THIS Update covers the practices and problems involved in infant and toddler feeding.

 

Infant feeding and toddler feeding are often topics of much concern for parents. This is especially so for first-time parents and for children born prematurely or with co-existing medical or surgical conditions. Problems may often occur but parents may need prompting to discuss them at times of medical review. To support medical practitioners, there are simple questionnaires for parents to fill in that may prove helpful for screening for feeding problems in infants and young children. 

 

Early discussion of feeding issues, reassurance and simple behavioural interventions may prove informative and helpful for parents.

 

What are optimal feeding practices?

The ability to sustain intake is practically dependent upon one’s ability to sustain an adequate intake of calories. This is achieved by nutritive sucking. The establishment of appropriate volumes of milk in a term infant typically occurs as the intake is graded up over the first week of life. Feeding is achieved through breastfeeding or bottle feeding successfully in the overwhelming majority of infants. There are strongly held views on the preferred method of infant feeding, but whatever works best for mother and child will be satisfactory and sustainable.

 

Feeding is presumed to come naturally, and successful breastfeeding is presumed rather than nurtured as much as it should be. There are strongly held views on the preferred method of infant feeding, but a pragmatic paediatrician’s view is that whatever works best for mother and child will be satisfactory and sustainable.  Breastfeeding is frequently chosen as the preferred initial option for feeding. It offers ease, convenience, nutritional completeness and it is obviously cost-effective. There is some debate as to how long one should breast feed in order to optimise benefits for the infant. 

 

The current recommendation is for six months before the introduction of solids. A recent (2012) update of the Cochrane review of this topic showed that babies breastfed exclusively for six months, as opposed to those exclusively breastfed for 3—4 months, experience less morbidity from gastrointestinal infection and have no deficits in growth. As would be anticipated, mothers who feed for longer also have more prolonged lactation-induced amenorrhoea. In short, while the nutritional wellbeing of each child should be considered individually, the review confirmed that there is every reason to advocate exclusive breast feeding for six months. 

 

Another Cochrane review from 2011 examined the question of whether the early introduction of additional food and fluids for healthy breastfed full-term infants afforded any nutritional advantages. For infants aged 4—6 months, there were no advantages in supplemental feeds in terms of risks related to morbidity or weight change. 

 

The utility of formula feeding relates to situations where breastfeeding is not faring well for a variety of reasons, where there are external/social/work pressures or where the infant may be unable to feed; for example, cleft lip and palate.

 

Preterm infants and feeding problems

The establishment of oral feeding in preterm infants requires patience and is related to gestational age. Specifically, it requires co-ordination between sucking, swallowing and breathing in the preterm infant neurologically maturing ex-utero. A stable suck and swallow 1:1 ratio is usually achieved by 33 weeks post-menstrual age. As this suck and swallow ratio is evolving, nasogastric tube feeding is used. One consistent issue is the extent of other complications of preterm birth problems that the preterm infant may be experiencing. These will influence the ability of the infant to suck.

 

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By Professor Dominic Fitzgerald

Coordinated by Dr Claire Berman MB.BCh

[email protected]