2. General Objective
• At the end of the session B.S.C 3rd year
students will be able to explain about “feeding
difficulties in newborn”
3. Specific Objectives
• At the end of the session B.S.C 3rd year
students will be able to:
-introduce feeding problems
- problems associated with feeding difficulty
- causes of feeding difficulty
- management of feeding difficulty
4. Feeding Difficulty
• Common problem in babies during the first
week of life.
• The difficulty is associated with incorrect
breastfeeding technique, small baby or due to
illness of baby.
5. Contd..
• Small babies have often difficulty feeding, as
they grow feeding improves.
• If the baby weighed less than 2.5kg at birth or
was born before 37 weeks of gestation,
evaluate and treat the specific feeding
problems.
6. Problems associated with feeding
The baby fed well at birth but now is feeding
poorly or has stopped feeding.
The baby has not fed well since birth.
The baby is not gaining weight.
The mother has not been able to breastfeed
successfully.
7. Causes –Sign and Symptoms
A. Suspected sepsis:
- Poor or no feeding after having well fed
-Maternal history of premature rupture of
membranes(more than 18 hours)
- Fever from onset of labour to three days after
birth.
8. Contd..
2. Twin or small baby:
-The sign and symptoms include:
• Feeding difficulty starts from onset of
delivery.
• Baby does not wake for feeds, feed slowly
and tries quickly.
9. Contd..
• Baby usually not ready to breastfeed although
breastfeeding technique is correct.
• Baby has physical features of a preterm baby.
10. Contd..
3. Poor attachment / incorrect positioning:
-The mother is not able to breastfeed
successfully.
- Mother has sore nipple.
- Starts on the first day of birth or later.
- Baby not well attached during breastfeeding.
11. Contd..
4. Cleft lip or palate
- Baby has cleft lip or
cleft palate causing
difficulty in latching on
or sucking.
14. Contd..
• Vomitus contains milk which may be bile
stained, e.g. intestinal atresia.
• Baby may have abdominal distension e.g.
intestinal obstruction, necrotizing enterocolitis.
• Nasogastric tube does not pass or tip of tube
returns .
15. Contd..
• Frothy secretions from mouth even when the
baby is not being fed.
• There may be a history of failure to pass
meconium within 24 hours of birth e.g.
Hirschrung disease.
16.
17. General Management
• Assess the condition associated with feeding
difficulty.
-Feeds without coughing
-Choking or regurgitating since the first
attempt feed. If yes insert Nasogastric Tube.
18. Contd..
• Insert gastric tube to find out the cause.
• If it does not passes or returns back, find the
possible cause.
• If it passes, confirm the proper placement or
the tube and aspirate the stomach contents.
19. Specific Management
1. Poor attachment/ incorrect positioning:
Support mother
If the baby is gaining 15gm/kg body weight
per day than the baby is normal.
Teach the correct breastfeeding methods.
20. Contd..
2. Small baby or twins:
Reassure the mother and support for feeding
Explain the importance of exclusive
breastfeeding for small baby
Ensure that the weaker baby gets enough milk
If poor sucking , give expressed milk
21. Contd…
3. Cleft lip/ cleft palate:
Provide emotional support to the mother.
Allow the baby to attempt breastfed for cleft lip
Give expressed milk with spoon for cleft palate
Give small feeding slowly
Counsel for alternate feeding methods.
22. Contd..
4. Gastrointestinal Malformation:
- Keep the baby warm
- Keep the baby nil per oral or do not give any
thing by mouth.
- Start IV and maintain fluid requirement
- Insert Nasogastric tube and ensure free
drainage
