Feeding Challenges in Infants: Gas, Spitting, and Hunger Issues

Milk consumption issues?

Hello, doctor.
My daughter has just turned two months old.
I understand that there are issues with feeding amounts, primarily focusing on the total intake for the day.
However, we have been facing a problem during feeding.
For instance, when we prepare 110 ml of formula, my daughter drinks very quickly (I know she is very hungry and will drink fast).
Therefore, we burp her frequently, approximately every 30 ml, doing this at least 2-3 times, but she doesn’t burp every time.
She has difficulty burping and tends to have gas.
Recently, when she drinks 110 ml and has consumed about 60 ml, we try to burp her, but sometimes she won’t let us because she might be too hungry, so we continue feeding her the remaining 50 ml.
Suddenly, she has milk at the corners of her mouth or spits up, and there was one instance of projectile vomiting, but the color was normal.
Even though she is clearly very hungry and wants to continue drinking, she seems unable to suck effectively, as if her stomach cannot hold too much milk.
She can suck and drink, especially since she has already consumed some, and the feeding process seems normal.
We have checked the bottle nipple and the formula, and everything seems fine.

I don’t understand why, when we try to feed her just a little more (about 10 ml), she starts crying.
She is clearly hungry but refuses to drink.
I wonder if it’s due to gastrointestinal discomfort.
We try to burp her to soothe her, but after calming her down, we continue feeding, and she drinks a little more before crying or outright refusing to drink.

I’m not sure if it’s because she can’t burp and has gas, or if she is feeling uncomfortable in her stomach, or if she is simply drinking too much at once and is too full to digest.
Previously, she didn’t have this issue; she wouldn’t refuse to drink when she was hungry, nor would she cry and have milk spilling from the corners of her mouth or spit up.

Overall, my daughter has been growing normally, and her bowel movements have been regular.
She can hold more milk in her stomach, so why is it that now, with a smaller amount, sometimes she drinks normally, but at other times, she has these issues? At least once a day, we encounter this situation, which has not happened before.

For example, during a feeding this morning, we prepared 110 ml, and when she had consumed about 50 ml, I tried to burp her but couldn’t get a burp out, yet she was still very hungry, so I continued to feed her.
Suddenly, it seemed like she couldn’t suck on the nipple anymore, and milk was spilling from the corners of her mouth, followed by crying.
Even though she was clearly hungry, I tried to soothe her and burp her.
After 5 minutes, I continued feeding her, but she only drank 10 ml, and the same situation occurred again.
So, I continued to soothe her, and after another 5 minutes, I tried to feed her again, but she only drank another 10 ml.
In the end, she only consumed 70 ml from that feeding, leaving 40 ml uneaten.
I have been worried about this issue since last week.
I wonder if it’s related to gas, but she used to drink quickly without these problems.
These issues have only recently emerged, and it’s not at every feeding, but at least once a day.

Trista, 20~29 year old female. Ask Date: 2023/07/09

Dr. Xiao Kaiwen reply Pediatrics

Newborns have a more sensitive gastrocolic reflex, so sometimes when they drink milk, it can lead to increased intestinal motility, resulting in temporary colicky pain.
This is a normal transient phenomenon, as long as there are no issues with frequent feedings or severe vomiting, and as long as their height and weight are increasing normally, bowel movements are regular, and slight abdominal distension is not a concern.

Reply Date: 2023/07/09

More Info

Feeding challenges in infants can be a source of concern for many parents, especially when it comes to understanding the reasons behind changes in feeding patterns, gas issues, and spitting. In your case, it sounds like your daughter is experiencing some discomfort during feeding, which can be quite distressing for both of you.

Firstly, it's important to recognize that infants have varying feeding behaviors as they grow and develop. At two months old, your daughter is still in a stage where her digestive system is maturing. It's common for babies to experience gas and spitting up, especially if they are feeding quickly or if they are not able to burp effectively. The fact that she drinks quickly when hungry indicates that she is eager to feed, but this can sometimes lead to swallowing air, which contributes to gas and discomfort.

When you mention that she sometimes has milk dribbling from her mouth or even spitting up, this can be attributed to several factors. One possibility is that she may be overfeeding, especially if she is consuming a significant amount of milk in a short period. While it’s essential to ensure she is getting enough nutrition, it’s equally important to pay attention to her cues. If she seems hungry but then refuses to drink, it could be a sign that her stomach is feeling full or uncomfortable.

The practice of burping your baby during feeds is crucial. You mentioned that you are attempting to burp her after every 30ml, which is a good strategy. However, if she is not burping easily, it may be beneficial to try different burping positions. Some babies respond better to being held upright against your shoulder, while others may prefer sitting on your lap, leaning slightly forward. Experimenting with these positions can sometimes help release trapped gas more effectively.

Regarding the spitting up, it’s not uncommon for infants to experience gastroesophageal reflux (GER), where the contents of the stomach flow back into the esophagus. This can happen due to the immaturity of the lower esophageal sphincter in infants. If she is spitting up but is otherwise healthy, gaining weight, and having normal bowel movements, this is usually not a cause for concern. However, if the spitting becomes excessive or is accompanied by distress, it may be worth discussing with your pediatrician.

You also mentioned that her feeding patterns have changed recently. It’s possible that she is going through a developmental phase where her feeding habits are adjusting. Babies can experience growth spurts, and during these times, they may feed more frequently or, conversely, may seem less interested in feeding. This can be confusing, but as long as she is growing and developing normally, it’s generally not a cause for alarm.

In terms of her overall health, it’s reassuring to hear that she is developing well and has regular bowel movements. If you continue to notice significant changes in her feeding behavior or if she seems to be in pain, it would be wise to consult with your pediatrician. They can provide guidance tailored to her specific needs and help rule out any underlying issues.

In summary, feeding challenges in infants can stem from a variety of factors, including gas, reflux, and developmental changes. By observing her feeding cues, experimenting with burping techniques, and maintaining open communication with your healthcare provider, you can navigate these challenges more effectively. Remember, every baby is unique, and what works for one may not work for another. Patience and flexibility are key as you both adjust to her evolving needs.

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