Nutramigen

I was reading Dr Jest's Caseblog. He posted on the topic of breastfeeding which reminded me of this situation that occurred to me recently.

Mrs Ward came to see me with her 10 week old baby boy. He was grizzly and appeared in pain every time he took a feed, and she thought he was not only lactose intolerant, but also soy product intolerant. She requested I prescribe him Nutramigen.

The thing is Mrs Ward had been here before with her older child. They had been referred to paediatric dietitians before a diagnosis of lactose intolerance was made, and nutramigen prescribed with good effect.

The history of the latest Ward child's feeding problems had been relatively short lived. What to do? Strictly speaking I should have referred to the dietitians again, or at least left things a little longer.

To complicate things however, Mrs Ward was clearly not coping, had had postnatal depression with her previous child, and was showing signs that this was happening again.

So I prescribed. The result is a much happier baby. But would things have settled down by themselves? The problem now is trying to convince Mrs Ward that her baby may not need Nutramigen. I've suggested a trial with normal formula milk, but to restart nutramigen at the first signs of problems. Perhaps understandably Mrs Ward is not keen in her current emotional situation.

Tricky one.