Most visits for feeding difficulties are due to parental perception that the infant's food intake is inadequate. The neonate's pattern of intake is not fully established until about 1 month of age. If weight gain is satisfactory and the infant is satisfied after feedings, intake is adequate. Parents can usually provide accurate information of the intake of bottle-fed infants. The weighing of breast-fed infants before and after feedings is not advised, since weights may be inaccurate. In addition, weighing may have adverse psychological effects on a mother whose infant is doing poorly.
Rarely, anatomic abnormalities can cause difficulty in feeding and swallowing. A careful history usually pinpoints such difficulties as having occurred from birth. The infants appear malnourished and dehydrated. The most likely causes are esophageal obstruction (e.g., stenoses, strictures, laryngeal clefts, or cleft palate) and compression of the esophagus or trachea by a double aortic arch. Infants with a recent decrease in intake have an acute disease, usually an infection. 1
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