Ask: How to feed an infant who doesn't want to eat?

Posted by Joan Comrie on September 3, 2013 

Raleigh feeding specialist Joan Comrie answers this week's "Ask" question.

Q. My 8-month-old baby is refusing to be fed. Initially, when I started at 5 months, she was receptive, albeit only to a teaspoon of pureed food. Then she started to refuse to open her mouth and now cries every feeding time. I stopped for awhile and continued again. She is still refusing to open her mouth. However, when I do get to put some food (e.g. cereal, pumpkin) in her mouth, she does swallow. I don't understand why it's so difficult for her to open her mouth readily. Is it psychological? 

She is formula fed and only taking 550-650 ml a day. She used to be exclusively breastfed for six months. I tried baby-led weaning a week ago and she is not consuming much, prefers to play with it for awhile then toss.

I am at a loss what to do, what to feed. Do I give the same thing everyday, do I feed every other day? Please advise. It is very stressful. I am a first time mum and I don't want to regret not doing my best to help her.

A. There are many reasons that a baby doesn’t want to eat. You are right to be concerned. I highly recommend that you ask your pediatrician for a referral for a feeding evaluation as soon as possible so that the reasons for her feeding refusals can be thoroughly addressed. We see babies like your daughter regularly at Carolina Pediatric Dysphagia. Based on her presenting issues, we can design a program to help her enjoy eating. It is important to get this problem addressed soon as early identification and intervention can significantly reduce the risk of further complications.

Your daughter, like all babies, should love to eat and readily open her mouth at the sight of the spoon. Feeding milestones have a window of opportunity that if missed, will make catching up more difficult. An 8-month-old typically would have moved through thin purees (Stage 1 baby foods), thicker purees (Stage 2 foods) and textured purees (mashed bananas) by now and should be moving on to chewing easy-to-eat foods such as graham crackers.  The fact that your baby doesn’t even want purees is definitely a red flag.  

Here are some tips to reduce stress until you can get a feeding evaluation scheduled:

  1. Find a feeding time in which she is neither too hungry nor too full. Make sure that she is in a good mood. Place her in a supportive high chair.
  2. Offer puree via spoon but if she doesn’t readily open her mouth, stop right away.  Place puree on the tray and let her explore the food with her hands or a spoon. 
  3. If unstressed, she will most likely place her hands in the puree and eventually begin to “taste the puree.” Don’t worry if she doesn’t do it the first time. She may need several exposures to food exploration before she is comfortable.
  4. Do not follow baby-led weaning. (Please refer to a previous posting on this topic).  With her inexperience and refusals of puree, she may have a bad experience (like gagging or choking on the food) and then completely shut down.
Feeding your baby should be fun for you and for her. When feeding becomes stressful, it is time to get some help. The good thing is, once her feeding issues are evaluated, you will better understand the problems and be on your way to fun mealtimes.

 

If you have a question about your child's health or happiness, ask Joan or any of our experts by sending email to mom2mom@newsobserver.com.


 

Joan Dietrich Comrie of Carolina Pediatric Dysphagia (919-877-9800) has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia. She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986. Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington, Ky., Vanderbilt Medical Center, Nashville, Tenn., and WakeMed, Raleigh) where she developed or reorganized the hospital's pediatric dysphagia program.

Joan has spoken on the topic of pediatric dysphagia nationally and internationally. She has published in a professional journal.  She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed. She has served as chairman and member of a subcommittee of the Special Interest Division 13 of the American Speech Language Hearing Association (ASHA). She has received her certificate of clinical competence (CCC) through ASHA and is licensed in the state of North Carolina.

 

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