The underfed newborn baby

Is my newborn baby underfed?

Newborn babies can have challenges. They may be weak and under stress from a difficult delivery. They may be in pain or sleepy because of painkillers received through the placenta. Some babies have trouble breastfeeding or are premature or ill. All of these conditions can result in underfeeding. Some newborns become very irritable when they are underfed, but others become sleepy. They don’t have the energy to create a fuss, so they sleep and are thought of as “good sleepers.” The sleepier they are, the less milk they get, and the sleepier they become. If babies remain underfed, they can develop jaundice and starvation. The risk of underfeeding rises if the first feed is delayed, if the mother has a low milk supply or nipple pain, or if the baby does not breastfeed often or well enough.

A) Describing the hungry newborn

Newborn babies are more likely to be underfed than older babies. They may be, or may have been, under stress and have limited strength and energy. They may have significant breastfeeding challenges or be premature or sick.

Newborn babies should be closely monitored to make sure they are getting enough milk and prevent problems (Flaherman 2017). When they remain underfed, they will often show signs such as excess weight loss, and can develop jaundice, dehydration, and starvation. These quickly clear when they are treated. 

1) The irritable newborn

All normal newborns will be upset occasionally but some newborns are very irritable because of underfeeding. This is a sign to caregivers and health-care providers to review the baby’s health, signs that the baby is taking in enough milk, and weight. 

2) The sleepy newborn  

Other underfed newborns become sleepy. They may have limited stored fat and sugar to keep them healthy in the face of hunger. They shut down because they do not have the energy to cry and fuss. 

These babies are often thought to be “good sleepers.” They are unable to let their caregivers and health-care providers know they are in trouble and their problems are easily missed and treatment is delayed.

B) Reasons for being underfed

Feeding problems can have one or more causes:

1) Difficult labour and delivery

Newborn babies may not get enough milk because they remain weak or sleepy from labour-related causes, including:

  • Stress:
    • A hard or long labour (Dew 2003)
    • An induced labour (Peters 2018)
    • A Caesarean birth (Gomes 2018; Goyal 2018)
    • Being cold or away from the mother after delivery
  • Ongoing pain from:
    • Forceps or a vacuum-assisted delivery (Miller 2017; Peters 2018)
    • A swollen scalp
    • A fractured collar bone (clavicle)
    • Neck trauma
  • Pain medications received through the placenta during labour (Dewey 2003)
  • Low blood sugar

Babies who are first-born are at higher risk of being underfed (Dewey 2003; Goyal 2018).

2) Being born before 39 weeks

Feeding challenges related to early birth are universal in very premature babies but can happen in babies who are born as late as 38 weeks in the womb. These babies are also more prone to being too sleepy.

3) Breastfeeding problems

The risk of underfeeding rises if (Goyal 2018):

4) Illness

The baby has an undiagnosed medical problem that makes them too weak or otherwise unable to breastfeed or needing more calories than average.

C) The sleep-hunger cycle

The sleep-hunger cycle.

Newborns, especially those born before 39 weeks of gestation or born too small, need regular and appropriate amounts of milk to be able to stay awake and feed effectively.

Some newborns become sleepier if underfed, compounding the feeding problem. This is the sleep-hunger cycle and it looks like this:

  1. Newborn babies who are underfed are weak and sleepy, don’t feed often or well, and don’t get enough milk.
  2. Then they try to save their energy and get sleepier.
  3. The sleepier they are, the less milk they get, and the sleepier they become.

This cycle is broken as soon as the baby gets enough milk.  

References

Dewey KG, Nommsen-Rivers LA, Heinig MJ, et al. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003 Sep;112(3 Pt 1):607-19

Flaherman V, Schaefer EW, Kuzniewicz MW, et al. Health Care Utilization in the First Month after Birth and Its Relationship to Newborn Weight Loss and Method of Feeding. Acad Pediatr. 2017 Nov 27  

Gomes M, Trocado V, Carlos-Alves M. Intrapartum synthetic oxytocin and breastfeeding: a retrospective cohort study. J Obstet Gynaecol. 2018 Aug;38(6):745-749
 
Goyal S, Malvia S, Poswal L, et al. Maternal factors and feeding pattern in neonates admitted with dehydration. International Journal of Contemporary Pediatrics 2018;5(4):1561-6
 
Miller AS, Miller JE, Taylor AM, et al. Demographic profile of 266 mother-infant dyads presenting to a multidisciplinary breastfeeding clinic: a descriptive study.
2017;16(1)
 
Peters LL, Thornton C, de Jonge A, et al. The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population-based cohort study. Birth. 2018 Mar 25