From the Guidelines
The workup for a 3-month-old with poor feeding should begin with a thorough history and physical examination, followed by an ultrasound (US) abdomen (UGI tract) as the initial imaging study, as recommended by the American College of Radiology 1. The initial evaluation should focus on identifying potential causes of poor feeding, including infection, gastrointestinal disorders, neurological issues, cardiorespiratory problems, or metabolic disorders.
- Key components of the history include:
- Feeding patterns, volume intake, frequency, and duration of feeds
- Associated symptoms like vomiting or diarrhea
- Recent changes in formula or feeding technique
- The physical examination should assess for signs of dehydration, weight loss, or failure to thrive by reviewing growth charts, and focus on:
- Oral anatomy
- Neurological status
- Cardiorespiratory function
- Abdominal examination
- Initial laboratory tests may include:
- Complete blood count
- Comprehensive metabolic panel
- Urinalysis
- Possibly blood cultures if infection is suspected
- According to the American College of Radiology, for an infant older than 2 weeks and up to 3 months old with a new onset nonbilious vomiting, US abdomen (UGI tract) is usually appropriate for the initial imaging 1.
- Specialized testing such as upper GI series, pH probe, or swallow study may be considered if anatomical or functional issues are suspected.
- Immediate referral to a pediatric specialist is warranted if there are concerning findings like significant weight loss, dehydration, or neurological symptoms.
- While investigating, ensure adequate hydration and nutrition, which may require smaller, more frequent feedings, different nipple types, or formula changes.
- In severe cases, hospitalization for IV hydration or nasogastric feeding might be necessary.
From the Research
Diagnostic Approach
When evaluating a 3-month-old infant with poor feeding, it is essential to consider various potential causes. A study published in 2014 2 found that infants presenting with lethargy or poor feeding may have underlying conditions such as hematologic disorders, dehydration, intracranial bleeds, serious bacterial infections, cardiac disorders, or neurologic disorders.
Potential Causes
Some potential causes of poor feeding in infants include:
- Hematologic disorders (6.6%) 2
- Dehydration (2.9%) 2
- Intracranial bleeds (0.7%) 2
- Serious bacterial infections (1%) 2
- Cardiac disorders (0.4%) 2
- Neurologic disorders (0.7%) 2
- Functional gastrointestinal disorders, such as irritable bowel syndrome or functional dyspepsia 3
- Small bowel dysmotility, which can be associated with neurological disorders 4
- Deglutition disorders, including feeding difficulties, swallowing disorders, and aspiration syndromes 5
Evaluation and Management
A comprehensive evaluation of the infant's developmental skills and maturation can guide targeted management approaches and prediction of feeding outcomes 6. The general principles of treatment are based on a biopsychosocial understanding and involve management of physical symptoms and, if present, psychological comorbidity 3. Symptom-based criteria are used to make a diagnosis, with judicious use of limited investigations in some patients 3.
Key Considerations
Key considerations in the evaluation and management of poor feeding in infants include:
- Assessment of the infant's developmental skills and maturation 6
- Evaluation for structure and function tests, and nutrition and feeding assessment 5
- Identification of potential underlying causes, such as hematologic disorders or neurological disorders 2, 4
- Management of physical symptoms and, if present, psychological comorbidity 3