Feeding Problems in Infants and Young Children
Feeding problems are common in infants and young children. Most of the problems may not have any serious consequences, and may get resolved without any medical intervention.
- Overfeeding, underfeeding, gastroenteritis, excessive loss of fluids, spitting up and vomiting food, and gastroesophageal reflux, are the most common feeding problems in infants.
- Most of the feeding problems in infants and young children may resolve by themselves. However, medical intervention may be necessary in some cases.
- Proper feeding techniques may help avoid feeding problems in infants.
Spitting Up Milk:
This usually occurs soon after feeding. Some of the swallowed milk is brought up effortlessly through either the nose or the mouth or both. Spitting up is partially due to the air swallowed with the milk, which is brought up as a burp along with the milk. This is most common in very young infants who are not able to stay in an upright position while feeding and afterwards. Almost all babies spit up milk, but feeding too fast, or swallowing too much air due to a faulty feeding mechanism, can make spitting up worse. Most infants do not have any discomfort while burping up milk. Spitting up semi-solid food is also common in older infants. The valve between the esophagus and the stomach, which normally prevents the stomach contents from returning into the esophagus, is not fully functional and efficient in them. This may result in bringing up partially digested food along with the gas. Spitting up becomes less frequent as the infant grows older, and it may eventually stop by the time the infant is one year old.
Certain feeding techniques and feeding positions may help reduce spitting up milk. Feeding the infant before it becomes very hungry may help avoid fast feeding which increases the chance of spitting up. If the infant is bottle fed, the flow of milk can be controlled by using a nipple with a smaller opening which lets out no more than a few drops of milk when the bottle is held upside down. Holding the infant upright while feeding, and afterwards, and stopping every five minutes for burping, also may reduce spitting up.
If the infant seems to experience any discomfort while spitting up, and if the frequency does not decrease by the end of the first year, it may be a condition called gastroesophageal reflux, which requires medical attention. If the food being spit up is greenish in color, or has blood mixed in it, or if choking or coughing is associated with spitting up, medical attention is necessary.
Vomiting
Forceful throwing up of ingested food is referred to as vomiting, which is almost always associated with discomfort. Unlike spitting up food, which is common in infants, vomiting is never considered a normal occurrence even in infants. A stomach infection such as viral gastroenteritis, urinary tract infections, ear infections or some other infection in the body may be the cause of vomiting in babies and children. Certain serious disorders such as hypertrophic pyloric stenosis may be responsible for projectile vomiting which may occur occasionally in some infants who are two weeks to four month-old. It results from a blockage at the junction of the stomach and the intestine. Potentially fatal inflammatory conditions such as appendicitis and meningitis or intestinal blockages also may cause vomiting. More often than not, vomiting due to these conditions is accompanied by severe pain, fever and lethargy. Vomiting may be continuous and persistent too.
Vomiting due to gastroenteritis usually tapers off without any specific treatment. Preventing dehydration, by giving the infant fluids, or specially prepared electrolyte solutions (ORS), is important. Small amounts of the prepared solution should be given more frequently, instead of giving a larger quantity, especially if frequent vomiting is present. Popsicles or jellies may be given to older children. With adequate rehydration measures, most infants and children may recover within a day. However, certain symptoms, if present, may indicate severe dehydration or some other serious disorder which require medical intervention. They include the following symptoms:
- Severe pain in the abdomen
- High fever
- Inability to hold down even small amounts of fluid
- Inability to pass urine
- Frequent vomiting which continues over 12 hours
- Bile or blood in the vomit
- Extreme lethargy and weakness
Underfeeding:
Underfeeding occurs when the infant is provided with less nutritional input than is required for normal healthy growth. This may arise due to problems with the infant or its mother or caregiver. If the infant has difficulty sucking milk, or swallowing food, it may result in underfeeding. Extreme fussiness, and certain disorders or illness, may cause lack of appetite in the infant, and it may refuse feedings. Faulty feeding techniques and improper preparation of formula can result in the infant receiving less nourishment than it requires. Mental instability and abusive nature, as well as poverty, and ignorance in parents are also some of the reasons for underfeeding.
Community healthcare agencies and volunteers can help educate parents on the correct usage of formula milk. The concentration of the formula should be adjusted according to the age of the infants. Illiterate parents who cannot follow the instructions on the container should be educated on the preparation of age-appropriate formula. Since breast milk has all the nutrition required by the infant in the first 6 months of life, promoting breast feeding, and educating new mothers on the correct way of feeding the baby, can help avoid underfeeding, especially in economically and socially weak communities. Frequent monitoring of the growth of the infant will help assess whether it is receiving adequate nutrition. If underfeeding is the result of parental neglect or abuse, Child Protective Services must intervene.
Overfeeding:
Providing more than the required amount of nutrition to the infant is considered overfeeding. Some parents tend to offer bottle whenever the infant cries, irrespective of the reason for the crying. Offering the bottle to distract the child from stressful situations, such as separation from parents, pain from bumps and falls, removing undesirable items from reach etc., as a reward, or to keep the child occupied, are common causes of overfeeding. It is not only a bad practice; it can cause long-lasting harm to the child’s emotional and physical well-being. Short term consequences may be frequent spitting up of food and diarrhea. Obesity and associated disorders are the long-term negative outcome of overfeeding.
Dehydration:
Loss of fluid from the body, either due to vomiting, or through diarrhea, is the most common reason for dehydration. When fluid intake is insufficient, as in the case of inadequate breast feeding or when the infant is not able to draw in enough quantity of milk, it may lead to dehydration. Marked decrease in the frequency of urination, crying without shedding tears, dry mouth, decreased activity, and listlessness, are the usual symptoms of moderate dehydration. Severe dehydration may make the infant lethargic and sleepy. Dehydration may lead to salt imbalances in the body, which in turn worsens the symptoms such as lethargy. It may cause seizures which can result in brain damage and death. Dehydration should be promptly treated with electrolyte solutions given orally. If severe vomiting is present, fluids may have to be administered intravenously.
Treating Dehydration:
Infants and young children are highly vulnerable to rapid dehydration when they have certain illnesses with symptoms such as vomiting or diarrhea. The fluid loss has to be compensated by giving the child fluids containing the electrolytes which are lost through vomit and frequent watery stools. Since breast milk contains all the electrolytes and fluid required by the infant, dehydration in a breast-fed infant can be prevented by frequent feeds. Formula-fed infants require specially formulated oral rehydration solutions which have the required electrolytes in the right proportion. ORS is available in drug stores as well as in grocery stores. The powder should be diluted with water according to the instructions on the pack. Pre-mixed preparations also may be available. The quantity to be given depends on the age of the child and its tolerance. As a general rule, 1to 3 ounces per pound of body weight, in 24- hours, is the ideal amount.
Older children may have clear soups and diluted fruit juices. Plain water is not enough, as it doesn’t contain the required electrolytes. Colas and sweetened fruit juices are not recommended, as they have too much sugar and no salt. They may contain chemicals which irritate the stomach too.
When fluids are given orally, care should be taken to introduce small quantities at a time. A teaspoonful or two, once every 10 minutes, is sufficient to start with. If it is tolerated, the amount can be gradually increased. If vomiting and diarrhea have reduced, formula milk can be reintroduced after a day. If liquids such as soups are well-tolerated by older children, bland foods such as toasts, jellies and rice can be given after 12 hours.
If the dehydrated infants or children cannot tolerate oral feeding due to severe vomiting, intravenous administration of fluids may be necessary. Feeding through nasogastric tube also can be considered. In this procedure, fluids are fed through a plastic tube passed into either the stomach, or the small intestine, via the nose and the throat. Extreme dehydration can be life threatening and may require intensive care.
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Yasser Elnahas
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