Differential Diagnosis for Breastfeeding Difficulties

The following differential diagnosis is organized into categories to help identify potential causes of a baby's severe feeding difficulties during the day with both breast and bottle, despite breastfeeding easily at night.

• Single Most Likely Diagnosis
  • Tongue-Tie or Oral Motor Issues: The baby may have a tongue-tie or other oral motor issues that make it difficult to latch and feed during the day when the baby is more alert and active. At night, the baby may be more relaxed, making it easier to breastfeed.
• Other Likely Diagnoses
  • Reflux or Gastroesophageal Reflux Disease (GERD): The baby may be experiencing reflux, which can cause discomfort and pain during feeding, leading to feeding difficulties. Symptoms may be worse during the day due to increased activity and feeding frequency.
  • Overstimulation or Sensory Overload: The baby may be overstimulated during the day, leading to feeding difficulties. This could be due to environmental factors, such as noise or light, or internal factors, such as sensory processing issues.
  • Lactation Issues: The mother may be experiencing lactation issues, such as low milk supply or plugged ducts, which can cause feeding difficulties during the day.
• Do Not Miss Diagnoses
  • Pyloric Stenosis: A condition where the pylorus muscle is thickened, causing gastric outlet obstruction. Feeding difficulties and vomiting are common symptoms, and if left untreated, can lead to severe dehydration and electrolyte imbalances.
  • Congenital Heart Disease: Some congenital heart defects can cause feeding difficulties due to increased energy expenditure and decreased cardiac output. If left undiagnosed, these conditions can lead to severe complications, including heart failure and death.
• Rare Diagnoses
  • Food Protein-Induced Allergic Proctocolitis (FPIAP): A rare condition where the baby has an allergic reaction to a protein in the mother's milk, causing rectal bleeding and feeding difficulties.
  • Galactosemia: A rare genetic disorder where the baby is unable to metabolize galactose, a sugar found in milk. Feeding difficulties and other symptoms, such as vomiting and diarrhea, can occur if the condition is not diagnosed and managed promptly.