Poor Feeding in Infants – Causes and Treatment
Poor feeding describes a newborn or infant's reduced ability to take in sufficient breast milk or formula. It can be a sign of various underlying medical conditions.
Things worth knowing about "Poor feeding"
Poor feeding describes a newborn or infant's reduced ability to take in sufficient breast milk or formula. It can be a sign of various underlying medical conditions.
What is Poor Feeding?
Poor feeding in infants refers to a reduced ability of a newborn or infant to take in adequate nutrition through breastfeeding or bottle feeding. The baby may suck too weakly, too briefly, or not at all, resulting in insufficient nutritional intake. Since regular and adequate nutrition is critical for the growth and development of infants, poor feeding is an important medical warning sign that requires prompt medical evaluation.
Causes
Poor feeding can have many different causes, which may originate from the infant or, in the case of breastfeeding, from the mother. Common causes in the infant include:
- Prematurity: Premature infants often have an immature suck-swallow-breathe coordination.
- Neurological conditions: Damage to the nervous system, e.g. from oxygen deprivation during birth (hypoxia), can impair sucking ability.
- Muscle disorders (myopathies): Conditions that reduce muscle strength also affect the sucking and swallowing muscles.
- Congenital malformations: Cleft lip, jaw or palate, as well as other anatomical features of the oral cavity, can make sucking difficult.
- Congenital heart defects: Heart defects can cause the infant to become fatigued quickly during feeding.
- Infections: General infections or sepsis can weaken the infant and reduce feeding intake.
- Metabolic disorders: Certain inborn errors of metabolism also affect feeding motivation and ability.
- Hyperbilirubinemia (neonatal jaundice): Elevated bilirubin levels can lead to excessive sleepiness and poor feeding.
On the mother's side, delayed milk let-down, flat or inverted nipples, or an overly strong milk flow can make feeding more difficult for the infant.
Symptoms and Signs
Parents and healthcare providers may recognize poor feeding by the following signs:
- Weak or uncoordinated sucking
- Short feeding sessions with frequent interruptions
- Failure to latch to the breast or refusal to suck
- Inadequate weight gain or weight loss
- Less frequent urination than expected (fewer than 6 wet diapers per day after day 4 of life)
- Marked drowsiness or sleepiness during feeding
- Coughing, gagging, or choking while feeding (suggesting a swallowing disorder)
Diagnosis
Diagnosis of poor feeding is based on a clinical assessment of the newborn or infant. The healthcare provider observes the feeding process directly, evaluating sucking strength, coordination, and endurance. Additional measures include:
- Weight monitoring: Regular weighing to assess growth and nutritional adequacy.
- Laboratory tests: Blood count, blood glucose, electrolytes, bilirubin, and metabolic screening to identify underlying causes.
- Imaging: Cranial ultrasound or echocardiography if neurological or cardiac causes are suspected.
- Swallowing assessment: If a swallowing disorder is suspected, a specialized assessment by a speech-language therapist may be required.
Treatment
Treatment of poor feeding depends on the underlying cause and the severity of the nutritional problem.
Feeding Support
- Guidance for parents from midwives and lactation consultants (IBCLC) to optimize latching technique and feeding positions.
- Use of breastfeeding aids such as nipple shields or specially designed feeding bottles with adapted teats.
- More frequent feeding sessions at shorter intervals.
Supplemental Nutrition
- Supplementing with expressed breast milk or specialized formula by spoon, finger feeder, or tube when the infant cannot drink adequately.
- In cases of severe poor feeding, temporary nutrition via a nasogastric tube may be necessary.
Treatment of the Underlying Condition
- Treatment of infections, metabolic disorders, or other underlying conditions contributing to poor feeding.
- Early intervention and speech-language therapy for neurologically based sucking weakness.
When to See a Doctor
Parents should seek immediate medical attention if their infant:
- feeds fewer than 8 to 12 times per day after birth,
- has fewer than 6 wet diapers per day after day 4 of life,
- is visibly losing weight or not gaining weight,
- coughs, gags, or turns blue while feeding,
- is very sleepy and cannot be woken to feed.
References
- World Health Organization (WHO): Infant and young child feeding. WHO Guidelines, Geneva, 2009. Available at: https://www.who.int/publications/i/item/9789241597494
- Lau, C.: Development of Infant Oral Feeding Skills: What Do We Know? The American Journal of Clinical Nutrition, 2016; 103(2):616S–621S.
- Poets, C.F. & Bassler, D.: Poor feeding in the newborn – causes and management. Monatsschrift Kinderheilkunde, 2016; 164(2):128–135.
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