countries, and there's no family history of any reaction to milk... so I'm 99.99% sure he can digest the lactose.

Now, I've never really cut anything out of my diet when breastfeeding (and this is my second baby who's been exclusively b-fed for 6 months and then weaned with continued b-feeding). The only things that I did reduce drastically was caffeine and alcohol (the obvious offenders that pass into your blood and milk - my OB/GYN even once said that the things that can't pass into your blood, don't pass into milk... that's debatable, but then he's an obstetrician...)

By the way, of those that have done formula + breastmilk. What are the baby's stools like? Because this time on Pepti-Junior and BM, mine is pooping around the clock! Greenish-yellow, slightly speckled liquid.... Is this normal?!
The first time we'd done this 'formula diet' thing, he did a poo once! in the whole 5 days he was on it.

elk4baby no advice for the actual pooing but just wanted to check that you are using two part nappy system. Two parters have much better containment all in ones or pocket nappies. Also i have found that terry squares with the and motherease pretty bomb proof
Hope you get to the bottom of it soon

Your doctor is talking bollocks. My DS is allergic to CMP, but was fine with my breastmilk once I cut out dairy from my diet.

Soya milk is vile, Oatly is much much nicer, you can get it in most supermarkets.

I think babies who are having pepti junior and other hypo formulas have interesting coloured poos too.

hazchem, we are in two-part nappies - the only way to go really! :) Tots Bots Flexi are pretty good (well, were fantastic with my first so I got my DS2 the same kind). But, get this: my little boy managed to produce a poo that beat a three part nappy he had on for the night - WeeNotions NightNotions nappy + Motherease Rikki + Motherease AirFlow. Now, can you suggest anything that would be more bomb proof that that?! :)

I'll need to find another paed, as it sounds like the one we saw was more interested in our cash than bubs (private paed through DH's work insurance). The first app't we had was for both DS1 and DS2. I booked a follow-up for DS2 (was very specific that it was just for one of them). The doc still insisted he takes a look at both when we came in (DS1 was perfectly fine) - and taking a double fee naturally...
We wouldn't go to him, if he wasn't the only private paed in our area (visits once a week). Having recently moved, we haven't registered with an NHS doc yet... maybe the NHS ones are better, we'll see.

ELK oh my god I've got nothing!
I would register with an NHS doctor. Also you could see if there is a children's center near you. The center near me has drop in dietians which are fab.

There were new NICE guidelines on food allergy in children which were published in Feb this year (google & you should find it). They recommend that the first test is to do a food elimination diet. You should see a dietician though. My GP was happy for me to mess with my 13 m.o.'s diet (we were checking for effects on his eczema) but not for more than a month at a time - any longer and we'd have to have seen a dietician.

Kellymom has some info on food sensitivities and there are links to info on lactose intolerance (which I think is pretty unlikely). Lactose intolerance usually develops from about age 4ish IIRC.

Other allergens can be transmitted via BM - there'll be more stories on the Allergies board, and Kellymom is always a good place to start looking.

Apparently about 60% of children with cow's milk protein allergy are also allergic to soya.

It sounds like the paed doesn't really know what he's talking about - I'd definitely try registering with an NHS doctor.