Child Not Feeding / Reduced Oral Intake

First actions / assessment

• Assess ABCDE first and determine whether the problem is inability to feed, refusal to feed, vomiting feeds, painful feeding, breathlessness while feeding, or general reduced intake. Clarify age, breastfed versus formula-fed, normal feeding pattern, percentage of usual intake, duration, number of wet nappies/urinations, vomiting, diarrhoea, fever, cough, coryza, breathing difficulty, noisy breathing, lethargy, irritability, rash, abdominal distension, pain, constipation, oral ulcers, thrush, teething, ear pain, urine symptoms, sick contacts, recent medication changes, and weight trend. In infants ask about colour change, sweating with feeds, tiring with feeds, aspiration/choking, and congenital history. Examine vitals, hydration status, capillary refill, mucous membranes, fontanelle, tears, respiratory effort, oxygen saturation, chest signs, heart rate, abdomen, rashes, ENT/oral cavity, ears, and neurological state. Check bedside glucose in any child who is lethargic, not feeding, or otherwise unwell. Investigations are guided by presentation: urine, viral testing, CBC/CRP, U&E, blood gas, cultures, CXR, abdominal imaging, or septic workup in young infants when indicated.