Diseases & Conditions


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. 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 an infant before he gets very hungry, burping him every 4 to 5 minutes, placing him in an upright position during and after feeding, and 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 and may require medical attention (see Digestive Disorders: Gastroesophageal Reflux ). If the material that is spit up is green (indicating bile) or bloody or causes any coughing or choking, medical attention is needed.

Vomiting: Vomiting is the uncomfortable, forced throwing up of feedings. It is never normal. Vomiting in infants is most often the result of acute viral gastroenteritis. It can also be caused by infections elsewhere in the body, such as ear or urinary tract infections. Less commonly, vomiting occurs because of a serious medical disorder. Infants between the ages of 2 weeks and 4 months may rarely have forceful (projectile) vomiting after feedings because of a blockage at the stomach outlet (hypertrophic pyloric stenosis). Vomiting can also be caused by life-threatening disorders, such as meningitis, intestinal blockage, and appendicitis. These disorders usually cause severe pain, lethargy, and continuous vomiting that does not lessen with time.

Most vomiting caused by gastroenteritis stops on its own. Giving the child fluids and electrolytes (such as sodium and chloride) from solutions available in stores or pharmacies prevents or treats dehydration. 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 who has severe abdominal pain, is unable to drink and retain fluids, has high fever, is lethargic or acting extremely ill, vomits for more than 12 hours, vomits blood or green material (bile), or is unable to urinate. These symptoms may signal dehydration or a more severe condition.

Overfeeding: Overfeeding is the provision of 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 and diarrhea. In the long term, overfed children can become obese (see Problems in Adolescents: Obesity ).

Underfeeding: Underfeeding is the provision of less nutrition than a child needs for healthy growth. It is one of many causes of failure to thrive (see Problems in Infants and Very Young Children: Failure to Thrive ) 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 and errors in formula preparation (see Newborns and Infants: Bottle-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.

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, then the doctor may admit the child to a hospital for evaluation. If the parents are abusive or neglectful, child protective services may be called.

Dehydration: Dehydration is usually caused by excess fluid loss, such as from vomiting and diarrhea, and occasionally by inadequate fluid intake, such as when an infant does not take in enough milk through breastfeeding. Children who are moderately dehydrated are less interactive or playful, cry without tears, have a dry mouth, and urinate fewer than 2 or 3 times a day. Children who are severely dehydrated become sleepy or lethargic. Sometimes dehydration causes the concentration of salt in the blood to fall or rise abnormally. Changes in salt concentration make the symptoms of dehydration worse and can worsen lethargy. In severe cases, the child can have seizures or suffer brain damage and die.

Dehydration is treated with fluids and electrolytes, such as sodium and chloride, given by mouth. In severe cases, intravenous fluids are needed.

Treating Dehydration

Illnesses that cause vomiting and diarrhea can lead to dehydration in children. In infants, dehydration is treated by encouraging an infant to drink fluids that contain electrolytes. Breast milk contains all the fluids and electrolytes an infant needs and is the best treatment. If an infant is not breastfeeding, oral electrolyte rehydration solutions should be given. These can be bought as powders or liquids at drug or grocery stores without a prescription. The amount of solution to give a child depends on the child's age, but generally should be about 1½ to 2½ ounces of solution in a 24-hour period for each pound the child weighs—thus, a 20-pound infant should drink 30 to 50 ounces total.

Children older than 1 year may try small sips of clear soups, clear sodas or juice diluted to half-strength with water, or popsicles. Plain water, juice, and colas are not good for treating dehydration at any age because the salt content of water is too low and because juice and colas have a high sugar content and ingredients that irritate the digestive tract.

Treatment of dehydration at any age is more effective if children are first given small, frequent sips of fluids about every 10 minutes. The amount of fluid can slowly be increased and given at less frequent intervals if the child can keep the fluid down without vomiting or getting severe diarrhea. Infants who are able to digest fluids over 12 to 24 hours can then resume drinking formula from a bottle. Older children can try broths or soups and bland foods (for example, bananas, toast, and rice). Infants and young children who are unable to digest any fluids, or who develop listlessness and other serious signs of dehydration, may require more intensive treatment with intravenous fluids or electrolyte solutions given through a thin plastic tube (nasogastric tube) that is passed through the nose and down the throat until it reaches the stomach or small intestine.

Last full review/revision January 2007 by Elizabeth J. Palumbo, MD

Source: The Merck Manual Home Edition