Baby does not gain weight (follow-up to an earlier question)

Question

Dear expert team,

I already asked a question about the issue „baby does not gain weight (being exclusively breastfed) on July 31, 2008.

Thank you very much for your answer.

Unfortunately since then the situation did not improve at all. On the contrary, he is growing thinner and thinner.
In the meantime our now six months old son was in hospital again. He had bloody mucilaginous stools. The reason for this could not be found with 100 % certainty even after a colonoscopy. It is supposed that this was due to a CMV-Virus infection. Anyway, after some time the stools improved on their own.

The former upper lobe atelectasis nearly disappeared. Only a small number of shades are still to be seen in the x-ray.
He still coughs relatively often. Because of heavy coughing fits he vomits, especially after meals. That occurs several times a week. In the majority of cases he then does not continue to eat (drink), thus he misses a complete meal.

Additionally his gall function is never correct although Ursofalk was increased up to 2.5 ml.

Unfortunately he did not gain nearly any weight yet. Now, at the age of 6 months, he only weighs 5700 g. That is although he currently is drinking a bit better.
We were advised to start supplementary food at the age of five months. This we did. We use the normal glasses of baby food you can buy and mix it with a bit of oil. Sometimes the purees are eaten in small quantities, sometimes absolutely refused. Apart from that he is still being breastfed, with each breastfed meal ( about 60 to 100 g) he now gets 3 ML Kreon for children.
The breast milk was never examined (which you advised). Nor was the oesophagus examined – however, a ultrasonic examination of the abdomen was performed.
In the CF-clinic we were told that the lacking weight gain is due to the many earlier problems he had.

We think it there is a different reason, because currently he is sort of healthy and in a good temper. He is eating a bit more food, but all that does not seem to have any effect whatever.

Sadly we feel that nobody can help us with the issue of lacking weight gain.

With kind regards
Roman K.

Answer

Hello,

Your child’s medical history sounds very complicated. When a mostly breastfed child has bloody mucilaginous stools this may be caused by an intestinal infection by Candida mycopathogens, Bacteria (salmonella, clostridia) or viruses (Rota virus, CMV virus). It is not so rare that an allergy against the cow milk protein is the actual reason. This is especially true if there is a lack of weight gain. At the age of your child this is finally to be clarified only by a complete conversion to hydrolyzate food and complete elimination of products containing cow milk protein. In this case the feeding of breast milk would have to be stopped also. Because of the complex situation you should urge that a paediatric gastroenterologist is consulted.

Best regards,
Dr. H.-G. Posselt

04.01.2009