Problem Solving: Newborn with poor feeding


I am working with a term infant just discharged home who is taking 40+ minutes to feed his bottle. He was referred by his pediatrician tour outpatient clinic since he is not gaining weight. Is this a normal time for newborns to feed? Can you help me think of what might be the issue?

The typical healthy newborn would not require 40 minutes to complete a bottle feeding.

While feeding times may vary from infant to infant or from feeding to feeding, the typical feeding time for a healthy newborn is 20-30 minutes. Some may indeed feed faster.

When the feeding time exceeds that average, for an infant without co-morbidities,  one might ask the question, what factors might be affecting efficiency? i.e. is nipple flow too fast and infant might be altering his sucking rate or pattern to limit flow? is the nipple shape not a good “fit” for the infant’s oral cavity? does the infant have a low hematocrit (blood count) that might affect endurance? is the infant jaundiced, which can affect drive/stamina? does the infant indeed have some subtle sucking or swallowing problem that is not readily apparent which might be affecting suck-swallow-breathe coordination? does the infant have GI symptoms during feeding that suggest GI discomfort as a reason for disengagement (i.e. stop-start behavior)? is the infant “working” hard during feeding (i.e. showing excessive breathing effort which can cause respiratory fatigue)? does the infant indeed have some subtle postural control or postural tone problems that may adversely affect stability and efficiency of motor patterns that underlie effective feeding? are there subtle oral-sensory issues? does the infant have state regulation problems that don’t support attaining a true quiet alert state shown to be optimal for feeding? what are the circumstances of the infant’s newborn history (prenatal, during delivery or after delivery) that might be playing a role, even though the infant is thought of as a “typical” newborn?

What else can you tell us about this infant so that we can help you problem-solve?

As I am thinking of possibilities to suggest to you as etiologies for this atypical feeding time, I am reminded of my good friend and colleague, Joan Arvedson, who said  “two important 4 letter words”  (LOL) are ……”What else?” , i.e. asking yourself as therapist “what else do I need to consider, what else do I  need to ask, what else might be helpful etc.”  Such wise words which I have never forgotten.

I find it’s asking the question that is most important, and you have 🙂 , and then asking more questions to help elucidate the answers, complete a differential. That problem-solving process is what makes our profession such a delight for me.



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