Please Breast Feed

2 babies, same problem, no solution.

A 45-day-old baby comes to the ER with mom and dad. He’s been more fussy lately, has been spitting up, crying a lot and appears in pain. Has normal vitals. The baby is otherwise healthy, no fever or respiratory distress. Still making wet diapers. Mom is worried about the spitting up and “just wants to be sure” the baby is ok. The baby looks great. There are no other concerning details from the history.

Dad thinks the baby has GI issues. He reports his whole family has GI issues including himself. So much so, that he excuses himself while we are talking because he has to use the bathroom. He figures the baby has acid reflux.

The baby is formula fed.

A 40-day-old baby comes to the ER with constipation. Had some small, hard bowel movements but nothing significant in the past 4 days or so. Parents have been using rectal suppositories and still not much progress. Upon getting a rectal temperature in triage, the baby had a large soft, greenish stool. He has normal vitals and otherwise looks great. The baby is otherwise healthy, no fever, no respiratory distress. Again, there are no other concerning details from the history.

The baby is formula fed.

I know the answer to both of these problems but that does not mean there is an answer in the ER.

Baby formula sucks. Breast milk is better.

However, at this point, neither mom is breastfeeding or capable of breastfeeding. Both couples were fairly young and not well off, medical literacy did not appear to be very high. Why mom didn’t breastfeed could be any number of reasons. Not able to, didn’t want to, working and can’t pump… Maybe mom tried but a combination of factors were at play.

Regardless, both babies have GI issues because they are on baby formula which is most often loaded with seed oils (for the fat component) and corn-based carbs. There are many formulas out there which I will admit I am not an expert in, so this is exactly what I told both couples. There may be other options that they will have to discuss with their pediatricians. One baby was already on at least a second type of formula because they had been having issues previously.

I’d like to tell them the truth. But what good does it do? We can’t go back in time. The horse is out of the barn. Neither baby got started in life on the nutrition that nature intended. So do I tell mom, “Hey, you screwed your kid up. You should have breastfed. What’s wrong with you? The next time you have a baby, you need to breastfeed.”

The dad with the GI issues and family history of GI issues? He even mentioned Crohn’s, which is largely a diet issue. Am I going to pivot the conversation based on the little bit of knowledge I have and explain to him my take on GI issues overall? That everything from Irritable Bowel Syndrome (IBS), Celiac disease, and Inflammatory Bowel Disease (IBD) e.g., Crohn’s and Ulcerative Colitis are often related to eating the wrong food? Some would argue these GI issues are on a spectrum, but all related to eating the wrong food.

I admit I have just a snapshot of what he and his family are dealing with. Clearly I’m not in a position to get into the nuance of what he eats, what his family likely eats, but it’s most likely the Standard American Diet, aka SAD. An ER visit for the baby is not the time or place to have that conversation.

But I wish someone WOULD have that conversation. He doesn’t need to suffer from GI issues so much that he has to duck out of our conversation to use the bathroom. His family doesn’t have to suffer with GI issues.

But the babies… well they are sort of stuck. Until they are on solid food and have more options. But at that point, the first foods will likely be grain-based snacks. Unfortunately, grains are one of the biggest contributors to GI issues.

The best I can do is reassure them that the babies are both well enough that we don’t need to do any testing. I don’t have any tests anyway that would pinpoint why they are spitting up or having constipation. Admittedly, I can’t prove that what I’m saying is true. But having seen enough babies with GI issues and knowing the truth about what actual healthy food is, it’s the most likely problem.

Like with a lot of my patients, I wish there was something else I could do.