Infant Feeding Issues: Decreased Milk Intake and Spitting Up

Issues with milk consumption (decreased milk supply and spitting up)

Hello, doctor.
My younger brother is currently 8 days old, with a birth weight of 3400 grams and now weighs 5300 grams at two months old.
Since receiving his two-month vaccinations (the pentavalent vaccine and the 13-valent pneumococcal vaccine) and the rotavirus vaccine, his feeding has not been good for the past 2-3 days.
Previously, he would drink 110-130 ml per feeding, with a total of about 760-780 ml daily across six feedings.
His last feeding would be around 11 PM, where he would drink 130 ml and could go until 5 AM the next morning (the first feeding is formula milk (Enfamil A+ hydrolyzed protein formula) mixed with probiotics).
However, now he only drinks 60-90 ml per feeding, sometimes vomits, cries while drinking, twists around, and sometimes falls asleep while feeding and cannot be awakened.
His last feeding is now at 7 PM or 9 PM, and he sleeps until 5 AM for the next feeding.
Occasionally, he wakes up around 3 AM, making intermittent noises, but after giving him a pacifier, he falls back asleep until 5 AM.
If he drinks his last feeding at 7 PM or 9 PM and doesn't drink again until 5 AM the next morning, should I wake him up to feed? Is the cooing sound he makes a sign of hunger? Is this situation considered feeding aversion? Is this behavior normal? Should I take him to the hospital for a check-up? Additionally, after feeding, should I give him water to rinse his mouth? He used to have daily bowel movements, but now he only has a bowel movement every two days; is this normal? He is also drooling—watching adults eat makes him drool, and sometimes he has bubbles in his mouth and loves to stick out his tongue; is this normal? If I want to switch from Enfamil A+ hydrolyzed protein formula to regular formula or Nutramigen, should I do it gradually, spoon by spoon, or can I switch directly? Thank you for taking the time to respond.

Candice, 20~29 year old female. Ask Date: 2017/02/03

Dr. Xiao Kaiwen reply Pediatrics

As long as the infant's height and weight increase normally (a two-month-old gaining 1.9 kg from birth weight is considered normal), and there are no illness-related issues such as enterovirus or gastroenteritis causing feeding difficulties, with normal urine output, this is considered a benign period of feeding aversion, and observation is sufficient.
There is no need to forcefully wake the baby for nighttime feedings, as they will naturally compensate during the day.
It is acceptable to give some water after feeding to help clear milk residue, as long as excessive water is not given.
Having bowel movements every two days to twice a day is acceptable (as long as the stools are not hard or watery).
Infants' swallowing skills are not yet fully developed, and it is normal for them to have saliva accumulation in the mouth; however, attention should be paid to local hygiene to prevent saliva rash.
As long as there are no accompanying symptoms resembling seizures (such as a vacant stare), it is normal for infants to frequently stick out their tongues or make cooing sounds.
Any formula from reputable brands that have passed national inspections can be switched directly without the need for gradual mixing.

Reply Date: 2017/02/03

More Info

It's understandable to be concerned about your infant's feeding habits, especially when there are noticeable changes. Let's break down your questions and concerns regarding your two-month-old brother's feeding issues, decreased milk intake, and other related behaviors.

1. Decreased Milk Intake and Feeding Patterns
It's common for infants to experience fluctuations in their feeding patterns, particularly after vaccinations. The decrease in milk intake from 110-130 ml to 60-90 ml per feeding can be concerning, but it may not necessarily indicate a serious issue. Infants can go through phases where they eat less due to various factors, including discomfort from vaccinations, growth spurts, or even developmental changes.
If your baby is crying while feeding, it could be a sign of discomfort, which might be due to gas, reflux, or simply being tired. It's essential to ensure that he is burped properly during and after feeds to help alleviate any gas that may be causing discomfort.

2. Feeding Frequency and Nighttime Feeding
Regarding your question about whether to wake him for feeds, if he is gaining weight appropriately and has enough wet diapers (at least 6-8 per day), it may be okay to let him sleep through the night. However, if he is showing signs of hunger (like crying or fussing), it’s reasonable to offer a feed. The "crying" you mentioned could be a sign of hunger, but it could also be a way of seeking comfort.

3. Spitting Up and Digestive Issues
Spitting up is common in infants, especially if they are feeding quickly or swallowing air. If he is spitting up frequently and seems uncomfortable, you might want to consult your pediatrician to rule out any underlying issues like reflux.

4. Bowel Movements
A change in bowel movement frequency from daily to every two days can be normal, especially if he is exclusively breastfed or formula-fed. Infants can have varying bowel movement patterns. As long as the stools are soft and he is not showing signs of distress, this may be acceptable.

5. Salivation and Oral Development
The drooling and tongue movements you’re observing are typical for infants around this age as they begin to explore their oral skills. This behavior is often a precursor to teething, which can start as early as three months.

6. Transitioning Formula
When considering switching from your current formula (like the hydrolyzed protein formula) to a regular formula, it’s generally recommended to transition gradually. This can be done by mixing the two formulas in increasing amounts over several days to allow your baby’s digestive system to adjust.

7. Water After Feeding
Regarding rinsing the mouth with water after feeding, it is not necessary for infants. Breast milk and formula provide all the hydration they need. Introducing water is typically recommended after six months when solid foods are introduced.

Conclusion
In summary, while your baby's decreased milk intake and feeding behaviors can be concerning, they may fall within the range of normal infant behavior. However, if you notice persistent crying, significant weight loss, or other concerning symptoms, it would be wise to consult your pediatrician. Regular check-ups are essential to ensure that your baby is growing and developing appropriately. Always trust your instincts as a parent; if something feels off, seeking professional advice is the best course of action.

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