Diarrhoea in breast fed babies
It is very unusual for a baby on breast milk alone to develop serious diarrhoea. The treatment is the same as outlined for bottle fed babies but breast milk will have to be expressed while the baby is on electrolyte solution. It is vitally important for the mother to continue breast feeding afterwards as it provides excellent protection against gastroenteritis caused by bacteria.
Certain drugs, including some antibiotics, can cause diarrhoea and foodstuffs such as spinach, if it is not freshly cooked, or orange juice can also cause loose stools. If the mother of a breast fed baby has taken a laxative it may also affect her babys stools. But these are unlikely to cause severe, prolonged diarrhoea, and there will usually not be a foul smell.
Frothy, foul stools
Congenital or primary lactose intolerance is a very rare disease in which the baby is born without lactase enzyme. It results in loose, frothy, foul-smelling stools during the first weeks of life and the baby does not gain mass. Special formulas which do not contain lactose (a milk sugar) are available and the baby will be taken off the breast or cows milk formula and given soya bean milk or a specially modified cows milk formula which has the lactose replaced. The inability to digest sucrose (sugar), is a more common condition with similar symptoms.
Secondary lactose intolerance is the more common form of lactose intolerance and occurs after an infection in which the babys ability to digest lactose is inhibited (83). Although this condition is temporary the child will also have to be taken off the breast or bottle and given a lactose-free formula of soya milk or specially formulated cows milk formula for a short period. This does not mean that you will have to stop milk feeds permanently because your baby will gradually be allowed back on the breast or usual bottle feeds. You will have to keep expressing in the meantime if you wish to continue breast feeding. In mild cases your baby could be back on the usual bottle or breast feeds in 24 hours, but in severe cases it could take up to a month before the lactase level (the enzyme which digests lactose) returns to normal, and then it could be more than three months before a normal diet can be introduced. A new drug that replaces lactase is being tested which will make it unnecessary to take the child off milk.
Gluten intolerance (coeliac disease) also produces frequent, foul, bubbly stools (123).
Cystic fibrosis and certain malabsorption conditions also result in excessive, bulky stools, often with a foul smell (293).
A baby who is having phototherapy for jaundice usually has dark, loose, greenish stools but they return to normal when the baby is removed from the lights.
The fashion for starting with solids as early as possible ended when research showed that it is not necessary or desirable for babies to have any solids added to their milk diet before at least the tenth week, and ideally only around the fifth or sixth month.
The breast fed baby will normally need solids later than the bottle fed baby, because all the nutrients in breast milk are absorbed and digested very well; therefore the timing and type of additions to the diet of bottle fed babies differs slightly from that of the breast fed baby.
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