Addressing Milk Refusal and Vaccination Concerns in Infants

Milk consumption issues + vaccinations

Hello Doctor: My baby was born on July 4, 2016 (currently 3 months and 21 days old).
Around September 23 (about two and a half months old), he started refusing to drink milk (at that time maintaining 3 hours/110cc), with a total intake of about 500-550cc.
After about two weeks, the situation improved, but now he cries when he sees the bottle and spits out the nipple.
Previously, we changed to 3.5 hours/120cc, but his total intake has now dropped to around 400-500cc, which worries me every day.
He has been passing a lot of gas these past couple of days; is this normal? (Is this situation considered milk aversion?) I have suggested to the caregiver to introduce solid foods at four months, but I am considering starting with fruit juice; is that okay? Will it make him drink even less milk? His birth weight was 2540g, 3700g at one month, 4600g at two months, and 5400g at three months.
He received the pneumonia vaccine, five-in-one vaccine, and rotavirus vaccine at two months and had a fever that peaked at 38.7 degrees Celsius.
We did not perform any physical treatment and just let him manage the fever, which fluctuated between 37.6-38.3 degrees Celsius for a whole day.
He is scheduled for his second round of vaccinations next month, so I am quite concerned...

rita, 0~9 year old female. Ask Date: 2016/10/26

Dr. Xiao Kaiwen reply Pediatrics

If an infant refuses to eat not due to illness (such as gastroenteritis or hand, foot, and mouth disease), and is growing and developing normally (for example, your 3-month-old child has already doubled their birth weight, which is normal), and has normal activity levels, this is referred to as a "feeding aversion period." During this period, complementary foods can be introduced as a substitute (supplementary foods do not exacerbate feeding aversion).
For a 4-month-old, complementary foods typically begin with diluted fresh fruit juices or infant rice cereal.
Infants tend to swallow more air while feeding and crying, which can lead to increased gas, so passing gas is normal.
Fever following vaccinations generally does not last more than 24 hours and is usually benign, resolving on its own without harming the body.
You may keep antipyretics on hand (which can be used if a fever occurs), and there is no need for excessive concern.

Reply Date: 2016/10/26

More Info

Addressing milk refusal in infants can be a challenging issue for many parents. It’s not uncommon for babies to go through phases where they refuse to drink milk, whether it be breast milk or formula. In your case, your baby, who is currently 3 months and 21 days old, has shown a pattern of milk refusal that has fluctuated over time. This can be concerning, especially when you notice a decrease in the total amount of milk consumed daily.

First, it’s important to understand that milk refusal can stem from various factors. Infants may refuse milk due to teething discomfort, changes in their environment, or even a preference for other tastes as they begin to explore solid foods. The fact that your baby is producing more gas could indicate that their digestive system is adjusting to changes in diet or that they are swallowing air while crying or fussing. This is generally normal, but if it is accompanied by discomfort or other symptoms, it may warrant further investigation.

As for introducing solid foods, starting with fruit juices is not typically recommended for infants under 6 months. The American Academy of Pediatrics suggests that babies should be exclusively breastfed or formula-fed until about 6 months of age. Introducing solid foods too early can lead to a preference for sweeter flavors, which might further decrease their willingness to drink milk. Instead, consider starting with pureed fruits or vegetables when your baby reaches the appropriate age, which is usually around 4 to 6 months. This can help ensure that they continue to receive the necessary nutrients from milk while gradually introducing new flavors.

Regarding vaccination concerns, it’s understandable to be worried about potential side effects, especially after your baby experienced a fever following previous vaccinations. Fever is a common reaction to vaccines, as it indicates that the immune system is responding to the vaccine. The fever you noted, reaching up to 38.7 degrees Celsius, is within the normal range of vaccine reactions. It’s important to monitor your baby during this time and provide comfort measures, such as ensuring they are well-hydrated and dressed appropriately for their comfort.

When it comes to the next round of vaccinations, it’s essential to discuss any concerns with your pediatrician. They can provide guidance on managing potential side effects and may suggest strategies to minimize discomfort, such as administering fever-reducing medications if necessary.
In summary, while milk refusal can be concerning, it is often a phase that many infants go through. Monitoring your baby’s overall health, ensuring they are still gaining weight appropriately, and consulting with your pediatrician about introducing solids and managing vaccinations will help you navigate this period. If the milk refusal persists or worsens, or if you notice any other concerning symptoms, do not hesitate to seek medical advice. Your pediatrician can provide tailored recommendations based on your baby’s specific needs and health history.

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