Feeding problems in babies: Home Doctor & Self Therapy

Most feeding problems in babies occur in the early months. Some newborns need practice at latching on to the breast, while bottle-fed babies may have trouble with different sizes of nipples and types of formula. Babies who are not getting enough milk are often excessively sleepy and slow to gain weight, while those who are overfed gain weight too quickly. Many breast-fed and bottle-fed babies effortlessly spit up small amounts of milk after a feeding; this is not a cause for concern. Some, however, regurgitate larger amounts of feeding and may wheeze. This condition, called reflux, may last for up to a year and is due to a weak muscle at the entrance to the stomach. It is most common in premature babies or those whose muscle tone is poor. A baby who feeds well but wakes screaming between feedings may have an allergy to milk.

See your doctor first

Make an appointment to see your doctor if:
● Your baby can't feed or won't feed
● Your baby has been feeding well, but has developed problems
● Your baby regurgitates large volumes of milk and/or there is blood in the vomit
● Your baby fails to gain or loses weight

What you can do yourself

Most feeding problems resolve themselves over time, but using the following tips will help. You can be sure that your newborn baby is feeding well if he or she produces 6 or more wet diapers a day, sleeps well, and gains weight at the predicted rate.
● Make sure your newborn baby feeds properly at least 6 times in 24 hours. Don’t assume a sleepy baby is "content"; wake your baby for feedings if he or she is sleeping for more than 4 hours.
● Babies who gain weight too fast are usually bottle-fed. Ask your doctor for advice about how to regulate feeding.
● If your baby tends to spit up milk after a feeding, change the diaper beforehand so that you don’t have to disturb your baby too much after he or she has fed. Pause and burp your baby at intervals during the feeding, and hold him or her upright on your lap afterward to allow gas to come up naturally. If you are bottle-feeding, try using a bottle and nipple specifically designed to reduce gas.
A baby who has been diagnosed with reflux needs a special feeding regimen until he or she grows out of the condition (see PRACTICAL TIPS, below).

Breast-feeding

● If you have not breast-fed before, there are several tips that will help get you off to a good start (see PRACTICAL TECHNIQUE, below). Make sure you have help from someone who has had experience in breast-feeding.
● Your baby may find it hard to latch on if your breasts are engorged or very full. Expressing a little milk before he or she begins to feed will soften the breast. This will also help if your baby chokes because your milk flows too fast.
● Until your baby has learned to breast-feed properly, don’t use pacifiers or bottles.
● Occasionally expressing milk by hand or using a breast pump between feedings will help empty the breast and stimulate a good supply of milk.
This also helps draw out a flat or inverted nipple, as does wearing a nipple shield.
● Make sure you eat an extra 500 calories a day and rest whenever you can to maintain a good milk supply for your baby.
● If your baby is unsettled and wakes screaming between feedings, try excluding dairy products from your diet for a week to see if the problem is due to an allergic reaction to them. If symptoms improve, continue these measures.
● If your baby is feeding too slowly, try a nipple with a larger hole. Conversely, a baby who gulps and feeds too fast may need a nipple with a smaller hole.
● Try changing to a different milk formula if your baby is consistently unsettled or unhappy after feeding. If he or she wakes screaming between feedings, try a hypoallergenic formula for a week to see if the problem is due to milk allergy.
If symptoms improve, continue these measures.
● If your baby has diarrhea and vomiting, be careful about washing your hands before a feeding and be meticulous about sterilizing bottles and equipment.

PRACTICAL TECHNIQUE

Successful breast-feeding It may take a little practice for both you and your baby to get breast-feeding right. These simple steps will help.
● Hold your baby with the head cradled in the crook of your arm, the bottom well supported and the arm tucked around your body. Whenever possible, have skin to skin contact with your baby during feedings.
● Stroke your baby’s cheek with a finger or your nipple so that the mouth opens wide and your baby turns toward the nipple. Expressing a little milk onto the nipple will help encourage your baby.
● Aiming your nipple at the roof of the baby’s mouth, make sure the nipple and as much of the areola around it as possible is taken into the mouth. When the baby closes his or her mouth it will form a tight seal.
● If your baby sucks only on the end of the nipple, he or she will not be getting milk and your nipple may become sore. Ease the baby off the breast by gently inserting a finger into the corner of the mouth and reposition him or her to try again.

Sucking position

Your baby should take the entire nipple and most of the surrounding areola into his or her mouth during breast-feeding.
The nipple is drawn to the back of the mouth The jaws press on the areola to pump milk Coping with reflux A baby with reflux will dislike being laid flat on his or her  back and needs to be handled carefully after a feeding. The following measures will help reduce regurgitation.
● Change your baby’s diaper before the feeding and handle your baby gently and hold him or her upright after the feeding.
● Give smaller feedings more frequently to avoid overloading your baby’s stomach.
● If you are bottle-feeding, use a thickened formula, designed for babies with reflux problems. (Ask your doctor for advice.) Don’t add extra powdered formula to a feeding. A breast-fed baby over 4 months old can be given 2 teaspoonfuls (10 ml) of baby rice cereal dissolved in 2 tablespoons (30 ml) of expressed milk or formula before feedings.
● Your baby may be more comfortable in a baby seat immediately after a feeding. Raising the head of the crib slightly on books or bricks may help make your
baby more comfortable during sleep.
Preventing reflux Keep your baby semi-upright in a baby chair or seat for the first 30 minutes or so after each feeding.

Seek further medical advice

Arrange to see your doctor if:
● Your baby appears lethargic or listless or you have concerns about his or her weight
● Your baby has symptoms of milk intolerance or allergy, such as diarrhea, vomiting, abdominal pain, and colic
● Reflux persists after the age of 18 months