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114 4.3 Common Feeding Problems in Infancy
to as ‘colic’. It occurs commonly in the late Both conditions usually resolve with time as the
afternoon and evening. It usually resolves by the infant grows and the length of the oesophagus
time the infant is about 5 months of age. increases and the gastro-oesophageal sphincter
becomes more efficient. GORD may continue
Causes of colic are unknown but it is thought to throughout infancy and beyond in some children.
be due to swallowing large amounts of air during Symptoms often improve when weaning onto solid
feeding which then becomes trapped in the food begins, or when the infant starts to walk and
digestive tract and causes bloating and severe is in a more upright position.
abdominal pain.
Management by the primary healthcare team is
Comforting and soothing the baby with a usually sufficient and should include explanation
massage or a warm bath sometimes helps. and reassurance to the parent. In addition:
Healthcare professionals should: ●● better positioning and attachment of breastfed
babies may help improve GORD
●● ask about the infant’s feeding routine and bowel
movements ●● changing breastfed infants to infant formula
will not help
●● observe a feed and correct positioning and
attachment in breastfed infants ●● volume and concentration of formula feeds
should be checked to make sure infants are not
●● check that formula feeds are being made up being overfed with large volumes or
correctly and not over- or under-concentrated over-concentrated feeds.
●● check the teat hole size of bottlefed infants A thickened feed can be considered for formula-fed
infants. This can be done by either:
●● check that infants are being winded correctly
during and after the feed. ●● adding a thickener, such as Thixo-D or Instant
Carobel (Cow & Gate) to the normal formula
Colic preparations are available in retail just before feeding; or
pharmacies but there is no scientific evidence to
support their use. ●● changing to a formula that thickens in the
stomach (e.g. Enfamil AR (Mead Johnson) or
Posseting and Gastro- SMA Staydown (SMA Nutrition)).
oesophageal Reflux
A medical practitioner may sometimes prescribe
Posseting is seen in most young infants. It occurs anti-reflux medications such as Gaviscon. It acts in
when the immature valve mechanism where a similar fashion to the formulas Enfamil AR
oesophagus and stomach meet (gastro- (Mead Johnson) or SMA Staydown (SMA
oesophageal sphincter) allows the stomach Nutrition).
contents to regurgitate back up into the mouth
without any harmful effects. Infants with mild If the problems persist, despite having taken the
posseting will gain weight and thrive normally above measures, or if the infant has faltering
(Puntis 2000). growth, referral to a paediatrician is recommended.
More severe reflux/regurgitation, resulting in GORD is sometimes caused by intolerance to
distress to the infant is called gastro-oesophageal cow’s milk protein (Farahmand et al. 2011) and a
reflux disease (GORD). In this case the stomach trial of a diet free from cow’s milk protein can be
contents come up into the oesophagus but not tried for 1–2 weeks to see if symptoms resolve:
always into the mouth. This causes discomfort or
pain to the infant but the carer will not necessarily ●● The mother of a breastfed infant would need to
be aware that it is happening. Screaming episodes exclude milk and foods containing milk from
may be caused by GORD. her diet.
