Feeding difficulties in infants

Premature babies often have a longer and more complex feeding journey than term babies. The suck-swallow-breathe coordination needed for safe, efficient feeding is one of the later skills to develop, and preterm babies may take weeks or months to master it. This is entirely expected, but it doesn't make it any less stressful for parents who are watching other babies feed effortlessly.

For premature infants, corrected age matters for everything, including feeding milestones. A baby born at 28 weeks who is now 4 months old chronologically is developmentally closer to a newborn. Weaning timelines, volume expectations, and feeding skills all need to be assessed against corrected age rather than actual age.

As highlighted by BSPGHAN, nutritional needs can also be higher for premature infants. Catch-up growth requires more energy and protein per kilogram than standard growth, and some premature babies benefit from fortified breast milk or specialist preterm formulas for longer than term babies would. A dietetic assessment helps ensure the nutritional plan matches your baby's actual needs rather than applying standard guidelines that may not fit.

Dysphagia, or difficulty swallowing, can affect babies of any age but is more common in premature infants, babies with neurological conditions, and babies with structural differences affecting the mouth, throat, or airway. Signs that a baby may have a swallowing difficulty include coughing or choking during feeds, a wet or gurgly voice after feeding, frequent chest infections, feeds that take a very long time, and breathing that becomes noisy or laboured during feeds.

Assessment of swallowing difficulties usually involves a speech and language therapist alongside a paediatric dietitian. The SLT assesses the safety and mechanics of swallowing, while I focus on ensuring the baby is getting adequate nutrition given any modifications needed, whether that's thickened feeds, modified positioning, or supplementary tube feeding while oral skills develop.

Many babies with mild swallowing difficulties improve as they grow and their neurological control matures. For others, particularly those with underlying neurological conditions, swallowing difficulties may be longer-term and need ongoing management. Either way, the goal is safe, adequate nutrition that supports growth and development.

A common experience when feeding is difficult is exhaustion. Feeds that take 45 minutes to an hour, a baby who falls asleep halfway through and never quite finishes, or feeds that happen every 1 to 2 hours because the baby doesn't take enough at each one. This pattern is wearing for everyone and often means the baby isn't feeding efficiently.

Common causes include a poor latch or attachment, low oral muscle tone, fatigue from an underlying condition, inappropriate teat flow rate, reflux causing the baby to pause and restart repeatedly, or a combination of several factors. A feeding assessment looks at all of these systematically and identifies what can be changed. Sometimes small adjustments, like a different teat, a different position, or better timing of feeds, make a significant difference.

Feeding difficulties in infants are best managed by a multidisciplinary team of HCPC-registered professionals. Depending on the nature of the difficulty, that might include a paediatric dietitian, speech and language therapist, lactation consultant, occupational therapist, and paediatrician. The right combination depends on what's driving the difficulty.

Asking for help early is not a sign of failure. Feeding difficulties are common, they have causes, and many of those causes can be managed or supported effectively. If feeding feels harder than it should, if your baby isn't gaining weight as expected, or if you're spending your entire day trying to get enough into your baby, a professional assessment can help to your baby's nutrition and to your own wellbeing.