Disorders of infant feeding

Last reviewed: 22 Feb 2023
Last updated: 04 May 2022



History and exam

Key diagnostic factors

  • time taken to feed >30 minutes
  • stressful mealtimes
  • faltering growth (crossing downward 2 centiles)
  • food refusal
  • craniofacial abnormalities
  • abnormal neurodevelopmental assessment
More key diagnostic factors

Other diagnostic factors

  • inappropriate volume of feed
  • vomiting
  • abdominal pain, distension, or colic
  • apnoea, desaturations, and bradycardias in premature infants
  • irritability or lethargy at mealtimes
  • abnormal feeding pattern on observation
  • underlying illnesses and previous hospitalisations
  • previous gastrointestinal or cardiac surgery
  • family history of atopy
  • family history of feeding problems
  • recurrent pulmonary infections and wheeze
  • coughing or retching at meal times
  • posture changes during feeds
  • atopic features
  • apparent life-threatening event (ALTEs)
  • drooling
  • ankyloglossia (tongue-tie)
  • features of genetic conditions
Other diagnostic factors

Risk factors

  • prematurity
  • intrauterine growth restriction
  • developmental delay
  • anatomical abnormalities of the oropharynx or gastrointestinal tract
  • gastrointestinal surgery
  • neonatal cardiac surgery
  • Down’s syndrome
More risk factors

Diagnostic investigations

Investigations to consider

  • temporary exclusion of cows’ milk protein
  • oesophageal 24-hour pH study
  • upper gastrointestinal contrast study
  • oesophageal impedance study
  • CXR
  • videofluoroscopic swallow
  • fibreoptic endoscopic evaluation of swallowing with sensory testing
  • upper gastrointestinal endoscopy with biopsy
  • radio-allergosorbent testing (RAST) to cows' milk protein
  • trial of lactose-free diet
  • faecal-reducing substances
  • tissue transglutaminase (TTG) antibodies and total immunoglobulin A
More investigations to consider

Treatment algorithm


anatomical abnormalities

gastrointestinal disorders

short bowel syndrome

neurological impairment


respiratory disorders

cardiac disorders

behavioural problems



Helen McElroy, MBChB, MSc, FRCPCH

Consultant Neonatologist

Medway NHS Foundation Trust





HM declares that she has no competing interests.


Dr Helen McElroy would like to gratefully acknowledge Dr Stephanie Gill and Dr Uma Sothinathan, previous contributors to this topic.


SG and US declare that they have no competing interests.

Peer reviewers

Alexander K.C. Leung, MBBS

Pediatric Consultant

Alberta Children's Hospital

University of Calgary




AKCL declares that he has no competing interests.

Sarah N. Taylor, MD

Assistant Professor

Division of Neonatology

Medical University of South Carolina

Children's Hospital




SNT declares that she has no competing interests.

  • Disorders of infant feeding images
  • Differentials

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  • Guidelines

    • Gastro-oesophageal reflux disease in children and young people: diagnosis and management
    • Pediatric gastroesophageal reflux clinical practice guidelines
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  • Patient leaflets

    GORD in children

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