Infant feeding problems: common causes how we get your baby eating again

Is your baby struggling to feed? In medical terms, “infant” refers to babies from birth to 12 months old. The good news is that we have several methods to diagnose and treat the causes of infant feeding problems. I’ll explain the signs and symptoms, the diagnostic tests and how we approach treatment.

Why some infants reject food

The most common reasons for infants rejecting food are:

• Gastroesophageal reflux disease (GERD)
• Food allergies, such as cow’s milk protein allergy
• A mechanical obstruction to swallowing or stomach outlet e.g. pyloric stenosis (a rare condition that can show symptoms as early as 8-12 weeks old)

Signs of infant feeding problems

Irritability is a key sign. This could take the form of crying, back arching and/or refusing food altogether while being fed. Your infant might also never appear satisfied after feeding. Perhaps they are not taking enough milk and/or have to feed regularly with no spacing between feeds. This may impact weight gain, and you may notice that your child is not thriving.

Infants might also experience:

• Feed refusal or aversion
• Vomiting
• Choking or gagging when feeding (bottle or breastfeeding)
• Skin rashes on the cheek or buttocks
• Abdominal distention
• Diarrhoea
• Constipation
• Blood in stool
• Mucus in the stool

When to see a paediatric gastroenterologist

It’s wise to seek specialist advice if the previously mentioned signs and symptoms don’t settle after seeing a primary care physician. We can then perform specific tests to find the underlying cause.

If your baby has a co-existing medical condition (e.g. a cardiac problem), it’s important to seek medical advice from your primary care physician early on.

When to visit the emergency department

Some children with significant acid reflux and feeding difficulty also have symptoms of apnoea ( infant stops breathing- infant goes pale, blue or floppy) which is a risk for cot-death. If your child is unwell and you can’t fully wake them, or if they turn blue, this is an emergency and you should immediately go to A&E.

Diagnosing the cause

It’s critical that the right investigation is done so that we can get the correct diagnosis. The first steps are to get a history of your baby’s health and to perform a general examination.

Sometimes, we’ll suggest baseline blood tests. These are generally used for babies that have poor weight gain or blood in the stools. If we suspect acid reflux is the cause, we’ll usually try treatment and then evaluate later to see if symptoms resolve.

We might also suggest a barium study, which is a special type of imaging test. In this test, barium (a substance that shows on X-rays) is swallowed and then the oesophagus is monitored to check for abnormalities.

In some cases, we might suggest a pH impedance study if the initial treatment doesn’t work. This measures acid reflux in the oesophagus, usually for 24 hours. If required, an endoscopy may also be part of the workup.

If your child is choking or gagging when feeding, we might also arrange a speech and language assessment.

Treating the feeding problems

How we treat your child’s feeding problem depends on the cause. After undergoing all of the appropriate assessments, we’ll create a personalised treatment plan.

In any child with feeding problems, our goal is to address vomiting, issues with weight, prevent feed aversion and complications related to reflux. If your child is diagnosed with GERD, we’ll usually try adjusting the type of milk they’re consuming and we might suggest medication. In most babies under six months old with reflux, the condition is normally worse simply because of the immaturity of the lower oesophageal sphincter.

If we suspect they have an allergy, we may also try changing the type of milk for a dairy-free one.

Discover how Dr Dhamyanthi Thangarajah can help you care for your child’s health – visit her profile.