Infant feeding problems: common medical causes and how we get your baby eating again

Written by: Dr Dhamyanthi Thangarajah
Edited by: Emma McLeod

Is your baby struggling to feed? In medical terms, “infant” refers to babies from birth to 12 months old. The good news is that we have several methods to diagnose and treat the causes of infant feeding problems. I’ll explain the signs and symptoms, the diagnostic tests and how we approach treatment.

A mother holding and looking at her infant child

Why some infants reject food

The most common reasons for infants rejecting food are:

  • Gastroesophageal reflux disease (GERD)
  • Food allergies, such as cow’s milk protein allergy
  • A mechanical obstruction to swallowing or stomach outlet e.g. pyloric stenosis (a rare condition that can show symptoms as early as 8-12 weeks old)


Signs of infant feeding problems

Irritability is a key sign. This could take the form of crying, back arching and/or refusing food altogether while being fed. Your infant might also never appear satisfied after feeding. Perhaps they are not taking enough milk and/or have to feed regularly with no spacing between feeds. This may impact weight gain, and you may notice that your child is not thriving.


Infants might also experience:

  • Feed refusal or aversion
  • Vomiting
  • Choking or gagging when feeding (bottle or breastfeeding)
  • Skin rashes on the cheek or buttocks
  • Abdominal distention
  • Diarrhoea
  • Constipation
  • Blood in stool
  • Mucus in the stool


When to see a paediatric gastroenterologist

It’s wise to seek specialist advice if the previously mentioned signs and symptoms don’t settle after seeing a primary care physician. We can then perform specific tests to find the underlying cause.


If your baby has a co-existing medical condition (e.g. a cardiac problem), it’s important to seek medical advice from your primary care physician early on.


When to visit the emergency department

Some children with significant acid reflux and feeding difficulty also have symptoms of apnoea ( infant stops breathing, infant goes pale, blue or floppy) which is a risk for cot-death. If your child is unwell and you can’t fully wake them, or if they turn blue, this is an emergency and you should immediately go to A&E.


Diagnosing the cause

It’s critical that the right investigation is done so that we can get the correct diagnosis. The first steps are to get a history of your baby’s health and to perform a general examination.


Sometimes, we’ll suggest baseline blood tests. These are generally used for babies that have poor weight gain or blood in the stools. If we suspect acid reflux is the cause, we’ll usually try treatment and then evaluate later to see if symptoms resolve.


We might also suggest a barium study, which is a special type of imaging test. In this test, barium (a substance that shows on X-rays) is swallowed and then the oesophagus is monitored to check for abnormalities.


In some cases, we might suggest a pH impedance study if the initial treatment doesn’t work. This measures acid reflux in the oesophagus, usually for 24 hours. If required, an endoscopy may also be part of the workup.


If your child is choking or gagging when feeding, we might also arrange a speech and language assessment.


Treating the feeding problems

How we treat your child’s feeding problem depends on the cause. After undergoing all of the appropriate assessments, we’ll create a personalised treatment plan.


In any child with feeding problems, our goal is to address vomiting, issues with weight, prevent feed aversion and complications related to reflux. If your child is diagnosed with GERD, we’ll usually try adjusting the type of milk they’re consuming and we might suggest medication. In most babies under six months old with reflux, the condition is normally worse simply because of the immaturity of the lower oesophageal sphincter.


If we suspect they have an allergy, we may also try changing the type of milk for a dairy-free one.


Discover how Dr Dhamyanthi Thangarajah can help you care for your child’s health – visit her profile.

By Dr Dhamyanthi Thangarajah
Paediatric gastroenterology

Dr Dhamyanthi Thangarajah is an expert consultant paediatric gastroenterologist operating in London. Her areas of expertise lie in paediatric endoscopy, gastroesophageal reflux (GERD), feeding difficulties, chronic abdominal pain, diagnostic coeliac disease and food allergy.

After graduating from King’s College, Dr Thangarajah went on to specialise in paediatric medicine and further trained at Bart’s Hospital, London. She subsequently subspecialised in paediatric gastroenterology and completed her training on the prestigious London circuit. She gained extensive experience during her time there in paediatric gastroenterology, nutrition and hepatology. She completed her PhD at Imperial College in which she focused on nutritional assessment in children with chronic gastrointestinal conditions. She completed her training in paediatric gastroenterology and is entered in the GMC specialist register for paediatric gastroenterology, hepatology and nutrition.

Dr Thangarajah takes on a holistic approach and strives to deliver an expert consultant-led service to all her patients. After becoming a consultant at Chelsea and Westminster Hospital, she became involved in the delivery of specialist services including a gastrointestinal motility, food allergy, inflammatory bowel disease and intestinal failure. As well as being a JAG certified paediatric endoscopist, she is also heavily involved in research and was awarded an innovation grant to develop mobile app technology to aid patient reporting to clinical teams.

Dr Thangarajah has since set up Kids London gastroenterology centre where she exclusively treats digestive problems and promotes nutritional health and wellbeing in children. Within the centre, children have access to renowned London specialists such as paediatric surgeons, paediatric hepatologists, specialist paediatric dieticians and paediatric clinical psychologists.

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