Brief Answer:
You need to know what that maroon stuff is.

Detailed Answer:
Dear XXXXXXX

While it might be tempting to think that everything red or maroon in colour is blood, one cannot be sure until one confirms it with a stool test. This is therefore the next, most logical step to take. Collect a sample of the maroon spot into a clear plastic or glass container - just 5-10 grams of stool material is enough for a diagnosis. Send this sample to a registered, good laboratory in your own vicinity, but farther if needed.

The reason for this advice is that if the presence of blood is confirmed, then we simply need to find out the reason for this. Usually, it is due to infection of the gut. However, such infections come with fever, pus or mucus in the stool and pain while defecating. It seems that your daughter does not have any of these problems.

If this is blood, we may have to go in for a special scan to confirm or rule out the presence of what is called Meckel's diverticulum. This is a small outgrowth of tissue growing out of the normal gut, and can cause painless fresh bleeding for months to years before it is diagnosed.

Is there a possibility that the maroon spots might NOT be blood? No, there is no other possibility here, as your child is only 4 months of age. Hence, it makes sense to get his stool sample and send it for testing for blood in stool.

Hope this hasn't confused you! Please revert to me with the stool report as soon as possible.

Dr. Taher

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Brief Answer:
Thank you for clarifying.

Detailed Answer:
The following is the list of foods to be avoided in your diet:

Milk foods to avoid

Avoid foods made with milk and soy products. However, soy oil and soy lecithin may be acceptable as they have no soy protein. Milk products include:

Artificial butter flavor
Curds
Lactoglobulin
Nougat
Butter
Custard
Lactose
Pudding
Buttermilk folids
Ghee
Malt milk
Simplesse
Calcium caseinate
Half and half
Milk
Sodium caseinate
Casein
Ice cream
Milk chocolate
Whey
Caseinate
Junket
Milk solids
Whey solids
Cheese
Lactalbumin
Nonfat milk solids (nonfat dry milk)
Yogurt
Cream

Soy foods to avoid

Soy products include foods with the word soy in them and:

Edamame
Miso
Tamari
Tempeh
Shoyu sauce
Teriyaki sauce
Textured vegetable protein
Tofu     

Soy may also be an ingredient in:

Hydrolyzed plant protein
Vegetable broth
Hydrolyzed soy protein
Vegetable gum
Hydrolyzed vegetable protein

I got this ready list from Wikipedia under MSPI. I am not aware of some of the things that are mentioned in this list. I have, in my 30 years of clinical experience in XXXXXXX and Saudi Arabia, never seen or managed a single case of MSPI. You would need to consult a dietician with the above list (or without it) and chart out a proper diet plan for yourself. The same things would be debarred for your baby as well once she is off your milk.

Dr. Taher

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Brief Answer:
We usually diagnose "Lactose Intolerance" and start children on soy milk

Detailed Answer:
Dear XXXXXXX

Unfortunately, that is the truth. MSPI is generally not thought of initially, and children are put on lactose-free diet when they report the presence of reducing substances in the stool. It is only when the problem continues to persist that we are forced to think of other, rarer illnesses. There is gluten enteropathy or coeliac disease, for example, which we consider. Also, there is sucrose intolerance (intolerance to sugar that we add to milk), fructose intolerance (the sugar found in fruit) and so on.

In my 24 years of clinical experience in XXXXXXX I have not seen a single case of MSPI.

I hope this explains the problem to you. I can get back to you after consulting a gastroenterologist in Paediatrics working in XXXXXXX

Dr. Taher

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