A mother contacted me recently with a very worrisome message: her baby was refusing all feedings. She tried everything–bottle feeding, a spoon and a syringe–in a desperate attempt to get her baby to drink a few sips. When a reflux baby refuses to eat, it is often referred to as a "feeding strike." A feeding strike is an extreme form of feeding aversion. The baby decides that it is too painful to eat and just refuses all nourishment. Perhaps the baby has associated pain and discomfort with every feeding and has decided to put an end to this painful experience once and for all.
I encouraged the mother to contact the doctor right away or go to the emergency room if necessary. A feeding strike can be very dangerous since an infant can dehydrate very quickly. I asked her the following questions:
- How many ounces did the baby drink today?
- How many wet diapers today?
- Any dry diapers?
- Any tears with crying?
A baby may be at risk for dehydration if she is drinking very little and not wetting as much. Some babies will even have dry diapers when they are normally soaking a super absorbent diaper. A dry tongue and a lack of tears with crying are also signs of dehydration.
Her baby was evaluated by the doctor right away and admitted to the hospital overnight for observation. The doctor adjusted the treatment plan and the baby gradually started drinking again. It was a scary experience for the family. Often, a feeding strike can be avoided if the pain from reflux is managed. Pain management may include standard reflux treatments such as a special diet and medication as well as small, frequent feeds and elevating the sleeping surface. The doctor needs to check in frequently with the family to determine if the treatment plan is working. If the baby is still crying with feeds or turning away from the bottle, this might be an early indicator of a painful response to eating. I often hear about feeding strikes in six-month-old babies. It makes me wonder if the parents and the doctors are waiting for the baby to outgrow reflux and decide to delay treatment. Gradually the irritation from reflux episodes become worse and worse until the baby cannot tolerate it anymore. The reflux might not be worse, but the pain might have increased from the constant irritation. That is why I always encourage parents to seek prompt treatment for reflux and to work closely with the doctor to assess the situation and develop a treatment plan to lessen pain and discomfort.
Remember that all reflux babies have good days and bad days and feeding strikes are relatively uncommon. Teething, a cold or other illnesses may cause fussiness during mealtime or decrease intake of formula or breast milk. A decrease in volume (ounces consumed per day) or frequency of feedings from illness is not considered a feeding strike but is a normal response to illness. It might help you to keep a record of meals, wet diapers and medications just in case a worrisome pattern is developing. Be sure to call the doctor or schedule a sick visit if you need input or a weight check. Mothers usually know something is wrong with their baby well before anyone else. Do not hesitate to report your concerns and observations to the doctor.