1. Occult blood loss ? show up in diapers in a couple ways ? o upper GI bleed " black ? iron is changing redox state and turning from red to black ? o lower GI bleed " more red ? high casein damaging GI tract ? can lead to blood loss ? can recommend formula has more whey protein ? o advocate for: access to lab values ? RECENT lab values ? Adults: same 2. Constipation ? Strategies to work through ? o Baby massage ? o Baby stretching ? Water down formula: ? o Adding more water may decrease total intake ? o Can help move material through ? o Could help dilute things causing constipation ? Calcium, more iron ? senna " GI stimulant DO NOT RECOMMEND FOR BABIES ? o Extracted " exlax 3. Lactose intolerance ? Breast milk has lactose ? Spit up ? Diarrhea ? Colic " fussy ? Approach feeding differently ? o Human milk pump and add lactase ? o Or: put lactase drops under tongue (RX) before feeding ? o Or: Lactose free milk based formulas (cows milk) ? o Last choice: soy based formula ? Probiotic RX that you can suggest ? o Can be given to babies in drops ? o Probiotic eats lactose and prevent symptoms ? o
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