Frequent Breastfeeding and Food Refusal Associated with Failure to Thrive

Abstract

This paper acquaints pediatricians and health care personnel with the triad of poor weight gain, frequent breastfeeding, and food refusal in infants during the second 6 months of life. The histories of six infants aged 8-11 months, with failure to thrive, food refusal, and frequent breastfeeding, are presented. All the mothers were facing significant stresses, which may have decreased their breast milk supply, and were leading them to use breastfeeding for their comfort and/or the comfort of their infant. The infants responded with continued frequent breastfeeding, refusal of complementary foods, and decreased weight gain. These infants fit the characteristics of the vulnerable child syndrome. Treatment of these infants required evaluation and treatment of the mothers' psychosocial issues along with a behavioral feeding program. Even with this multidisciplinary approach, these infants showed very slow catch-up growth. Pediatricians and health care personnel should use and build on this information in the evaluation and treatment of infants with similar problems.

Get full access to this article

View all access options for this article.

References

1. Work Group on Breastfeeding . Breast-feeding and the use of human milk. Pediatrics. 1997;100:1035-1039; http://www.aap.org/policy/re9729.html.

2. Dewey KG , Heinig MJ , Nommsen-Rivers LA . Differences in morbidity between breastfed and formula-fed infants. J Pediatr 1995;126(5 part 1): 696-702.

3. Duncan B , EyJ , Holberg CJ , et al. Exclusive breastfeeding for at least 4 months protects against otitis media. Pediatrics. 1993;91:867-872.

4. Wright AL , Holberg CJ , Martinez FD , et al. Breastfeeding and lower respiratory tract illness in the first year of life. Br Medj 1989;299:945-949.

5. Wright AL , Holberg CJ , Taussig LM , Martinez FD . Relationship of infant feeding to recurrent wheezing at age 6 years. Arch Pediatr Adolesc Med. 1995;149:758-763.

6. Saarinen UM , Kajosaari M. Breast-feeding as prophylaxis against atopic disease; prospective follow-up study until 17 years old. Lancet. 1995;346: 1065-1069.

7. Cohen RJ , Brown KH , CanahuatiJ , et al. Determinants of growth from birth to 12 months among breastfed Honduran infants in relation to age of introduction of complementary foods. Pediatrics. 1995;96:504-510.

8. Dewey KG , PeersonJM , Brown KH , et al. Growth of breastfed infants deviates from current reference data. A pooled analysis of US, Canadian, and European data sets. Pediatrics. 1995;96:495-503.

9. Dewey KG , Heinig MJ , Nommsen LA , Lonnerdal B. Adequacy of energy intake among breastfed infants in the DARLING study: relationships to growth velocity, morbidity, and activity levels.J Pediatr 1991;119:538-547.

10.

10. Ramsay M , Gisel EG , Boutry M. Nonorganic failure to thrive: growth failure secondary to feeding-skill disorder. Dev Med Child Neurol. 1993;35: 285-297.

11.

11. Blackman JA . Children who refuse food. Contemp Pediatr. 1998;15:198-216.

12.

12. Illingworth RS , Lister J . The critical or sensitive period with special reference to certain feeding problems in infants and children.J Pediatr 1964;65(6 part 1):839-848.

13.

13. BlackmanJA , Nelson CLA . Reinstituting oral feedings in children fed by gastrostomy tube. Clin Pediatr. 1985;24:434-438.

14.

14. Hyman SL , Porter CA , Page TJ , et al. Behavior management of feeding disturbances in urea cycle and organic acid disorders.j Pediatr 1987;111:558-562.

15.

15. Toporoff EG , Story M. The feeding arena: a developmentally based model for assessing mother-infant feeding interactions. Fop Clin Nutr 1997;12:62-72.

16.

16. Newton M , Newton NR . The let-down reflex in human lactation. J Pediatr 1948;33:698-704.

17.

17. Blatchford DR , Hendry KAK , Wilde CJ . Autocrine regulation of protein secretion in mouse mammary epithelial cells. Biochem Biophys Res Commun. 1998;248:761-766.

18.

18. Green M , Solnit AJ . Reactions to the threatened loss of a child: a vulnerable children syndrome. Pediatrics. 1964;34:58-66.

19.

19. Thomasgard M , Metz WP . The vulnerable child syndrome revisited. Dev Behav Pediatr 1995;16:47-53.

20.

20. Singer LT , Nofer JA , Benson-Szekely L , Brooks LJ . Behavioral assessment and management of food refusal in children with cystic fibrosis. JDev Behav Pediatr 1991;12:115-120.

21.

21. WestonjA , Stage AF , Hathaway P , et al. Prolonged breastfeeding and nonorganic failure to thrive. Am J Dis Child. 1987;141:243-244.