Feeding problems with babies

How to tell if your baby has a feeding problem

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November 26, 2019 | by Alexis Rodriguez, M.D.

Categories: Healthy Driven Moms

Some babies have trouble eating and drinking at first. They may spit up, avoid new foods or refuse to eat certain foods. They may have trouble holding food and liquid in their mouth. These issues are usually normal and temporary.

A child with a feeding problem or disorder will keep having trouble. Twenty-five percent of all children will experience feeding difficulties during infancy and early childhood that can affect their overall health and development.

When a baby doesn’t like solids, it’s easy to assume they are a “picky eater.” But poor feeding is different from picky eating, which doesn’t usually start until your baby becomes a toddler. A baby may have a feeding problem when they can’t eat or drink enough of the right things to stay healthy.

Feeding problems may include difficulty swallowing, called dysphagia. This is the inability of food or liquid to pass easily from the mouth to the throat, through the esophagus and into the stomach. Dysphagia can result in aspiration, which may cause pneumonia and/or other serious lung conditions.

How do you know if your baby has a feeding problem or disorder? Some common red flags include:

Refuses to eat and drink
Isn’t gaining weight or growing as expected
Arches back or stiffens when feeding
Cries or fusses when feeding
Regularly takes a long time to eat (more than 30 minutes)
Falls asleep or isn’t alert when feeding
Avoids foods with certain textures
Drools a lot, coughs or gags when feeding
Has problems chewing and swallowing
Has trouble breathing while eating and drinking
Frequently spits up or vomits
Has a hoarse or raspy voice during or after feeding

Feeding difficulties in babies may happen because of breastfeeding challenges. Lactation consultants can teach you how to feed your baby and help with latching difficulties, painful nursing, low milk production and other issues.

Poor feeding may also be caused by temporary illnesses, including ear infections and colds. These can make feeding uncomfortable for babies and will normally stop when the illness is treated. Other factors that may affect a baby’s ability to feed are stress, pain from teething and medication side effects.

Babies with certain health problems or conditions may also have feeding difficulties. Some possible causes for infant feeding and swallowing problems include:

Prematurity, low birth weight
Certain traumatic birth injuries (cerebral palsy)
Structural abnormalities (cleft lip, cleft palate)
Reflux or other stomach problems
Lung or respiratory problems (asthma)
Heart disease
Nervous system or muscle problems (muscular dystrophy)
Developmental delays or disabilities (autism)

If left untreated, feeding problems can negatively affect your baby’s health. Malnutrition is a top concern. Babies need to feed and digest the necessary nutrients to develop and grow properly. If they don’t get the necessary nutrition, it can lead to a condition known as failure to thrive.

Feeding issues can also put infants at risk for dehydration, aspiration, pneumonia or other lung infections, and delayed physical and mental development which can lead to speech, cognitive and behavioral problems.

The earlier the problem is addressed, the better the long-term outcome. Treatment for feeding disorders varies based on what’s causing the issue and the symptoms involved. A team approach, including the child’s doctor, dietitians and speech-language pathologists, is often the best way to treat these issues.

For instance, babies and children with dysphagia are often able to swallow thick fluids and soft foods better than thin liquids. A speech-language pathologist can suggest techniques for feeding that may help improve swallowing problems.

Treatment may also include medicines for reflux, trying different foods or textures, changing the temperature of food, changing the feeding schedule (e. g., smaller, more frequent meals), changing your child’s position while eating, and/or switching feeding methods. In severe cases, your child may need to get nutrition in other ways, such as through a feeding tube.

If you think your baby is having trouble with feeding, let your child’s doctor know right away. While feeding problems are usually minor, your doctor will want to rule out an underlying medical issue.

Some warning signs of feeding problems include wetting fewer than four diapers per day, infrequent or hard stools in the first month, your baby becomes more yellow instead of less during the first week.

If your baby shows any signs of emergency, such as a fever over 100 degrees, wheezing, bloody vomit or stool, or constant crying, get immediate medical attention. Signs of an allergy or digestive disturbance include vomiting after feeding, frequent loose or watery stools, blood in the stools or a severe skin rash.

The Edward-Elmhurst Health Pediatric Feeding Clinic takes a comprehensive approach to the full spectrum of feeding disorders in children of all ages and concentrates on feeding, nutrition and growth. Our multidisciplinary team includes a pediatric dietitian, pediatric speech-language pathologist, pediatric gastroenterologist and a pediatric nurse. For questions, please call 630-527-5409.

Explore children’s services at Edward-Elmhurst Health.

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Featured Expert

Alexis Rodriguez, M.D. Specialty: Pediatric Gastroenterology

Dr. Rodriguez specializes in pediatric gastroenterology. Read More >>

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Feeding Problems | Pediatrics

Feeding can become a problem when your child is losing weight or having trouble gaining the right amount of weight for their age. Your child or baby has feeding problems when:

They can’t eat or drink anything.
They can’t eat and drink enough of the right things to stay healthy.
They choose not to eat or drink enough of the right things to stay healthy.

With a baby, you might have breastfeeding problems. Other baby feeding problems might come from your baby not being able to suck, chew, or swallow.

Eating disorders in young children are called feeding disorders. They might also be called toddler eating disorders. (Usually, the term eating disorder is used for pre-teens, teenagers, and adults.)

Sometimes problems with eating get better without treatment. Sometimes your baby or child will need to be seen by a doctor.

With treatment, feeding disorders can get better. Eating can turn into a safer, easier, and happier experience for your child and the rest of the family. Treatment can also help your child become healthier.

Sometimes feeding problems are due to a child not being able to suck, chew, or swallow. This might stem from a physical problem such as a cleft palate or tongue tie. When the cause is less clear, you can look for these signs:

Not gaining weight well
Coughing, choking, or gagging when eating or drinking
Throwing up often
Choking on food or drink once during a meal and not eating again
Eating and breathing coordination problems
Not eating baby food purees by 8 months old
Not eating table foods by 12 months old
Not using a cup by 16 months old
Eating baby foods at 16 months old
Avoiding foods with a certain texture or from a certain food group (such as fruits and vegetables)
Eating fewer than 20 kinds of food, especially when they stop eating certain foods and don’t replace them with other foods
Crying or arching the back at most meals
Taking more than 30 minutes to eat meals on a regular basis

Other signs within your family can include:

Arguing with your child about food and feeding
When feeding your child is difficult for everyone
Eating problems you have that your child may get from you

If your baby or child is losing weight or having trouble gaining the right amount of weight for their age, you should see a doctor. While some feeding problems can get better without treatment, it is best to make sure that the cause isn’t serious.

If your baby is very uncomfortable when eating or their spit up is green or bloody, you should take them to a doctor right away.

Feeding disorders are more than picky eating. Feeding difficulties in children are almost always caused by some other medical problem, including:

Gastroesophageal reflux [GAS-troh-ih-SOF-oh-JEE-uhl REE-fluhks]. This is a condition where acid from the stomach flows back into the esophagus, the tube that connects your child’s mouth to their stomach.
Eosinophilic esophagitis [EE-oh-sin-oh-fil-ik EE-sof-a-jai-tis] or inflammation of the esophagus
Other stomach or intestine problems
Seizures
Nervous system problems
Premature birth
Sensory system problems
Autism
Craniofacial [CRAY-nee-oh-FAY-she-awl] syndromes or abnormalities of the face or head
Heart or lung problems
Face and mouth muscle problems
Problems swallowing certain liquids and food textures

When a baby has a problem with breastfeeding, these medical problems might not be the cause. Breastfeeding doesn’t necessarily come easily for everyone. You may have difficulty with positioning your baby or have sore or tender nipples. Your baby might be spitting up. Some spitting up is normal for all babies. It happens when they eat too fast or swallow air. Remember that it takes practice and patience to find a pattern that works best for you and your baby.

Your child will have a clinical feeding evaluation at a therapy center. The feeding specialist (either a speech-language pathologist or an occupational therapist) will talk with you about:

The foods your child eats
Where and when your child eats
Who feeds your child

The therapist will look at your child’s mouth and face. They will watch your child eat or be fed. By watching children eat, the specialist can learn how they move their mouths, think while eating, and control their bodies. They can also see a child’s general ability to eat. If the therapist thinks your child may not be swallowing safely, they will schedule another evaluation.

After the feeding evaluations, the therapist may recommend several ways to help your child, including:

Putting your child in certain safe eating and drinking positions
Giving your child certain drinks and foods that are safe for them
Helping your child to eat a wider variety of foods, and drink assorted drinks
Teaching you and your child safe feeding and drinking skills
Coordinating services with other medical and therapy professionals

Most causes of feeding problems cannot be prevented. Some steps you can take to make eating a healthy time that your child likes include:

Not arguing about food
Making food fun
Avoiding power struggles over food
Being patient when giving your baby or child new foods to try

Healthy Children

Your child or baby has feeding problems when they can’t eat or drink or when they can’t eat and drink enough of the right things to stay healthy. If your child is losing weight or having trouble gaining the right amount of weight for their age, they might have a feeding disorder. With treatment, feeding disorders can get better.

© 2018 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns.

Frequently asked questions and problems with breastfeeding

Publication date: 05/05/2019

Recently, women have increasingly begun to choose breastfeeding over formula. And this is easy to explain, because mother's milk individually gives the baby all the necessary substances and forms his immunity. It also establishes and strengthens the bond between mother and child. But often unprepared mothers are faced with a number of issues that we will analyze in order today.

Will I be able to breastfeed?

Definitely yes! All it takes is your desire to breastfeed. Any woman, regardless of breast size or physique, can handle this. Mom must understand the physiology of lactation: how much milk the child has sucked out, so much of it will come for new feeding. Therefore, it is better for mothers to understand in advance the nuances and issues of lactation. A lactation specialist with his competent opinion will help you figure it out.

What to do before the milk arrives?

In the first days, the mother secretes colostrum, which has its own nutritional value and the amount of it will be enough for the baby to saturate. It contains many vitamins, immunoglobulins and it helps to improve digestion. And the more often you put the baby to the chest, the more it will be.

What can cause pain while breastfeeding?

The most common cause is incorrect application. This can cause pain and cracked nipples. Also, mothers face this when they try to bottle-feed their baby at the same time with a nipple. Since the technique of sucking on a bottle is different from sucking on the mother's breast, the baby can become confused and hurt the mother. But if the pain is felt rather inside the chest, stagnation and lactostasis may be the cause. To avoid this, you need to adjust the application and seek help from a specialist.

What causes lactostasis and how to avoid it?

Laktostasis is a blockage of the milk duct by a fat drop of milk. It can also occur when the glandular tissue of the breast is injured, for example, if the mother incorrectly breastfeeds the child, sleeps on her stomach, or wears the wrong underwear. All this can cause stagnation, as well as when the baby does not empty the breast well or the mother “hoards” milk in her breast for a long time before feeding. Therefore, young mothers need to follow certain rules in order to avoid milk stagnation, and also know how to help themselves if it does happen.

How often should a newborn be breastfed?

In the first weeks, offer your baby the breast when he is anxious, in other words, on demand. During the first days, the child can be applied to the breast several times an hour. When lactation improves, the mother will already learn to understand the baby’s signals and will know when to feed the baby, but at least once every 2.5 hours. The baby at the same time determines the duration of the meal. Here the individual character of the child and his temperament are important. For one, 10-15 minutes will be enough, and for another, an hour will not be enough.

Should I follow a diet while breastfeeding?

Research shows that mother's nutrition does not pass into breast milk in its original form, but provides it with various nutrients and beneficial micronutrients. And strong-smelling foods (onions, garlic) will not be able to discourage the baby’s desire to suckle the breast. Because the food eaten by the mother first enters the gastrointestinal tract, where it is digested and all its beneficial substances are absorbed by the walls of the stomach and enter the bloodstream. Already at the final stage, breast milk is produced from the blood and lymph. Therefore, if you ate, for example, a cutlet, it will not go directly into milk. But eating, of course, is better than natural and healthy food. It is advisable to exclude fast food from your diet and not "lean" on any one particular product. Because there are all preservatives and additives completely get into the milk due to the fact that they are absorbed by the blood.

Of course, do not overeat and abuse foods that cause allergic reactions.

When and how should a baby be weaned?

WHO recommends exclusive breastfeeding up to 6 months (without complementary foods) and continued until 1.5-2 years. However, the decision in this matter remains with the mother. It is advisable to wean the baby smoothly: signs of lactation fading should last at least two months. At this point, the milk changes again and becomes close in composition to colostrum. During this time, the baby will receive the required amount of antibodies and immunoglobulins.

Our Clinic – HM is always open for you. Breastfeeding consultant Titova Anastasia Mikhailovna is always ready to help you sort out all the issues and help solve the problems that arise. We are located at Orekhovo-Zuevo, st. Dzerzhinsky, d 41, Clinic New Medicine.

Most common breastfeeding problems. How to help yourself and your baby.

Countless materials have adorned the naturalness and simplicity of breastfeeding. Indeed, there are mothers to whom this process is given easily and naturally, but not all of them belong to them. Unfortunately, for some women, breastfeeding fails for some reason or causes great stress. This is reinforced by the fact that in the postpartum period, young mothers can be very emotional and subject to anxiety due to hormonal changes. Whatever the specific situation and mother’s experience in breastfeeding, certified pediatric nurse Elita Svareniece finds it incredible that it is possible to breastfeed a baby for two years absolutely without “accidents” - like in yoga classes or during meditation, because in real life this does not happen .

Breastfeeding or not?

Successful breastfeeding is based on the mother's desire to breastfeed. It is not without reason that in many countries women are asked the question - will you breastfeed or not? In the world and in Latvia, breastfeeding is consciously supported, assisting this process, namely, if the state of health of the newborn and the mother allows it, the child is put to the breast as early as possible.

1. Breastfeed as soon as possible

The breast transforms within 24-48 h after childbirth. Therefore, it is important to put the newborn to the breast during this period - the more often, the more impulse arises in the mother's body that the baby was born, and the "dairy factory" begins to work. The first 2 postpartum hours are especially important - if the child is applied to the mother's breast, his pituitary gland receives a signal, and the hormone prolactin, which is responsible for the secretion of milk, begins to be released. Remember - milk production is not affected by the size and shape of the breast!

2. Benefits of breastfeeding for a woman

Nature has wisely arranged so that breastfeeding facilitates the postpartum period for a woman, because under the influence of the process, postpartum bleeding stops faster, the uterus shrinks more successfully - when the baby is "sucked" to the mother's mammary gland, it is released oxytocin, which constricts blood vessels. Breastfeeding affects a woman's long-term health by reducing the risk of breast and ovarian cancer and diabetes. For example, the risk of breast cancer is reduced by 30%, and the risk of osteoporosis by 80% if a woman breastfeeds two children. The risk of developing an ovarian tumor is reduced by 25%.

3. Is it necessary to express milk and when?

Expression of milk becomes important for a woman's breasts when lactation has developed, namely after 10-14 days. At first, a woman often falls into stress, as she cannot express anything particularly. It must be understood that with her own hands a woman will never be able to express as much as a child can suck or pump out an electric breast pump.

In the first weeks after childbirth, the use of an electric breast pump is not recommended, but later they are indispensable. If you want to promote the production of milk, you need to completely express the milk. Thus, to actively promote milk production, increase its volume to create a reserve or “milk bank” by freezing, or to take care of your breasts, there is no better, better and more comfortable method than pumping with a breast pump.

Which breast pump should I choose?

Breast pumps are different. A breast pump should fit your lifestyle. Think about where you will most often use it and find out if it is convenient and suitable for you: is it light, quiet and powerful enough, does it have soft silicone or hard plastic grips? This is important, since the shape and size of the female breasts are different. The advantage of silicone overlays is that they adapt to the unique anatomical properties of a woman.

Truly superior - electric and manual breast pumps Philips Avent. Their special Natural Motion technology mimics baby suckling and stimulates the breast to help milk flow faster. The suction rhythm can be easily adjusted to individual needs and milk flow. This breast pump is gentle, lightweight, portable (with a strap), quiet, with soft pads of a universal size that gently adjust to the size and shape of the nipple, learn more . Also Philips makes special Natural feeding bottles, which have a nipple shape similar to a woman's nipple, allowing you and your helpers to feed your baby as naturally as possible.

The choice of a breast pump is very individual - you need to consider your needs, listen to the recommendations of professionals or other mothers, but remember that the final decision and choice is yours.

What is the best way to breastfeed?

1. Basic principles

The baby should be put on the breast, not the breast on the baby.
Belly-to-belly position should be maintained so that the child does not have to turn his head to the side and his esophagus is open.
When putting the baby to the breast, it is important to direct the nipple towards the nose, and not try to put it in the mouth - the baby will smell the milk and open his mouth. In this way, you can place the nipple as deep as possible into the baby's mouth and will not feel pain when feeding.

2. Duration of feeding

One feeding should not last more than an hour, so that the baby does not use the breast as a pacifier. Optimal feeding time: about 45 minutes. Sometimes it can be 3-5 minutes, especially in hot weather, when the child only wants to drink. During feeding, it is important to hear the rhythm of sucking - the child does not eat without stopping, he stops when the muscles of the mouth get tired.
If there is a good flow of milk, the baby can eat in 10 minutes, but he enjoys the process. If you see that the nipple is deep in the mouth and the child dozed off while eating, after 10 minutes you can carefully select the breast, however, if the child wakes up and begins to actively suck again, you need to give him the opportunity to continue eating.

3. Other important things

In the labor ward, women are usually advised to give their baby on both breasts to create a “double demand” and produce more milk. Later, having achieved stabilization of the flow and volume of milk, it is better to offer one breast at one feeding of the baby, and the other at the next.
It is important not to tear the baby away from the breast, as a vacuum forms in the baby's mouth while eating. It is more correct to put a finger in the corner of the mouth to let in air and easily remove the breast from the baby's mouth without damaging the nipples.

Sore nipples

After 30 seconds after the start of the next feeding, the pain should significantly decrease or disappear altogether. It is very important that the pain does not increase. If the pain increases during feeding, it means that the baby has not grasped the breast correctly or there is a problem in the nipple.
If the reason for this is not the incorrect position of the child during feeding, then the reasons may be different and all sorts - cracked nipples, inverted nipples, etc. In such cases, special creams, bra pads, learn more, breast pads or nipple protectors, as well as special devices (in English - niplette), with which you can gently “pull” out inverted nipples, can help in a non-surgical way.
The process of breastfeeding can be traumatic for the mother even if the baby has a short frenulum of the tongue, which connects the lower part of the tongue with the base of the mouth. For this reason, it is difficult for the baby to skillfully suck milk from the mother's nipple - he cannot press the nipple against the palate. The baby compensates by sucking harder, causing the nipples to hurt and become inflamed.

Problems with nipples can also occur due to leakage of milk, so care must be taken when using bra liners and changing them regularly, as heat and moisture are an ideal breeding ground for bacteria.

Painful, swollen and full breasts can be helped by cold and warm compresses, as well as cabbage leaves popular in Latvian folk medicine.
If there is thrush on the breast, it is necessary to treat not only the mother's nipples, but also the baby's mouth and even the bottom. Thrush on the chest occurs due to some kind of imbalance in the body or errors in hygiene, so always wash your hands before breastfeeding and after changing diapers.
Do not use breast pumps if your nipples are damaged. First you need to fix the problem - heal the nipples, and only then you can resume pumping with a breast pump.

Mother's milk is the best for a child

Mother's milk contains proteins and vitamins in such proportions and quantities that a baby can fully obtain and use them without overworking. Therefore, it is considered optimal if, in the first six months of life, the baby does not receive anything other than mother's milk, which provides the ideal microflora of the intestinal tract, contributes to its maturation and permeability, and reduces the risk of diarrhea and other intestinal infections.
Breastfed babies have a lower risk of allergies and chronic diseases.
During the following years of life, breastfed children have fewer problems with excess weight, in turn, in children who were formula-fed, body weight may be more often underestimated or increased.

For a child, breastfeeding is not only a process of eating and drinking, but also a sense of security - the infant's adaptation to the big world, a way of calming down, exchanging tenderness through the mother's touch and forming a psycho-emotional connection with her.

Mother's milk contains fatty acids, including unsaturated fatty acids, which are extremely important for the maturation of the brain, the development of the nervous system and visual centers. A breast-fed child has a high intellectual development, as he received unsaturated fatty acids that contribute to brain function.
Sudden infant death syndrome is less common among breastfed infants.
Babies who received mother's milk before 12 months are less likely to suffer from ear infections, because sucking milk works all the muscles of the face, the mouth develops properly and the ear muscles are trained.
Mother's milk is 87% water, so the baby can drink from it (no additional water required). Closer to the nipple, milk is water with trace elements, while more nutritious "fatty" milk is located deep in the breast.
A woman's nipple has a lot of nerve endings that analyze the composition of the baby's saliva. When this information is perceived by a woman's body, milk changes composition and even color. For example, if a child falls ill, more lymphocytes, leukocytes and other biologically active substances are formed that cannot be included in any mixture.
Mother's milk contains various nutrients with a high energy value. In the morning, when my mother slept, the milk is more fatty, in the evening - less. This explains why babies are more restless in the evenings and more often ask to be breastfed.

Situations when breastfeeding is not recommended

A child should not be fed with an acute herpesvirus infection, especially on the nipple. In this case, while the breast is being treated and the acute outbreak of infection is reduced, you need to express milk and bottle feed the baby.

Breastfeeding is incompatible with taking medications that are contraindicated for breastfeeding mothers - namely, drugs that pass into mother's milk and can potentially harm the baby. The choice and, if necessary, the replacement of drugs is determined only by the doctor. Antibiotics are not recommended during breastfeeding.
HIV infection can also enter the baby's intestinal tract and subsequently into the bloodstream with mother's milk. Also, if an HIV-positive mother has cracks in the nipples, infected mother's blood can enter the child's body through microcracks.
The rationality of breastfeeding should also be considered in the case when in the postpartum period a woman is in a pronouncedly unstable psycho-emotional state (not to mention serious psychotic and depressive symptoms). In such cases, a young mother, without realizing it, can cause any harm to the child.