Milk Aversion and Fontanelle Concerns in Infants

Issues related to milk aversion and fontanelle?

Hello Doctor: My daughter has just turned seven months old, and recently, over the past week or two, she has been very averse to milk.
Especially in the last few days, whenever I try to feed her milk, she pretends to gag as soon as she sees the bottle approaching her, and she keeps her mouth tightly closed.
Even if I force the bottle into her mouth, she won’t suck.
If she does drink, it’s only about 60cc, and if I offer her water, the situation is completely different.
Over the past few days, her total milk intake has been around 350cc per day (during the day, I have been giving her complementary foods like fish porridge or apple puree, which she seems to enjoy).
Is this daily milk intake sufficient to meet her nutritional needs? Additionally, she rejects milk but enjoys drinking plain water.
What is the maximum amount of plain water I can give her in a day without it being considered excessive? Also, I have noticed that her fontanelle sometimes pulsates and sometimes does not.
When I touch it, sometimes it feels bulging, and other times it feels sunken.
Are these normal phenomena? Please help me with these questions, thank you.

Jie Ma, 30~39 year old female. Ask Date: 2005/05/31

Dr. Cai Zhengxian reply Pediatrics

Dear Mother Qi,
Greetings from Dr.
Tsai Cheng-Hsien, attending physician of pediatrics at Tainan City Hospital.
It is common for babies aged 5 to 7 months to refuse milk or breast milk while showing a preference for foods with different flavors or textures.
This phenomenon is referred to as "milk refusal period." The exact cause is unknown, but it coincides with the time when solid foods are typically introduced.
Based on your description, you are a dedicated mother who prepares diverse complementary foods and observes your baby closely.
We recommend offering a variety of solid foods and trying to give milk before bedtime, as your baby may be more receptive to it.
However, please avoid allowing your baby to fall asleep with a bottle to prevent bottle caries.
It is advisable to offer plain water between meals, especially during hot weather, to avoid affecting normal nutritional intake.
Regarding the fontanelle, it is normal for it to pulsate noticeably when lying down and to appear slightly sunken when sitting up.
However, if there is noticeable pulsation even when sitting up and the fontanelle is bulging after a head injury, please be cautious of potential intracranial pressure issues.
Tainan City Hospital cares about the health of you and your baby!

Reply Date: 2005/05/31

More Info

When it comes to infants, particularly those around seven months old, milk aversion can be a common concern for parents. Your daughter’s refusal to drink milk, coupled with her willingness to consume water and solid foods, raises several important points regarding her nutritional needs and overall health.

Firstly, it’s essential to understand that infants typically require a significant amount of milk for their nutritional needs, especially in the first year of life. The American Academy of Pediatrics recommends that infants aged 6 to 12 months consume about 24 to 32 ounces (approximately 700 to 950 ml) of breast milk or formula daily. This amount ensures they receive adequate calories, protein, fat, vitamins, and minerals necessary for growth and development. If your daughter is only consuming around 350 cc of milk daily, this is significantly below the recommended intake, which could lead to nutritional deficiencies.

Given that she is eating solid foods like fish porridge and apple puree, it’s crucial to ensure these foods are rich in nutrients that can supplement her diet. However, solid foods should not replace milk entirely at this stage. You might consider exploring different types of milk or formulas, as some infants may have preferences or aversions to specific flavors or textures. Additionally, introducing milk in various forms, such as mixed into foods or as part of a smoothie, may help her accept it better.

Regarding her preference for plain water, it’s generally safe for infants to drink water, but it should not replace milk. For a seven-month-old, offering small amounts of water is fine, but it should be limited to about 4 to 8 ounces (approximately 120 to 240 ml) per day. Too much water can lead to water intoxication, which can dilute essential electrolytes in the body.

Now, concerning the fontanelle (the soft spot on an infant's head), it’s normal for it to exhibit some pulsation and to feel different at various times. The anterior fontanelle typically closes between 9 to 18 months, and during this time, it can appear bulging or sunken depending on the infant's hydration status and overall health. A bulging fontanelle may indicate increased intracranial pressure, while a sunken fontanelle can suggest dehydration. If you notice significant changes in the fontanelle's appearance or if your daughter exhibits other concerning symptoms (such as lethargy, irritability, or feeding difficulties), it’s essential to consult a pediatrician.

In summary, while your daughter is showing a preference for solid foods and water, it’s crucial to address her milk aversion to ensure she meets her nutritional needs. Experimenting with different milk types, incorporating milk into her meals, and monitoring her overall health and hydration status will be vital. If her aversion persists or if you have concerns about her growth or hydration, seeking guidance from a pediatrician or a pediatric nutritionist would be beneficial. They can provide tailored advice and support to help you navigate this phase of her development.

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