Feeding problems are a common source of irritability and crying in young babies as well as concern in their parents. Such problems may include a reluctance to feed, constant hungry crying, and swallowing too much air, leading to regurgitation. There may also be special problems for mothers who are breast-feeding. This chart deals with most of the common problems that may arise.
Possible causes Reluctance to feed is most often due to a minor illness, such as a cold. However, if it persists, it may also be caused by a more serious illness. Young babies who refuse to feed may become dehydrated. Call your doctor immediately if your baby is under 3 months old and has refused feeds for more than 3 hours, or is over 3 months old and has refused feeds for more than 6 hours.
Action Your doctor will examine your baby to exclude an underlying illness. If a cold is the problem, your doctor may advise you to clean your baby's nostrils, which may help him or her to breathe while feeding.
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Possible cause and action Some babies, like some adults, eat less than others. Providing that your baby is happy, alert, and gaining weight at the expected rate, there is no cause for you to be concerned.
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Possible causes A number of different underlying illnesses may cause a continuing reluctance to feed and poor weight gain. Consult your doctor.
Action Your doctor will examine your baby and may arrange for tests to look for any cause of your baby's feeding problem. He or she will treat any underlying cause and may advise you on feeding your baby.
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Possible causes Frequent feeding is normal in breastfed babies (many babies require 8 or more feeds a day) and helps maintain your milk supply. However, if you baby is 6 months old, he or she may be ready to start solids.
Action If you are getting tired from disturbed nights and your baby is not ready for weaning, try expressing milk so that someone else can give your baby a bottle (seeBottle-feeding a breast-fed baby). If you think your baby may need weaning, introduce small amounts of solids once a day (seeIntroducing solids to your baby), or ask your nurse or doctor for advice.
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Possible cause A delayed "let down" reflex, in which milk is not immediately released when your baby starts to suck, may be the cause.
Action Try to relax while breast-feeding, and avoid feeding your baby in circumstances that make you feel uncomfortable, such as in public places. Make sure that you are not distracted. Stimulating the nipple just before your baby latches on may also help.
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Possible cause The hole in the teat may be the wrong size for your baby, causing milk to be released too quickly or too slowly.
Action Check the flow of milk through the hole in the teat. If the flows seems too quick or too slow, try using a different teat.
21See your doctor within 24 hours
Possible cause Gastro-oesophageal reflux, in which the stomach contents leak back into the oesophagus, may be the cause. However, if the symptoms only occur occasionally, they may be due to wind (seeDealing with wind).
Action Your doctor will examine your baby to exclude other causes. You may be advised to put your baby to sleep on his or her side with the head higher than the feet. If your baby is old enough, spending more time sitting in a baby chair may be helpful, as will thickening his or her feeds with cornflour or a commercial thickener. Your doctor may also suggest a drug that helps to prevent gastro-oesophageal reflux. Most babies will grow out of this condition by the age of 1.
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Possible cause Babies are often not keen to move on to solid food, and this is not a cause for concern.
Action Initially, try giving your baby small amounts of solid food once a day. Make sure the food is smooth and not too thick. Gradually provide a wider variety of tastes (seeIntroducing solids to your baby).
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Possible causes Your baby may dislike the new texture or taste of the food. He or she may also be less willing to eat something new if he or she is tired.
Action Stop giving your baby the new food for a while. Try it again at a later date, preferably at breakfast time when your baby is less likely to be tired.
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Possible cause It is not uncommon for older babies to suddenly take a dislike to a food they previously ate happily. This is normal and not a cause for concern.
Action Try to vary your baby's diet, and gradually introduce a wider variety of tastes and textures. If your baby refuses to eat one particular food, stop offering it to him or her, and reintroduce it at a later date. However, if you are concerned, consult your doctor or nurse.
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Possible cause The initial rush of milk from the breast that occurs when your baby starts to feed may be causing him or her to choke. This is particularly likely to occur during the first feed in the morning after there has been a long gap between feeds.
Action Try expressing a little milk before starting to feed your baby. If this does not seem to help, consult your doctor or nurse.
26See your doctor within 24 hours
Possible cause Gastro-oesophageal reflux, in which the stomach contents leak back into the oesophagus, may be the cause. However, if the symptoms only occur occasionally, they may be due to wind (seeDealing with wind).
Action Your doctor will examine your baby. You may be advised to put your baby to sleep on his or her side with the head raised. If your baby is old enough, spending more time sitting in a baby chair may help. Your doctor may also suggest a drug that helps gastro-oesophageal reflux. Most babies grow out of this condition by the age of 1.
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Possible cause Breast-fed babies are often very reluctant to take a bottle unless it is introduced at an early stage.
Action Follow the self-help advice for bottle-feeding a breast-fed baby. If your baby still refuses a bottle, try using a feeder cup.
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Consult your doctor if you are unable to make a diagnosis from this chart.
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Consult your doctor if you are unable to make a diagnosis from this chart.
Self-Help Bottle-feeding a breast-fed baby
Bottle-feeding a baby It may be easier to get your baby to take a bottle if someone else offers it. If possible, use expressed milk, not formula.
Many breastfed babies never need to be bottle-fed. In some circumstances a cup, spoon or dropper can be used if the baby cannot be fed at the breast. While most breastfed babies will accept a bottle if necessary, it may be difficult to get some babies, who are a number of weeks old, to take a bottle. The following suggestions may help:
Try offering the bottle while walking around the room with your baby.
Feed expressed milk not formula.
Try a silicone teat instead of rubber, or try a differently shaped teat.
Ask someone else to offer the bottle when you are not in the room.
Family Doctor Health Advisor is for information purposes only, and is designed as a general reference and catalyst to seeking further information.
The RACGP is not engaged in providing medical or other advice or services, and is not responsible for the results of any actions taken by any person on the basis of any information in this publication, or for any error in, or omission from, this publication.
Publication Date: 31 March 2009 Authorised By: RACGP
