My child has feeding challenges- what now?
If you have been told your baby has feeding challenges, it can be overwhelming and scary. Feeding difficulties usually improve with the help of your healthcare team- and often, it is a temporary setback. You may need to see your pediatrician more frequently. You might also take your infant to see a dietitian, speech therapist, or lactation counselor. Whether you are seeing your doctor, a feeding team, or therapists, there are a few things you might want to do to prepare for an appointment. Preparing for your appointment helps you get the most out of your visit and helps your healthcare team get a good picture of how your baby is feeding at home. Giving your team information about how your baby is eating at home means they can tailor the plan to address your baby’s feeding issues and help your baby thrive.
What will happen at this visit?
While there may be several things that can happen at your visit, your healthcare team will most likely want to see how your infant is growing and what they are eating. This will help them see progress, and provide the information needed to make changes to your baby’s care plan. At the visit, your healthcare provider will ask you to talk about how your infant is eating and review any weight measurements you might have taken while at home. They will weigh and measure your baby’s length and head circumference in the clinic. They might also want to follow up on lab work like vitamin or electrolyte levels.
Your healthcare team may ask you to record what are described as “ins and outs”. This means tracking everything that comes into your little one’s mouth, and everything that goes out in diapers. It is important to be consistent with tracking! This could mean logging everything in a notebook using an old-fashioned pen and paper, dictating into your phone, or using an app. You might want to use your phone for pictures- especially if your infant has multiple doctors. That way, you can easily show ins and outs, like supplements, vitamins, or medication.
What will my baby’s healthcare team say?
Your baby’s healthcare team may recommend changes to what and/or how your baby eats. Breast milk is the gold standard for infant nutrition. However, for some infants, other sources of nutrition might be recommended in addition to breast milk. Doctors and/or dietitians and feeding therapists may recommend supplementing breast milk or increased feedings of breast milk. They might suggest new habits, such as to keep meal times consistent, and only eat at certain places (like the table). They may also recommend special formulas or recipes to help increase the calories or protein consumed by your infant.
Weight gain may be very important for your infant with feeding challenges. The healthcare team might ask you to weigh your infant at home and track their food intake. If so, make sure to ask them for instructions.
Tracking the ‘ins’
This is a detailed log of everything your infant consumes, or takes in. Depending on the age and feeding skills of your infant, this could include breast milk, formula, food, vitamins, medications, and fluids like water. Additional details like mealtimes and how long mealtimes last will help give a full picture of how your infant eats. Monitor and record any symptoms at mealtime to help the care team identify possible concerns- for example any gagging, coughing or spit up that is more than normal.
Tracking the ‘outs’
Monitor diaper changes and track them – you can easily forget these details when you’re at the clinic! Your dietitian and/or doctor will want to know how often you change your infant’s diaper, and how often they have bowel movements. It is also helpful to track the color and consistency of stools.
What should I do to prepare for the visit?
It is very helpful to keep all your documents in one notebook, or a folder so everything is in the same place. To prepare for the visit, bring everything that might help with you. This includes logs of your ‘ins and outs’, weights, and any new medications or vitamins your infant might have been put on since the last visit by different providers. Also, bring any notes you have from other members of the healthcare team you see. For example, if you also saw a speech language pathologist, or a breastfeeding counselor- bring those notes with you as well. It is also important to bring your questions! This can be an overwhelming time and keeping your questions in one place will help you remember to ask them at the visit.
Amy R. Gelfand, MS, RDN, CDN
Medical Science Liaison, Faltering Growth
Amy Gelfand is a Registered Dietitian. She completed her master’s degree and dietetic internship at NYU. She held the credential of a Certified Nutrition Support Clinician for 10 years (2011-2021) and has worked with a variety of pediatric and neonatal populations, helping families achieve optimal growth and development for their littles ones.
Failure to Thrive In Infants: Symptoms, What to Expect & Ways to Help (nationwidechildrens.org)
Failure to Thrive (for Parents) – Nemours KidsHealth
Failure to Thrive | Children’s Hospital of Philadelphia (chop.edu)
Failure to Thrive: A Practical Guide – American Family Physician (aafp.org)