A Baby Not Feeding When Ill

When to get help

Call emergency services — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if your baby is too breathless to feed, is floppy, will not wake or does not stay awake, has a rash that does not fade under a glass, or is grunting.

Seek urgent same-day advice — NHS 111 in the UK, your GP or out-of-hours service in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, Healthline on 0800 611 116 in New Zealand — if any of these apply:

• Your baby is under three months and is feeding noticeably less than usual, at all. Small babies have very little reserve.
• Fewer wet nappies than usual, or no wet nappy for six hours or more.
• Your baby has taken under about half their usual amount for more than a day, or has refused two or three feeds in a row.
• Feeding is being refused alongside a fever, vomiting or diarrhoea.
• A dry mouth and tongue, no tears when crying, unusual sleepiness or irritability, or a sunken soft spot.

NICE guideline NG143 lists poor feeding in infants as an amber, intermediate-risk feature in a child with fever, alongside dry mucous membranes and reduced urine output. That is national guidance treating feeding refusal as information, not as fussiness.

Why illness puts babies off feeding

Several ordinary mechanisms overlap. A blocked nose makes sucking hard, because a baby has to break the seal to breathe. A sore throat or mouth ulcers make swallowing hurt, which is why hand, foot and mouth disease and thrush both reduce intake. An ear infection hurts more when sucking changes the pressure. Fast breathing means a baby cannot sustain a long feed. And a baby who feels rotten simply has less appetite, exactly as you would.

That means the fix often is not about the milk at all. Clearing a nose before a feed, or offering shorter feeds more frequently, can restore most of the intake without anything else changing.

Measuring intake without a scale

You do not need to weigh anything. Wet nappies are the measure that clinicians will ask for, because urine output tracks hydration directly.

After the first week, a well-hydrated baby typically produces at least six reasonably wet nappies in twenty-four hours, and pale urine. The number that matters is the comparison with your baby's normal day, and the direction of travel. Disposable nappies make wetness hard to judge, so if you are unsure, put a folded tissue or a piece of kitchen roll inside the nappy, or weigh a wet nappy against a dry one of the same brand on kitchen scales.

Also count feeds rather than minutes. Eight to twelve feeds in twenty-four hours is typical for a young breastfed baby; if that has dropped to four, you have a number to report.

Getting more in

Offer smaller amounts more often rather than trying to force a full feed. A baby who cannot manage twenty minutes may manage five, six times over. Feed at the first sign of interest rather than waiting for a schedule, and use the calmer moments — many ill babies feed better half-asleep than fully awake.

Clear the nose before feeding if it is blocked: saline drops or spray, then a few minutes upright. Feed in a more upright position, which helps both a blocked nose and a sore ear. If your baby is breastfeeding, expressing a little to soften the breast can make latching easier for a baby who is struggling.

If your baby is over six months and on solids, drop the solids priority entirely while they are ill. Milk is the fluid and the calories; food can wait a few days.

What not to do

Do not dilute formula to make it go further or to hydrate a baby. Do not give plain water as a substitute for milk in a baby under six months, and do not give juice, fizzy drinks or homemade salt and sugar mixtures. Do not use an oral rehydration solution in a baby under one without asking, because the advice depends on age and weight.

Do not force a bottle or push a teat into a resisting mouth, which usually makes the next feed harder. And do not assume that a baby who has stopped feeding is just teething; teething does not stop a baby feeding for a day.

Newborns are a separate case

In the first weeks the threshold is much lower. A newborn who has become sleepy and is not waking for feeds needs to be woken and fed, and if they will not feed, that is a call today rather than tomorrow. The American Academy of Pediatrics lists a baby who is too sleepy to feed regularly, or who is not producing the expected wet and dirty nappies, among the warning signs of breastfeeding problems that should prompt contact with a clinician.

Weight is the other measure in the early weeks. If your baby is not back to birth weight by about two weeks, or is losing weight, ask for a feeding assessment rather than adjusting things yourself.

After the illness

Appetite usually returns within a day or two of a baby feeling better, and often overshoots for a few days afterwards. Expect more frequent feeds and some extra night waking while your baby catches up, and expect solids to be refused for longer than milk in a weaning baby. Neither needs correcting.

Go back if feeding has not returned to normal within about a week, if weight has not recovered, or if your baby starts refusing feeds again after an initial improvement.