3 Common Feeding Problems For Healthy Infants

Wednesday, October 4, 2006 - 2:57pm

By Erica Lesperance, RD, LD

Feeding problems in infants are usually minor but can cause severe anxiety in parents. If they are not addressed, they can also have serious consequences. It can be difficult to tell the difference between normal infant behaviors and symptoms of a more serious problem. Awareness of the following common infant feeding problems may help parents make this distinction.

1.   Milk allergy in infants

Due to an immature gastrointestinal tract and immune system, some infants do not build protection against common allergens found in cow's milk, which is the basis of most commercial formulas. The infant's immune system mistakenly sees the milk protein as dangerous and tries to fight it off. An allergic reaction occurs, which can present itself in a variety of ways including loose stools, vomiting, gagging, irritability or colic and skin rashes. Onset of a milk allergy usually occurs in the first four months of infancy; most children grow out of it by the age of two.

Treatment of a milk allergy involves the elimination of milk proteins from the diet by switching to a soy or hypoallergenic formula. Since milk proteins cross over into the breast milk, breastfeeding moms may need to restrict their dairy intake, taking care to obtain adequate calcium through other sources.

2.   Infants and constipation

Most infants have several bowel movements per day. However, it is equally normal for a young baby to have as few as one bowel movement per week. As long as stools are soft, this is not constipation. Constipation is a condition where stools become firmer and harder than they previously were. Severe discomfort and irritability can result, which may interrupt an infant's feeding and sleeping habits. The most common causes of infant constipation are low fluid intake, excessive fluid losses, and use of certain medications. Breast-fed babies are less likely to suffer from constipation, in part because breast milk is easier to digest than most commercial formulas.

Before resorting to aggressive treatment for constipation, the following is recommended to encourage movement in the bowel:

  • Increase fluid intake by offering plain water or adding water to bottles.
  • Massage the infant's stomach, starting at the belly button and working outwards in circles in a clockwise direction.
  • Lay the infant on his back. Hold his legs and turn them gently in a quick cycling motion. This will put gentle pressure on the intestines to make them move.
  • Bathe the infant in a warm bath to promote relaxation so the stools are passed more easily. Incorporate stomach massage if necessary.
  • For infants over two months old, offer 2-4 ounces of diluted fruit juice twice a day. If the baby has begun solid foods, try foods with high fiber content such as peas, beans, apricots, and prunes.

When dietary modification does not correct constipation, medications such as colace, maltsupex and lactulose may be prescribed. Occasionally glycerin suppositories are recommended, but laxatives or enemas should never be used without specific instruction from a doctor.

3.   Gastroesophageal reflux in infants

Spitting up occurs when swallowed formula or breast milk is regurgitated through the mouth or nose. Almost all infants spit up because the valve that separates the esophagus and stomach is immature and does not keep all of the stomach's contents in place. While this may be a very messy inconvenience, it is completely normal and most infants will outgrow this by the age of one. However, spitting up that seems to cause discomfort, interferes with feeding and growth, or persists into early childhood could be gastroesophageal reflux (or simply reflux) and may require medical attention. Vomiting, irritability, difficulty breathing, food refusal, back arching or twisting, and chronic cough may all be indicators of reflux. Though severe cases of reflux require medication, mild to moderate reflux can often be managed with the following feeding practice modifications.

  • Feed smaller amounts, more times per day.
  • Burp the infant every four or five minutes during feeding.
  • Switch to a hypoallergenic formula, as reflux can be the result of an allergy to soy or cow's milk.
  • Position the infant upright during and after feeding, allowing gravity to aid in stomach emptying.
  • Eliminate exposure to cigarette smoke and caffeine.
  • Thicken bottle feedings with a small amount of rice cereal. This is thought to prevent food from backing up into the esophagus. It is worth noting because many parents and doctors report that this has been an effective reflux management technique. However, it is not scientifically proven and also provides extra calories, possibly making it harder for an infant to know when he has had enough to eat.

Suspect a feeding problem? Consult your doctor in the first instance

As the parent of an infant, it is important to recognize behaviors that indicate feeding problems. The above suggestions may be helpful in managing these situations. However, a doctor should be consulted for proper diagnosis and treatment recommendations.