Recognising underfeeding in your bottle-fed baby
Underfeeding can be a serious problem for babies, but before you jump to assumptions about your baby's milk intake, read about the signs you need to look out for.

Many parents jump to the assumption that their baby is underfeeding if she does not drink as much milk as they were expecting, or if her milk consumption suddenly drops. There could be many reasons for this, including developmental changes that particularly occur around the age of four to five months.

You can tell if your baby is underfeeding by looking out for observable signs, such as:

  • Poor weight gain or none over a number of weeks (do not base your observations on one week as weight can fluctuate depending on bodily fluids or burning excess fat)
  • Less than five wet disposable nappies in a 24-hour period
  • Infrequent, hard dry stools
  • Restlessness, or a fretful, irritable and wakeful baby
  • Babies can become excessively sleepy and non-demanding when they are weak, unwell or extremely underweight 

Why she might be underfeeding

  • Inability to suck effectively - this could be due to problems such as cleft palate, tongue tie or cerebral palsy
  • Premature and unwell babies may also suck ineffectively
  • Rigid feeding schedules that do not suit your baby
  • If the feeding equipment you are using is inappropriate for your baby
  • Incorrect formula preparation resulting in diluted formula
  • Giving baby too much water
  • Sleep deprivation can cause baby to become too exhausted to demand feeds, feed effectively or wake during the night for feeds
  • Previous painful, unpleasant or stressful feeding experiences could give your baby an aversion to feeding

A baby’s temperament can also influence milk intake. Some babies are so placid their hunger cues can easily be overlooked. When their needs are not met, they complain in only a minor way.

What to do

Underfeeding means a baby is not ingesting enough calories/kilojoules for healthy growth. It is one of many reasons for poor growth. The first step is to have your baby examined by a medical doctor to assess the possibility of a physical cause.  If no physical cause for underfeeding is identified try the following strategies:

  • Ensure your baby gets plenty of sleep. This might require you to resolve any underlying problem that might be causing her to wake prematurely from her sleep.
  • Closely observe your baby’s behavioural cues. If her hunger cues are not obvious offer feeds at three to four hourly intervals during the day. But don’t try to make a hungry baby wait until it’s ‘feed time’.
  • Respond appropriately to your baby’s feeding cues and stop the feed when she wants to stop. Don’t try to force her to feed as this can cause a behavioural feeding aversion.
This article was written by Jane Barry and adapted for Kidspot, New Zealand's favourite parenting resource for Early Life Nutrition.
Breastfeeding is best for babies and provides many benefits. Combined breast and bottle feeding in the first weeks of life may reduce the supply of your own breast milk. Always consult your doctor, midwife or health care professional for advice about feeding your baby. This post is part of the Early Life Nutrition story.
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