COMMON FEEDING PROBLEMS

COMMON FEEDING PROBLEMS

Most infants, particularly newborns, suffer from such feeding problems as regurgitation , vomiting, suckling and swallowing difficulties, dehydration, fever, excessive crying, “3 months colic”, change in bowel habit, underfeeding, overfeeding or “bottle addiction” all these are preventable.

Too little feed, too heavy feed, too frequent feed, wrong feeding technique, poor respect to bottle hygiene, etc. figure prominently among the underlying causes.

Regurgitation

Several babies(not breastfed) spit up a little of the feed along with swallowed air. “Posseting “ is the name given to this phenomenon. With some babies, posseting becomes a habit. They relish to bring back some milk and chew it just like a cow chews the cud. This is called “rumination”. Though harmless, it does make the baby somewhat smelly. In order that he does not inhale any bit of the regurgitated milk, he should be put on his side and never on his back. This position also makes it difficult for him to regurgitate and continue with rumination.

Regurgitation need not bother unless it is interfering with the nutrition of the baby. Also if the baby brings back the entire food, particularly more than once, there is a case for finding out of the cause. There is a notion is that regurgitation is because of “wind production”. It is not that the baby is small wind-producing machine but because he has swallowed excess air with feed or as a result of crying. The solution lies in guiding the mother about the proper technique of “burping”.

Vomiting

It may be due to overfeeding, prolonged burping, too much of swallowed air, gastroenteritis or some other infection. If the body shoots the milk half way across the room, the so-called “projectile vomiting”, the possibility of hypertrophic pyloric stenosis exists.

Suckling and swallowing difficulties.

Some difficulty in suckling is normal during the first few days. It is understandable since this is the period in which the baby and the mother are practicing the teqnique. Certain mechanical problems such as cleft palate, cleft lip, large tongue and nasopharyngeal obstructions as in choanal atresia, may interfere with feeding. Local conditions of the breast like cracked nipple, retracted nipple, engorgement and abscess also cause sucking difficulties.

Preterm baby is prone to have suckling and swallowing difficulties. Likewise, cardiac or respiratory disease associated with tachypnea, intracranial      hemorrhage and neonatal jaundice figure among several causes of feeding difficulties.

Dehydration fever

Disinclination of feed, fever and drowsiness may occur in some newborns about the third or fourth day of life. In such infants, one should exclude infections(not forgetting urinary tract infection) as the cause of dehydration fever. The body with dehydration fever may lose 5 to 15 percent of body water. Administration of additional feeds of water over about 12 hours brings down the temperature. Simultaneously, he begins to accept feed normally and gains weight. If a fulminant infection is seriously suspected in an infection who is immature or is at risk for one or the other reason, antibiotics are recommended even if a specific site of infection cannot be recognized.

Excessive crying

Crying in a newborn is almost always a manifestation of hunger or thirst, chilliness, need for the mother or a wet napkin.

Repeated crying may begin to get on the mother’s nerves. An insecure mother may not develop the much-needed warm emotional relationship with such a baby. There are, at times, instances of baby battering. Irritability of an infant during the mother’s menstrual periods is well-known observation. Whether it is related to fall in the breast milk supply, mother’s irritability or some substances in breast milk during menstruation that cause discomfort to the infant is not clear.

Colic

Sometimes a baby begins crying soon after birth, particularly towards late afternoon or evening and keeps doing so during the first three months or so. This condition has been christened “three months colic”, or “evening colic”. None of the above mentioned causes seems to account for its occurrence. Excessive intestinal activity is said to be the cause. It is borne out by the presence of exaggerated bowel sounds as revealed by auscultation. Administration of a mild antispasmodic agent may help these infants.

Change in bowel Habit

Infants on cow milk, especially if underfed and given inadequate fluids and sugar, may pass constipated stools-stools of hard consistency- which cause a good deal of straining and discomfort. As a result, the fear of pain may cause retention. The passage of such a stool, on its own or following rectal examination, can lead to anal crack or fissure. Some infants start having spurious diarrhea.

Most constipated newborns respond to addition of water, some brown sugar, honey or glucose to the intake. Magnesium hydroxide (one to three teaspoonfuls) and liquid paraffin(one to four teaspoonfuls) are often employed as stool softners. These are, as far as infants on liquid paraffin over a prolonged period who, though otherwise well nourished, developed xerophthalmia. It was attributed to prevention of absorption of vitamin A by liquid paraffin. Lipid pneumonia ia another serious side-effect of the agent.

In obstinate constipation , one should exclude cretinism and congenital megacolon (Hirsch sprung disease). Recurrent episodes of loose motions are often due to poor bottle hygiene.

Underfeeding

A highly diluted formula, often due to ignorance or economic considerations, is a well known cause of failure to gain weight. The underfed baby takes his feed quickly, showing that he has been hungry for long. Dissatisfied with the amount made available to him, he usually cries until he goes to sleep. After few hours, usually much before the due time for feed, he wakes up and cries.

Bottle addiction

It is not infrequent to see mothers grumbling that, “the little rascal refuses to part with the bottle” even at 24 months. Little do they realize that the reason is indeed rooted in their failure to have replaced the bottle by spoon and cup at about six months or little earlier. It is unwise to have a baby on bottle after one year of age.

Overfeeding

It is not a common problem in our country. Most infants, as a rule, refuse to accept excess feed. And pushing the feed forcibly is quite a difficult job. But, then, some mothers do manage to give the baby larger and larger feeds. These babies are likely to suffer from infantile obesity. That does not, however, always happen. Some just stop gaining weight. Such a baby is unhappy, vomits large amount of feed, has fatty diarrhea and keeps crying.

In experienced Mothers

Not all mothers are good enough and well prepared for the newborn. Some are sadly lacking in self confidence and unsure how to handle the baby. They worry too much and are very apprehensive. Their nervousness somehow influences the baby. As a result, he becomes more demanding and cries a lot to the mother’s further annoyance. This interaction may lead to rather unhealthy relationship between the mother and te baby.

We have observed such a situation very often in the case of young educated mothers who opt to live by one or to the other stereotyped handbook of baby care. They just try to blindly ape it rather than follow sound advice and their own judgement based on individual merits of the