Feeding Problems

Spitting up (burping up) is the effortless return of swallowed formula or breast milk through the mouth or nose after feeding. This is normal as long as it is not excessive. Almost all infants spit up, because infants cannot sit upright during and after feedings. Also, the valve (sphincter) that separates the esophagus and stomach is immature and does not keep all of the stomach's contents in place. Spitting up gets worse when an infant eats too fast or swallows air. Spitting up usually stops between the ages of 7 months and 12 months.

Spitting up can be reduced by

Spitting up that seems to cause an infant discomfort, interferes with feeding and growth, or persists into early childhood is called gastroesophageal reflux Gastroesophageal Reflux in Children Gastroesophageal reflux is the backward movement of food and acid from the stomach into the esophagus and sometimes into the mouth. Reflux may be caused by the infant’s position during feeding... read more and may require medical attention. If the material that is spit up is green (indicating bile) or bloody or causes any coughing or choking, medical attention is needed immediately.

Vomiting is the uncomfortable, forced throwing up of feedings. It is never normal. For a more complete discussion, see Vomiting in Infants and Children Vomiting in Infants and Children Vomiting is the uncomfortable, involuntary, forceful throwing up of food. In infants, vomiting must be distinguished from spitting up. Infants often spit up small amounts while being fed or... read more .

Vomiting in infants is most often the result of acute viral gastroenteritis. Viral gastroenteritis Overview of Gastroenteritis Gastroenteritis is inflammation of the lining of the stomach and small and large intestines. It is usually caused by infection with a microorganism but can also be caused by ingestion of chemical... read more is an infection of the digestive tract that causes nausea, vomiting, diarrhea Diarrhea in Children Diarrhea is a very common problem in children (see also Diarrhea in adults). Diarrhea is frequent, loose, or watery bowel movements (BMs) that differ from a child’s normal pattern. Sometimes... read more , and cramps. Vomiting can also be caused by infections elsewhere in the body, such as ear infections Overview of Middle Ear Infections in Young Children Middle ear infection is infection of the space immediately behind the eardrum. Middle ear infections (otitis media) may occur in older children and adults (see Otitis Media (Acute)) but are... read more or urinary tract infections Urinary Tract Infection (UTI) in Children A urinary tract infection is a bacterial infection of the urinary bladder ( cystitis), the kidneys ( pyelonephritis), or both. Urinary tract infections are caused by bacteria. Infants and younger... read more .

Less commonly, vomiting occurs because of a serious medical disorder. Infants between the ages of 2 weeks and 4 months of age may rarely have forceful (projectile) vomiting after feedings because of a blockage at the stomach outlet (hypertrophic pyloric stenosis Hypertrophic Pyloric Stenosis Hypertrophic pyloric stenosis is blockage of the passage out of the stomach due to thickening (hypertrophy) of the muscle at the junction between the stomach and the intestines. The thickened... read more ). Vomiting can also be caused by life-threatening disorders, such as meningitis Meningitis in Children Bacterial meningitis is a serious infection of the layers of tissue covering the brain and spinal cord ( meninges). Bacterial meningitis in older infants and children usually results from bacteria... read more (infection around the brain and spinal cord), intestinal blockage Intestinal Obstruction An obstruction of the intestine is a blockage that completely stops or seriously impairs the passage of food, fluid, digestive secretions, and gas through the intestines. The most common causes... read more , metabolic disorders, increased pressure within the skull (due to fluid on the brain Hydrocephalus Hydrocephalus is an accumulation of extra fluid in the normal spaces within the brain (ventricles) and/or between the inner and middle layers of tissues that cover the brain (the subarachnoid... read more or a mass in the brain Overview of Brain Tumors A brain tumor can be a noncancerous (benign) or cancerous (malignant) growth in the brain. It may originate in the brain or have spread (metastasized) to the brain from another part of the body... read more ), and appendicitis Appendicitis Appendicitis is inflammation and infection of the appendix. Often a blockage inside the appendix causes the appendix to become inflamed and infected. Abdominal pain, nausea, and fever are common... read more .

Most vomiting caused by gastroenteritis stops without treatment. Giving the child fluids and electrolytes (such as sodium and chloride) from solutions available in stores or pharmacies prevents or treats dehydration Dehydration in Children Dehydration is loss of water from the body, usually caused by vomiting and/or diarrhea. Dehydration occurs when there is significant loss of body water and, to varying amounts, electrolytes... read more (fluid loss). A child who is vomiting frequently may tolerate small amounts of solution given more often better than large amounts given less often.

A doctor should see any child with vomiting who

These symptoms may signal dehydration or a more severe condition.

Overfeeding is giving more nutrition than a child needs for healthy growth.

Overfeeding occurs when children are automatically fed as a response to crying, when they are given a bottle as a distraction or activity, or when they are allowed to keep a bottle with them at all times. It also occurs when parents reward good behavior with food or expect children to finish their food even if they are not hungry.

In the short term, overfeeding causes spitting up Spitting Up read more and diarrhea Diarrhea in Children Diarrhea is a very common problem in children (see also Diarrhea in adults). Diarrhea is frequent, loose, or watery bowel movements (BMs) that differ from a child’s normal pattern. Sometimes... read more . In the long term, overfed children can become obese Obesity in Adolescents Obesity is defined as a body mass index (BMI) equal to or greater than the 95th percentile for age and gender. Although genetics and some disorders cause obesity, most adolescent obesity results... read more .

Underfeeding is giving less nutrition than a child needs for healthy growth.

Underfeeding is one of many causes of failure to thrive Failure to Thrive in Children Failure to thrive is a delay in weight gain and physical growth that can lead to delays in development and maturation. Medical disorders and a lack of proper nutrition are causes of failure... read more and may be related to the child or the caregiver. Underfeeding may result when a fussy or distracted infant does not sit well for feedings or has difficulty sucking or swallowing. Underfeeding can also result from improper feeding techniques Breastfeeding Breast milk is the ideal food for newborns and infants. Although babies may be fed breast milk or formula, the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend... read more and errors in formula preparation (see Bottle-feeding Formula Feeding In the hospital, newborns are usually fed shortly after delivery, then ideally on demand thereafter. During the first week after birth, babies take ½ ounce to 2 ounces at a time, gradually increasing... read more ). Poverty and poor access to nutritious food are major reasons for underfeeding.

Occasionally, abusive parents and parents with mental health disorders purposely withhold food from their children.

In infants, underfeeding can result in dehydration and yellowing of the skin (jaundice Jaundice in the Newborn Jaundice is a yellow color to the skin and/or eyes caused by an increase in bilirubin in the bloodstream. Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells... read more ).

Community social agencies (such as the Women, Infants, and Children [WIC] program in the United States) can help parents purchase formula and can teach them proper techniques for formula preparation and feeding. If an infant is so far below expected weight that supervised feedings are necessary, the doctor may admit the child to a hospital for evaluation. If the parents are abusive or neglectful Types Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (for example, clergy, coach, or teacher)... read more , Child Protective Services may be called.

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.