Abstract

PIP: In Britain more mothers want to breastfeed their infants. For medical staff who have been trained in a traditional of bottle feeding the problem of failure to thrive because of inadequate breastfeeding may be less well recognized than formerly. There appears to be 2 main types of clinical presentation: fretful underfed infants and "contented" underfed infants. With the fretful underfed infants there is often a history of constant crying and irritability associated with frequent but short feeds. Colic and vomiting are common and the infants look undernourished and show poor weight gain. The "contented" underfed infants give the impression of being satisfied after feedings, but they look undernourished and do not show adequate weight gain. The extent to which inadequate breastfeeding contributes to the problem of failure to thrive in Britain is unknown. Among a group of 21 infants under the age of 6 months who were admitted to the hospital during the January 1 to December 31, 1978 period, failure of breastfeeding was diagnosed in 9 babies. In antenatal classes the practical aspects of breastfeeding should be discussed, particularly with primigravidas. There needs to be emphasis on the management of breastfeeding. The importance of frequent feeding in establishing lactation should be stressed. Hospitals have an important role in getting breastfeeding off to a good start, and community health workers need to become aware that breastfeeding does not exempt babies from being underfed. Underfeeding at the breast must be recognized as a likely diagnosis in breast-fed infants who are failing to thrive. For the contented underfed baby it is sometimes worthwhile trying to increase the frequency of breastfeeding. For the fretful underfed infant possible reasons for poor milk production must be considered.