When Baby’s Milk Intake Drops – Is it a relapse?

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  • May 2, 2019
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You may have successfully resolved your baby’s feeding aversion after reading my book or as a result of following the recommendations I made during a consultation, but fear that your baby will relapse. Unfortunately, a previously feeding-averse baby can relapse if she feels pressured to feed, irrespective of whether this was the parent’s or caregiver’s intention or not.

Your baby’s milk intake will fluctuate from feed to feed, day to day, and week to week for many different reasons. When there is a dip in her intake, which will occur at times, this will understandably heighten your feelings of anxiety.  You might question, has she relapsed?

A relapse is a possibility; however, in most instances when a baby’s milk intake drops below what is expected there are other reasons involved.  How best to react in response to the drop in his milk volume, depends on the cause. The first step is to determine the cause. The following are common reasons for a baby to drink less than usual:

  1. Increased solids
  2. Reduced appetite
  3. Step-back days
  4. Relapse

 

I will explain each of these in greater detail, but below is a quick guide on how to tell the difference.

 

1.  Increased solids

 

Healthy babies and children regulate their dietary intake according to energy content (calories/kilojoules) of the foods they eat. The more calories your baby receives from solids, the less milk he drinks; and visa versa.

Milk is the most important food for babies at 6 months of age, but solids are more important than milk by 12 months. A gradual decline in milk intake, corresponding with a gradual increase in solids consumed occurring between the ages of 6 to 12 months, is normal. However, the shift to solids can occur too soon for some babies.

After getting over their feeding aversion, some babies become ‘milk lovers’, preferring milk to solids. Others accept milk simply as a means to satisfy their hunger, but favor solids. Those favoring solids might drop their milk intake too soon. The latter is more likely to occur when a baby is given hypoallergenic formula. It’s understandable that a baby would prefer the taste of solids compared to the bitter taste of hypoallergenic formula.

 

SIGNS

Baby may at times passively reject milk feeds, or takes only small amounts before stopping in a relaxed/content manner. Feeding behavior ratings are mostly 4s and 5s. It appears like he’s simply not interested in drinking milk. However, he’s very receptive to eating solids and may consume large amounts.

 

WHAT TO DO

  • Check with your baby’s health care professional that the balance between milk and solids is appropriate for his stage of development.
  • Offer milk before solids.
  • Wait for 20-30 minutes after a bottle-feed before offering solids.
  • If necessary, limit the amount of solids offered.
  • If all else fails, try to include baby’s milk or formula powder in his solids.

 

If baby is given hypoallergenic formula, ask his doctor if he actually needs to be given this milk. Many feeding-averse babies are misdiagnosed with milk allergy or intolerance based solely on their oppositional feeding behavior and/or slow growth, and without clearly identifiable signs that point to milk allergy or intolerance.

  

2.  Reduced appetite

 

Your baby’s appetite will fluctuate from feed to feed, day to day and week to week, and so will the amount of milk he consumes during individual feeds and throughout a 24-hour period. This is normal for all babies

 

CAUSES

Baby’s appetite will fluctuate depending on his state of health, how active he is, growth phase, sleep quality and more. Common reasons for reduced appetite include a plateau in growth, which occurs between growth spurts, or a return to baby’s genetically predetermined growth path after a period of catch-up growth. Appetite may also be reduced when baby is ill, teething, or in the days following vaccinations.

Sometimes you will be able to pinpoint the reason your baby drinks less and sometimes you won’t. Either way, periods of reduced appetite tend to pass.

 

SIGNS

  • If due to baby’s growth stage – his milk intake and/or solids intake might drop. He passively rejects some offers to feed, or willingly accepts the bottle, feeds and ends the feed in a relaxed/content manner. Feeding behavior ratings are mostly 4s and 5s.
  • If due to illness, teething or vaccinations, a baby might fuss during the feed (and at other times) due to discomfort, nausea, or feeling unwell. There may be physical signs of illness or teething or history of recent vaccination. Feeding behavior ratings are mostly 2s and 3s.

 

Depending on the cause, a baby’s appetite could be reduced for days or weeks.

 

WHAT TO DO

  • Trust your baby! His appetite will return in time. Remember, if he were breastfed rather than bottle-fed, you would have no idea how much milk he was receiving. Follow his feeding cues and avoid pressuring him to eat.
  • If baby is unwell, and milk intake is deficient, try sleep-feeding during the day, but only until he has recovered. Sleep-feeding during the day does break one of the feeding rules; however, this rule may need to be broken when a baby is unwell.

 

 

3.  Step-back days

 

A step-back day is when a baby’s total daily milk intake is lower, and feeding ratings are not as good as previous days. It appears as if the baby has regressed. During the process of resolving your baby’s feeding aversion, step-back days could cause you to doubt if the program is going to work for your baby, or worry that there could be unresolved medical issues inhibiting his progress. As a parent of a previously feeding-averse baby, you may fear that he has relapsed.

 

CAUSES

The most common cause is tiredness. An overtired baby is more likely to reject a feed outright, or display conflicted feeding behavior, or fall asleep while feeding. Step-back days due to poor sleep are typical for all babies – feeding-averse or not. However, the risk of poor sleep is increased when a baby is not eating enough – as is the case in the early stages of resolving his feeding aversion. And so it can appear like the baby is stuck in a vicious cycle, where he has trouble sleeping because he’s hungry (but not willing to eat because of his aversion), and on the other hand, he is eating even less because he’s too tired and impatient to eat. But he’s only stuck until he gets some decent sleep, which can happen overnight.

Other reasons for a step-back day include:

  • a highly distractible baby feeding in a new or stimulating environment;
  • being fed by someone yet to gain baby’s trust in regards to responding to his feeding cues.

 

SIGNS

  • A small reduction in milk intake – for example, 2 to 4 ounces (60 to 120ml) in 24 hours.
  • Baby might reject some feeds and fusses more during feeds compared to previous days.
  • Feeding behavior ratings are mostly 3s.
  • A step-back day typically lasts for one day but could involve two consecutive days, before baby’s milk intake and feeding ratings improve.

 

WHAT TO DO

  • Hang in there! A step-back day, or two, doesn’t mean the program is not working. While baby might drink less and is fussier in general due to tiredness, you’re still regaining his trust by following my feeding rules and recommendations. With some decent sleep, baby will be feeling better, and in turn, his feeding behavior and milk intake will improve.
  • While resolving baby’s aversion – continue to follow my feeding rules and recommendations (described in my book ‘Your Baby’s Bottle-feeding Aversion’). Supporting your baby’s sleep can help to reduce the incidence of step-back days. Be aware of his sleep associations. Provide these when he shows signs of tiredness to help him fall asleep, and support his sleep by maintaining his sleep association for the entire time he needs to nap during the day. (Note: an exception is if your baby is accustomed to falling asleep while feeding, which is something I strongly recommend you prevent, both day and night, due to the complications this causes to a baby’s sleep and feeding.)
  • After resolving baby’s aversion – if necessary support him to learn sleep habits that enable him to fall asleep independent of your help and thus allow him to self-regulate his sleeping patterns, as this has the potential to reduce the occurrence of step-back days significantly.
  • If the drop in milk intake and behavioral ratings continue for more than 2 days – determine if the cause could be reduced appetite (with high behavioral ratings) or relapse (with low feeding ratings).

 

 

4.  Relapse

 

A relapse means baby’s intake and feeding behavior initially improved as a result of following my feeding recommendations, but now his milk intake and feeding behavior is as bad, if not worse, than before you started my program.

A baby could be partially or fully over his feeding aversion and experience a complete relapse if the reason he first became averse to feeding was to occur again.

 

CAUSES

The most common cause of a relapse is because the baby feels pressured to feed. Once baby is over his feeding aversion, some parents start to bend the feeding rules, for example, offer more often, hovering with the bottle when baby rejects, and/or sleep-feeding during the day, and this reignites baby feeding aversion. Or it could be that another caregiver unknowingly and unintentionally pressures baby, mistakenly believing they are “encouraging” him to eat.

There are also less common reasons for relapse, such as returning to sleep-feeding baby during in the day, choking episodes or pain while swallowing due to a sore throat or inflamed esophagus due to food allergy or acid reflux.

 

SIGNS

  • Baby rejects outright or takes very little despite visible signs of hunger.
  • Feeding behavior ratings are mostly 1 or 2 (lower than a step-back day).
  • Relapse typically occurs suddenly. It’s like one day baby is enjoying feeding, and the next day he acts as if he hates it. However, in some cases, a return to the baby’s previously feeding-averse behavior can occur gradually. A slower decline tends to occur as a result of the parent reverting back to sleep-feeding their baby during the day.
  • Baby’s milk intake remains low for longer than a day or two (which is the case for step-back days).
  • If due to pain, baby will cry during and after feeding and at random times unrelated to feeding

 

WHAT TO DO

  • Check that you have not been bending the rules.
  • Check with all persons feeding baby to ensure there is no pressure.
  • Cease solids temporarily.
  • Start the process again. It worked previously; it can work again. Expect that it will take as long as the first time before baby gets over his aversion once again.

 

PREVENTION

  • Prevention is better than cure! Your baby has already demonstrated that he’s sensitive to being pressured – hence why he became averse to feeding in the first place. This means he’s susceptible to relapse if he feels pressured To prevent a relapse, I encourage you to stick to my feeding recommendations over the long term. These have the potential to resolve and prevent a feeding aversion that develops due to pressure.
  • Avoid bending of the rules. In the case of a feeding aversion, there’s a point where bending the rules too far will cause baby to relapse. Where that point is varies depending on your baby’s sensitively to pressure. Some babies are more sensitive than others.
  • If anyone new is to feed baby, provide clear instructions that he should not be pressured. You may need to give examples of what pressure means, as not everyone recognizes when they’re pressuring a baby to feed. Also, describe to them the behavior your baby’s displays when he’s done.

 

Written by Rowena Bennett, RN, RM, MHN, CHN, IBCLC.

© Copyright Yourbabyseries.com. All rights reserved. Permission from the author must be obtained to reproduce all or any part of this article.


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