Infant Feeding: Addressing Milk Refusal and Solid Food Introduction

Milk consumption issues. Infant complementary foods?

Hello Dr.
Hsiao, I would like to ask about my baby who is now over 4 months old and is drinking Abbott Similac infant formula.
Recently, he has started to show signs of milk aversion.
Since he was one month old, he has been drinking 120cc every three hours, but now his intake varies and he often doesn't finish his bottle.
The only time he finishes 140cc is at night.
Will this milk intake affect his growth and development? Additionally, since he has atopic dermatitis, should the introduction of solid foods be delayed?

Irene, 40~49 year old female. Ask Date: 2016/09/12

Dr. Xiao Kaiwen reply Pediatrics

As long as the child's growth and development curve is normal and has not fluctuated significantly (please refer to the growth chart in the child health handbook), the amount of milk consumed is sufficient for nutrition.
If the growth and development curve is normal, activity levels are appropriate, and there is no pathological refusal to eat (such as vomiting and diarrhea due to gastroenteritis, hand-foot-mouth disease causing oral ulcers that prevent eating, etc.), it can be classified as a benign period of milk refusal.
This is a normal situation for infants that does not affect their health status, and complementary foods can be introduced.
For children with allergic predispositions, "highly allergenic" complementary foods should be delayed (such as wheat, shellfish like shrimp and crab, citrus fruits, and berries like strawberries and kiwis), while low-allergen complementary foods can be introduced without issue (such as rice cereal or rice flour).

Reply Date: 2016/09/12

More Info

When it comes to infant feeding, particularly in the context of milk refusal and the introduction of solid foods, there are several important factors to consider for your baby's growth and development. Your concerns about your 4-month-old baby’s milk intake and the potential impact on his growth are valid, especially given his history of atopic dermatitis (eczema).

Firstly, it is essential to understand that infants have varying appetites, and it is not uncommon for them to experience phases of decreased milk intake, often referred to as "milk refusal." This can be influenced by several factors, including developmental milestones, teething, or even discomfort from conditions like eczema. At 4 months, babies are also becoming more aware of their surroundings, which can distract them during feeding times.

The recommended daily intake of formula for infants typically ranges from 24 to 32 ounces (about 700 to 950 mL) per day, depending on their weight and individual needs. If your baby is only consuming around 140 CC at night and less during the day, it may be concerning, especially if he is not meeting the lower end of this range consistently. Insufficient milk intake can lead to inadequate calorie and nutrient consumption, which is crucial for growth and development during these early months.

Regarding the introduction of solid foods, the general guideline is to start introducing solids around 6 months of age. However, if your baby has atopic dermatitis, it is advisable to consult with a pediatrician or a pediatric allergist before introducing new foods. Some studies suggest that early introduction of certain allergenic foods may help reduce the risk of developing food allergies, but this should be approached cautiously, especially in infants with existing skin conditions.

If your baby is showing signs of readiness for solids (such as being able to sit up with support, showing interest in food, and having good head and neck control), you might consider introducing single-grain cereals or pureed fruits and vegetables. Start with small amounts and observe for any adverse reactions, particularly given his skin condition. If he shows any signs of discomfort or worsening eczema, it may be wise to delay further introductions until you can consult with a healthcare professional.

In terms of managing his milk intake, here are some strategies you might consider:
1. Frequent, Smaller Feedings: Instead of sticking to a strict schedule, offer smaller amounts of milk more frequently. This can help if he is feeling overwhelmed by larger volumes.

2. Comfort and Environment: Ensure that feeding times are calm and comfortable. Sometimes, distractions or discomfort can lead to refusal.

3. Monitor Growth: Keep track of his weight and growth patterns. Regular check-ups with your pediatrician will help assess whether he is growing adequately despite the reduced milk intake.

4. Hydration: Ensure he stays hydrated, especially if he is not consuming enough milk. If you notice signs of dehydration (such as fewer wet diapers), seek medical advice promptly.

5. Consult a Specialist: Given his history of atopic dermatitis, it may be beneficial to consult a pediatric dietitian or allergist who can provide tailored advice on feeding strategies and the timing of introducing solids.

In summary, while your baby's current milk intake may be concerning, it is essential to monitor his growth and consult with healthcare professionals for personalized guidance. The introduction of solid foods should be approached with caution, especially considering his skin condition. With the right support and strategies, you can help ensure that your baby receives the nutrition he needs for healthy growth and development.

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