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Feeding Problems

By

Christopher P. Raab

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Aug 2021| Content last modified Aug 2021
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  • Some feeding problems resolve without treatment, but others require medical attention or hospitalization.

  • Proper nutrition and feeding techniques can alleviate some feeding problems.

Feeding problems in infants and young children are usually minor but sometimes have serious consequences.

Spitting up

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

  • Feeding infants before they get very hungry

  • Burping them every 4 to 5 minutes while feeding

  • Placing them in an upright position during and after feeding

  • Making certain the bottle nipple lets out only a few drops with pressure or when the bottle is upside down

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

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 Hypertrophic Pyloric Stenosis ). 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 Hydrocephalus 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. Older children can be given popsicles or gelatin, although red versions of these foods can be confused with blood if the child vomits again.

A doctor should see any child with vomiting who

  • Has severe abdominal pain

  • Is unable to drink and retain fluids

  • Has a high fever

  • Is lethargic or acting extremely ill or acting very different than usual

  • Vomits for more than 12 hours

  • Vomits blood or green material (bile)

  • Does not urinate in 8 hours

These symptoms may signal dehydration or a more severe condition.

Overfeeding

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. Overfeeding 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 Common feeding problems include gastroesophageal reflux, gastroenteritis, too much food, too little food, and dehydration (fluid loss). Some feeding problems resolve without treatment, but others... 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

Underfeeding is giving less nutrition than a child needs for healthy growth. It is one of many causes of failure to thrive Failure to Thrive 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. Although babies may be fed breast milk or formula, the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend exclusive... read more Breastfeeding and errors in formula preparation (see Formula 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 Formula Feeding ). 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 Jaundice in the Newborn ).

Community social agencies (such as the Women, Infants, and Children [ WIC] program) 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 neglect is withholding essential things from children. Child abuse is doing harmful things to children. Some factors that increase the risk of child neglect and abuse are poverty, drug... read more Types , Child Protective Services may be called.

More Information

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

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