Baby won’t eat – is reflux the cause?

Guest post by Rowena Bennett

I feel for babies who suffer from ‘acid reflux’. Pain associated with untreated acid reflux can cause babies to display long periods of inconsolable crying, wakefulness leading to sleep deprivation, and distressed and avoidant feeding behaviour resulting in poor growth.

Thankfully, once effectively treated with acid-suppressing medications, a baby no longer produces stomach acid in concentrations that will burn his oesophagus. Hence, he will no longer suffer pain or display distressed behaviour associated with acid reflux.

If your baby acts as if he would rather starve than eat, and acid-suppressing medications don’t appear to be helping, it might be time to consider other possibilities. For example:

• Misdiagnosis: It might have been assumed that acid reflux was the cause of your baby’s distressed feeding behaviour when in reality it’s not. There are many reasons for healthy babies to cry and refuse to feed or eat when hungry or eat less than they need for healthy growth, besides acid reflux. A common cause to consider is feeding aversion.
• An unrelated or coexisting problem: Acid reflux has been effectively managed through the use of medications. However, his troubled feeding behaviour continues due to other reasons. A diagnosis of acid reflux does not exclude a baby from experiencing feeding problems due to other causes. In fact, a physical problem or medical condition increases the risk of a baby developing a feeding aversion.

Behaviour associated with feeding aversion

A feeding-averse baby can display a number of the following behaviours:

• Becomes tense, cries or screams when a bib is placed around his neck, or when placed into a feeding position, or when shown the bottle, or after stopping to burp.
• Reluctantly eats only when ravenous and then eats only a small amount.
• Takes a few sucks before pulling away crying.
• Appears to be conflicted about eating. For example, pulling off and on repeatedly in a tense or upset manner.
• Rejects feeding while held in arms.
• Avoids eye contact while feeding.
• Fusses when held in a feeding position even when not being offered a feed.
• Feeds only while in a drowsy state or asleep.
• Drinks less milk than expected.
• Accepts milk from a dropper, syringe, spoon or sippy cup, or enthusiastically eats solid foods after refusing to breastfeed or bottle-feed.

The type and intensity of behaviour displayed by feeding-averse babies vary depending on age, temperament, level of hunger and alertness at the time, the feeding strategies the parent employs, and how long the parent persists in trying to feed their baby.

Reasons babies become averse to feeding

Babies can develop an aversion to breastfeeding, bottle-feeding or the process of eating solid foods due to fear of feeding. Some babies become averse to one, two or all three feeding methods.

A baby can become fearful of feeding if an event occurring at the time he is feeding cause him stress, fright or pain. For example:

• Being repeatedly pressured or forced to feed.
• Pain experienced while sucking or swallowing.
• Aspiration or choking.
• Medical procedures involving the baby’s face, nose or mouth.

A single instance does not usually cause a baby to become averse to feeding, but could if the experience was traumatic. If such occurrences are repeated at all or most feeds, the baby learns to link the act of feeding with the event that causes him stress, fright or pain. As his memory develops, he learns to expect a similar occurrence each time he feeds. He then tries to avoid feeding in an attempt to avoid the event that causes him stress, pain or fright.

Most feeding-averse babies will display behaviour that appears as if they are experiencing pain. And so parents and health professionals will understandably assume pain is the cause. However, in the vast majority of cases, it’s not pain that feeding-averse babies fear, it’s the stress caused by being pressured or forced to feed against their will.

To date, I have assisted in over 1500 feeding aversion cases. In 90 per cent of cases ‘pressure’ was the original cause of the baby’s avoidant, distressed feeding behaviour. In around one-third of cases, the baby would display avoidant-feeding behaviour while awake but feed without resistance when drowsy or asleep. Once the parent realised this, they no longer pressured their baby to feed while awake, which was something they had repeatedly done in the past. In these cases, pressure was the original cause, but sleep-feeding became a secondary cause that indirectly reinforced the baby’s refusal to feed while awake.

In 10 per cent of feeding-aversion cases, ‘pressure’ was a secondary cause, which reinforced the baby’s aversive feeding behaviour long after the original cause of feeding refusal – which could have been acid reflux or another physical cause – had naturally resolved or was effectively treated with medications or dietary change.

How to tell if pain is the cause

It’s relatively easy to rule out pain as the cause of a baby’s avoidant, distressed or conflicted feeding behaviour by assessing his mood and behaviour at times when he’s not feeding. Pain is unlikely to be responsible if:

• Baby is happy when you stop feeding him.
  Pain fades; it doesn’t suddenly disappear when the feed has ended. If your baby is happy as soon as he realises you have stopped trying to feed him, pain is probably not the cause of his troubled feeding behaviour.
• Baby is content between feeds.
  Discomfort associated with conditions such as acid reflux, milk protein allergy or intolerance is not restricted to feeding times. Your baby would be distressed and cry at random times day and night in addition to feeding times if he is suffering pain due to these or other problems that cause pain. If your baby is content between feeds, his feeding refusal is probably not due to pain.
• Baby feeds well in a drowsy state.
  Sleep does not numb a baby to the sensation of pain. If your baby feeds will while drowsy or asleep, you can probably rule out pain as the cause.
• Baby will accept milk or food from other sources.
  If a baby experiences pain swallowing while breastfeeding or bottle-feeding, he will also experience pain swallowing milk or food from other sources, for example, a syringe, spoon or sippy cup.

If you suspect pain is the cause of your baby’s aversive feeding behaviour, your baby’s doctor is the best person to advise you on effective treatments. However, don’t overlook ‘pressure’ as a secondary cause of his avoidant, distressed feeding behaviour.

You may find the solution that you so desperately seek by enhancing your knowledge about the various causes and solutions to infant feeding aversion.

Article by:

Written by Rowena Bennett, RN, RM, MHN, CHN, IBCLC, and author of ‘Your Baby’s Bottle-feeding Aversion’ and ‘Your Sleepless Baby’.

Websites: babycareadvice.com and rowenabennett.com.

This article has been written for RISA Inc. Copyright laws apply. Permission to copy must be obtained from the author.