Addressing Milk Intake Issues in Infants: A Pediatric Guide

Milk consumption issues?

Hello Doctor,
I am a mother living in the Jinshan District of New Taipei City.
I would like to ask you about my baby who is over 8 months old.
He was born weighing 3800 grams and was drinking 100 ml of milk.
Until he was 2 months old, his milk intake was normal and increased, but after receiving the rotavirus vaccine, his milk intake drastically decreased.
It improved a bit after a month.
Since this is my second child, I also have an older daughter in kindergarten.
When she gets sick, she tends to pass it on to her brother, and because of this, our whole family tested positive for COVID-19 for the first time in May this year.
Due to frequent illnesses, my baby's milk intake has been inconsistent; sometimes he refuses to drink altogether.

We started introducing solid foods when he was 4 months old, and initially, he ate well and enjoyed fruits.
However, in recent months, he has shown little interest in solid foods and refuses to eat fruits.
We have consulted with a general clinic, and they diagnosed him with milk aversion.
They prescribed appetite stimulants, including Hepilim and probiotics, which did improve his appetite and milk intake, but once we stop the medication, he refuses to drink again.
Continuously relying on medication is not a solution.

We took him to the gastroenterology department at Chang Gung Memorial Hospital in Keelung, where an abdominal ultrasound was performed, and they said there were no significant issues.
They prescribed more appetite stimulants, but his milk intake is still low; he recently weighed only 8 kg.
His weight had not increased for several months.
The doctor at Chang Gung suggested using a contrast agent for an esophageal study, but I was reluctant because he is still so young.
I did not go back, but my baby still does not show much interest in drinking milk, which has persisted for six months.
His activity level seems fine, but his weight percentile is below the normal range.

I am at my wit's end with this issue.
Do you have any good suggestions? To add, his milk intake varies between 40, 20, 50, and 100 ml, with most days being very low.
Sometimes, I can only get him to drink when he is asleep, and even then, he might not drink at all.
His total milk intake for the day is only around 150 to 200 ml, and on better days, it reaches 400 ml.
I can only manage to feed him about 100 ml of porridge twice a day.
😢😢😢

Yang Guo, 40~49 year old female. Ask Date: 2023/09/07

Dr. Xie Wanghu reply Pediatrics

Hello, Mom.

1.
An 8-month-old weighing 8 kg is within the 50th to 85th percentile, which is very good.

2.
After 4 months, milk can be consumed as desired, but solid foods become more important.
A varied diet is essential, and milk can be given once a day.

3.
Please do not force-feed anything.
Thank you.

Reply Date: 2023/09/07

More Info

Addressing milk intake issues in infants can be a challenging journey for many parents, especially when faced with fluctuating feeding patterns and concerns about nutrition and growth. Your situation, as described, highlights several important aspects of infant feeding that warrant careful consideration.

Firstly, it is essential to recognize that a decrease in milk intake can occur for various reasons, including illness, changes in routine, or developmental milestones. In your case, it seems that your baby experienced a significant drop in milk consumption following vaccinations and subsequent illnesses, which is not uncommon. Infants may temporarily lose their appetite due to discomfort or illness, and this can lead to a cycle of reduced intake and weight gain concerns.

Regarding your baby's current weight and feeding habits, it is crucial to monitor not just the quantity of milk consumed but also the overall nutritional intake. At 8 months, your baby should be transitioning to a more varied diet that includes solid foods alongside breast milk or formula. While milk remains an important source of nutrition, especially for calcium and vitamin D, the introduction of solids should complement milk intake rather than replace it entirely.
If your baby is showing signs of food aversion, it may be beneficial to explore different textures and flavors. Sometimes, infants may refuse certain foods due to their texture or taste. Offering a variety of foods, including purees, mashed fruits, and soft finger foods, can help stimulate interest in eating. Engaging your baby during mealtime, such as allowing them to self-feed or participate in family meals, can also encourage a more positive attitude towards food.

In terms of milk intake, if your baby is only consuming small amounts (40-200 ml per day), it is essential to ensure that they are receiving adequate nutrition from other sources. You mentioned using appetite stimulants, which can be helpful in the short term, but relying on medication long-term is not ideal. Instead, focus on creating a positive feeding environment, offering small, frequent meals, and being patient as your baby adjusts to new foods.

If your baby continues to refuse milk and solid foods, it may be worth consulting with a pediatric nutritionist or a gastroenterologist for further evaluation. They can provide tailored advice and may suggest alternative formulas or supplements to ensure your baby is meeting their nutritional needs.
Additionally, consider the emotional aspect of feeding. Babies can pick up on parental stress, so maintaining a calm and relaxed atmosphere during feeding times is crucial. Avoid pressuring your baby to eat, as this can lead to negative associations with food. Instead, focus on creating a pleasant mealtime experience.

Lastly, keep in mind that growth patterns can vary significantly among infants. Regular check-ups with your pediatrician will help monitor your baby's growth and development. If there are ongoing concerns about weight gain or feeding, your healthcare provider may recommend further assessments to rule out any underlying issues.

In summary, addressing milk intake issues in infants requires a multifaceted approach that includes monitoring overall nutrition, exploring different feeding strategies, and maintaining a positive feeding environment. If challenges persist, seeking professional guidance can provide additional support and reassurance for both you and your baby. Remember, you are not alone in this journey, and many parents face similar challenges as their little ones grow and develop.

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