Refusal to Feed or Intolerance to Feedings

Most infants with a serious illness do not feed well. They might refuse to nurse or to take a bottle of formula, or they take much longer than usual to feed. One should be concerned about the infant who is vomiting, particularly if projectile, or if the vomitus is bilious. Most infants regurgitate or spit up, and this normal finding needs to be distinguished from true vomiting. Normal regurgitation is effortless, but vomiting is more forceful. In an infant who is septic, intolerance to feedings is very common. One of the early signs of congestive heart failure in a newborn is a change in ability to feed. The infant will tire during feeding and may also become diaphoretic.

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