3: Feeding Challenges

Common Infant Feeding Issues

Colic

Colic is the sudden onset of very fussy behavior.

This includes long bouts of crying and possible tummy issues.

Infant Refusal

The baby turns away from food offered.

May also spit food out or refuse to swallow the food.

Fear of New Foods

The baby refuses specifically newly introduced foods.

Fear of Eating

The baby may scream and/or cry around food, often following a traumatic event such as choking or vomiting.

Consequences

If causes of feeding issues persist (tummy issues, poor feeding environment, etc.) infants can develop “mealtime negativity”. This can make infants feel anxious or upset about mealtimes or objects associated with mealtimes, making feeding problems worse.

Potential Causes

Previous Bad Experience

Choking or vomiting can be a traumatic event for infants, this may cause them to avoid specific foods, or all foods related to such incident.

GI Problems

Acid reflux, digestive issues, constipation, and gas can all cause infants to be hesitant towards feeding.

Illness

Cough, cold, or fever could increase fussy behaviors around mealtime.

Inappropriate Caregiver Behaviors

Inconsistent feeding schedules, forcing infants to eat, shifting from breast/bottle feeding too quickly, distracting environment, ignoring hunger cues, and overfeeding an infant can all cause issues when feeding.

Solutions

Meet Other Needs

Parents may assume that when an infant cries they are hungry, this may result in overfeeding and feeding problems.

Eating Environment

Infants respond best to a consistent feeding schedule without distractions. Caregivers or family members should model eating behaviors. Infants should be sitting in a highchair without slouching.

Division of Responsibility

Caregivers are responsible for what, when, and where a child eats, but a child can determine how much they eat. Force feeding and promotion of the “clean plate club” promotes poor feeding behaviors into early childhood and on in life.

Keep Trying

Infant tastebuds are rapidly changing. Foods that they disliked a week ago may be something they will like now. It can take up to 15 times introducing a new food for a child to start liking it! You can introduce several types of foods in one day but try to separate these throughout the day to avoid sensory (taste, smell, texture) overload for your little one.

Delay Sweets and Salt

We are born loving the tastes of sugar and salt. Introducing these foods before more bitter flavors, like those in grains and vegetables, can cause pickier infants. It is recommended to begin with vegetables, grains, and meats before moving onto fruits, dairy, juice, and artificial flavors or products with added sugar and salt.

Limit Meal Times

Limit meals to no more than 30 minutes. If the infant doesn’t eat within 30 minutes, it is best to stop the feeding and come back to it later.

Slightly Increase Fiber and Fluids

Both of these can help prevent constipation or even diarrhea. Both issues can prevent infants from wanting to eat. Blended whole grains and 1-1.5 oz of water can help with these issues.

Popular Feeding Strategies

Three Main Concerns

1. Choking hazard

2. Iron deficiency

3. Baby not getting enough calories or nutrients

What Does the Current Research Show?

There is not enough evidence to support baby-led weaning and the concerns mentioned above need to be addressed with more research.

Baby-Led Weaning

The traditional method of transitioning babies to solid foods is through spoon-feeding purees by an adult with gradual changes to more family foods. Baby-led weaning does not use spoon feeding. It uses whole, small pieces of food (soft) given to the baby when complementary feeding starts. The baby can then pick up the food themselves and put it in their mouth. Then the baby will decide what to eat and what not to eat.

Responsive Feeding Handout

Responsive Feeding

Responsive feeding is recognizing your baby’s hunger or fullness and responding to their cues to promote a healthy eating pattern.

Why Do Responsive Feeding?

Helps develop healthy eating habits

They will be aware of their own hunger and fullness cues, and this can help prevent overeating. In the long term it can help lower the risk of the child becoming overweight or obese

Helps the child learn to feed themselves
Help eliminate the fight at mealtimes
Helps with bonding

How to Responsive Feed

This is one type of way to do the feeding - use these tips for the first solid food feeding:

Be in a comfortable environment with minimal distractions
Look at the child and talk to them while you are feeding them
Watch for their cues and respond to them - let them start or stop when they are hungry or full
Be warm, nurturing, and affectionate during mealtime

Responsive Feeding Cues

Hunger Cues

Moving hands to mouth
Opening mouth when food or a spoon is offered
Getting excited when they see food
Following food with eyes

Fullness Cues

Unlatching while breastfeeding
Pushing food away
Closing mouth when food is offered
Turning head away from food
Fidgeting or playing with food

Not every child will show every cue - you will learn their specific ones

Tips: Do not force the baby’s mouth open if they do not want food. Remember that they do not have to finish a bottle or all the food. Do not use food as a reward or punishment.

References

Arts-Rodas D, Benoit D. Feeding problems in infancy and early childhood: Identification and management. Paediatr Child Health. 1998;3(1):21-27. doi:10.1093/pch/3.1.21

A to Z: Feeding Problems, Infant (for Parents) - Advocate Aurora Health. Kidshealth.org. Published 2024. Accessed February 28, 2024. https://kidshealth.org/Advocate/en/parents/101559.html?WT.ac=ctg

Bernard-Bonnin AC. Feeding problems of infants and toddlers. Can Fam Physician. 2006;52(10):1247-1251.

Edwards S, Ann McGrath Davis, Ernst L, et al. Interdisciplinary Strategies for Treating Oral Aversions in Children. Journal of Parenteral and Enteral Nutrition. 2015;39(8):899-909. doi:https://doi.org/10.1177/0148607115609311

‌Brown JE, Lechtenberg E, Murtaugh MA, et al. Nutrition through the Life Cycle. 7th ed. Cengage Leaning; 2017.

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