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118 4.3 Common Feeding Problems in Infancy
●● If the mother’s milk supply has diminished, she improvement in weight gain, the infant should be
may benefit from taking domperidone 10 mg referred to a paediatrician.
three times a day in consultation with a lactation
specialist. Some infants with certain diseases or
syndromes have particularly high energy
●● If the infant is sleepy or reluctant to feed it may requirements and those unable to take sufficient
be necessary for the mother to express her milk volumes of standard infant formula should be
for some time and feed her infant with her referred to a paediatric dietitian. A ‘high-energy’
expressed breast milk by syringe, cup or bottle infant formula may be recommended (e.g.
until the infant is passing frequent yellow stools Infatrini or SMA High Energy). These should
and is more alert. The infant can then be only be used with dietetic and/or medical
re-introduced to the breast. recommendation and ongoing assessment.
●● A healthcare professional should check that the Vitamin D Deficiency
mother is eating a balanced diet and drinking
adequate fluid. Infants born to mothers with low vitamin D levels
before and during pregnancy may be born with low
●● The interaction between the mother and infant vitamin D levels themselves. This can lead to low
should be considered. plasma calcium and they may present with:
●● The mother should be asked about any ●● stridor or seizures
emotional stress or anxieties as this can reduce
her milk production. ●● tetany
●● The social circumstances of the family should ●● cardiomyopathy
be assessed and support arranged where
necessary. ●● reduced muscle tone – floppy infant.
Management of faltering growth in They may also present with delayed closure of
formula-fed infants anterior fontanelle – prominent forehead.
The healthcare professional should first take a diet Even infants who are not breastfed and receiving
history and/or ask parents to keep a feed and food small amounts of vitamin D in formula milk have
diary. presented with these symptoms.
●● Check frequency and volume of feeds taken. Rickets may be seen in late infancy but is usually
seen in toddlers.
●● Check that the appropriate formula is being
used and that it is being made up correctly with Specialist Infant Formulas
good hygienic practices.
Specialist infant formulas are prescribable for
●● Check the size of the teat on the bottle is certain medical conditions as specified in the
appropriate. British National Formulary (www.bnf.org,
Appendix 7, Borderline Substances) (Table
●● Check the infant is not constipated. 4.3.1). Only a qualified doctor can prescribe
them, although doctors often do so on the
●● If the infant was born preterm, check that the advice of a paediatric dietitian. The formulas
parents are continuing to use a preterm formula are available over the counter if a parent asks a
as directed by the paediatrician or dietitian. pharmacist to order them. However, they are
much more expensive than standard formulas
●● If weaning foods are being offered check their and therefore most parents would ask for them
suitability. to be prescribed.
If there are no obvious dietary causes of faltering
growth or the above measures do not result in
