Clinical Presentation and Physical Examination
- A term infant does not feed by mouth.
- Examine the infant. Is he or she ill or well appearing?
Diagnosis and Treatment
- In an ill-appearing infant, evaluate for sepsis, respiratory distress, and congestive heart failure. Appropriate evaluation depending on signs and symptoms would be then indicated.
- In a well-appearing infant, consider whether he or she is (has):
- Borderline preterm? Telltale signs include thin red skin, poorly developed breast tissue, undescended testes or poorly developed scrotal rugae (prominent labia minora), and few creases on the anterior third of the feet. A detailed Ballard score would also be helpful
- Not feeding because he or she has never fed so far or may be very young (only a few hours old) and not learned how to feed. Tincture of time is all that may be required.
- Very sleepy from just being a normal infant or from maternal magnesium sulphate or narcotics? Cold? Hypoglycemic? All these are easily reversible and require observation.
- Anatomical barriers to feeding (cleft palate, small chin)?
- Topical infection (oral thrush)? Tongue tie is not a cause of
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