Disorders of infant feeding

Last reviewed: 3 May 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
  • apnea, desaturations, and bradycardias in premature infants
  • irritability or lethargy at mealtimes
  • abnormal feeding pattern on observation
  • underlying illnesses and previous hospitalizations
  • 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
  • anatomic abnormalities of the oropharynx or gastrointestinal tract
  • gastrointestinal surgery
  • neonatal cardiac surgery
  • Down syndrome
More risk factors

Diagnostic investigations

Investigations to consider

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

Treatment algorithm


anatomic abnormalities

gastrointestinal disorders

short bowel syndrome

neurologic impairment


respiratory disorders

cardiac disorders

behavioral 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

    • Physiological gastroesophageal reflux
    • Malrotation with intermittent volvulus
    • Intermittent intussusception
    More Differentials
  • Guidelines

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

    Reflux in very young children

    More Patient leaflets
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