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Intolerance of Feeding in Infants

By Meg Brannagan ; Updated June 13, 2017

Feeding intolerance occurs when a baby is unable to eat and digest food without becoming ill. The condition affects both preterm and full-term infants. Feeding intolerance may be difficult for parents to manage, as feedings often are a time of bonding with a baby. Instead, parents may be faced with an infant who screams with each feeding. Diagnosis can help determine the underlying cause of intolerance and lead to the best method of treatment.


A baby may have allergies to protein or lactose found in formula, leading to a cow’s milk allergy or lactose intolerance. Breastfeeding infants may have hypersensitivity to foods a mother eats, which are transmitted to the baby through breast milk. According to Cedars-Sinai Medical Center, feeding intolerance may also occur due to gastroesophageal reflux -- a condition where food and stomach acid come back up the esophagus after eating, causing pain and spitting.


Symptoms of feeding intolerance include spitting up or vomiting after feeding, diarrhea and irritability. Infants may have slow weight gain because of feeding refusal. If feeding causes discomfort, an infant will naturally avoid eating and may lose weight. Preterm infants may also have temperature instability or high blood sugar. Infants who are fed with a feeding tube may have increased gastric residuals, indicating the food is not being digested.


Feeding intolerance that is due to allergies is diagnosed by trial and error. A physician may recommend a specific formula, but often the baby must eat for several feedings before seeing results. Breastfed infants who show feeding sensitivity benefit from a mother’s elimination diet. The foods that most commonly cause problems are eliminated first, but some mothers must strictly limit foods in order to determine cause. Reflux is diagnosed by a number of tests, including a 24-hour pH probe study, which checks the level of a baby’s stomach acid; or a bronchoscopy, which checks for lung damage associated with acid reflux.


Many types of formula exist for infant hypersensitivities to feeding. For a formula-fed infant who has a cow’s milk allergy or is lactose intolerant, changing formula to a soy-based product may reduce symptoms. Le Leche League International states that breastfed infants with feeding intolerance often improve when their mothers begin an elimination diet by discontinuing offending foods. Gastroesophageal reflux is treated with medications that reduce stomach acid production and by feeding an infant with a nasogastric tube until he tolerates feedings.

Premature Infants

Infants born prematurely may suffer from feeding intolerance because their gastrointestinal system is immature. Premature babies often have less energy to eat; do not have the coordination to suck and swallow; and have lower immune function, placing them at higher risk of intestinal infection. Preterm infants may need calorie-fortified milk to boost weight gain if they do not tolerate feedings. They may also need some feedings via a nasogastric tube until they have more capability to eat on their own.

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