Bottle Feeding Problems

Expert Q&A

Baby girl drinking from bottle on sofa
Does your baby get fussy when she drinks her bottles?. Tom Merton/Caiaimage/Getty Images

Question. My daughter is five weeks old, and for the past week and a half she starts screaming while taking her bottle. She usually takes 4 to 5 ounces, but since she has started screaming she only takes 1 to 2. She sometimes chokes really bad while eating and spits up a whole lot. She acts really hungry, but then screams like she is in pain and finally it's like she just gives up on eating. I have called her pediatrician and even taken her in to see him, but he just keeps saying she probably has a stomach bug and it will run it's course.  What do you think the problem is? Heather, Rock Spring, GA

Answer. Unless someone else at home is sick with a stomach virus, that isn't a likely cause of this problem...

Bottle Babies Have Problems Too

While some new parents who have problems breastfeeding think it will be smooth sailing if they switch to formula, it's important to understand that bottle babies drinking formula can have feeding problems too.

What kinds of problems?

Refusing to eat and choking can be caused by anything from acid reflux or a formula intolerance to issues with the bottle and nipple.

Fixing Bottle Feeding Problems

Before you switch your baby's formula or buy a premium bottle that is supposed to reduce colic and gas, it is important to think about some simple questions, such as:

  • Does your baby have any other symptoms, like a runny nose, cough, or fever, etc? These types of symptoms might indicate that your baby is sick and needs further evaluation and it isn't just a bottle or formula issue.
  • Is your baby having problems at each feeding, or only occasionally? If it is not with every or most feedings, then you may just be misinterpreting her hunger signs and are trying to feed her either too early, so that she isn't hungry, or too late, so that she is overly fussy because she is very hungry. Keeping a diary of her feedings for a few days might make it easier to get a good picture of how much she is eating each day and how often.
  • Does it seem like the formula is coming out of the nipple too fast or too slow for your baby? Either can be frustrating for some babies. When you turn a full bottle of formula over, how quickly does the formula come out? You should get about a drop a second at first. If it is slower or you see a much faster stream, then you might try a different nipple.
  • Is the formula too cold or too hot. Are you warming her bottles of formula? If so, how are you doing it?
  • A formula intolerance might also cause a baby to be fussy during feedings, although these children also usually have other symptoms, like diarrhea or a lot of gas. If this is the problem and your baby is on a cow's milk based formula (Enfamil Lipil, Similac Advance, or Gerber Good Start), then a change to an elemental formula (Enfamil Nutramigen or Similac Alimentum) might be helpful. Be sure to talk to your pediatrician before changing your baby's formula though.

Unfortunately, many parents try all of these tips and tricks to fix their baby's bottle feeding problems without success.

Reflux vs. Other Feeding Problems

So, what else could cause a baby to refuse to eat?

If a baby is fussy, doesn't want to eat, and spits up a lot, then she very well may have acid reflux.

Treatment might include:

  • switching to a baby formula that could reduce spitting up, like Enfamil AR (added rice) or Similac for Spit-Up
  • lifestyle changes, especially feeding smaller amounts more frequently
  • burping your baby more frequently
  • an acid reducer medication

Of course, you also want to make sure that your baby is gaining weight well and doesn't have a fever or signs of any other problems.

What To Know About Bottle Feeding Problems

Other things to know about bottle feeding problems include that:

  • Seek immediate medical attention if a baby with feeding difficulty is also vomiting blood or a green or yellow fluid.
     
  • Adding a tablespoon of rice cereal per ounce of formula is a home remedy for thickening formula that works for some infants with acid reflux that some pediatricians recommend.
     
  • If you suspect that your baby has acid reflux, you usually shouldn't re-feed them after they spit up a large amount of formula or breastmilk. It is often hard to judge exactly how much they are spitting up and you will likely end up overfeeding your baby, leading to more spitting up. Instead, wait until the next feeding to give another bottle.
     
  • Talk to your pediatrician before continuously switching bottles, nipples, and formulas for feeding problems.
     

In addition to your pediatrician, a pediatric gastroenterologist can help manage infants with bottle and formula feeding problems.

Sources:

American Academy of Pediatrics Clinical Report. Use of Soy Protein-Based Formulas in Infant Feeding. PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1062-1068.

Vandenplas Y. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2009;49:498-547.

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