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Diagnosed with Oral Aversion or Feeding Aversion? Getting Started: Parents, Therapists have you covered your bases? Ask the rig

Posted Oct 13 2009 10:06pm
Hi All
Had a very nice mom write to me today and I decided to post some of this information to help others trying to sort out what it means to have a child with feeding aversion or oral aversion. Please know, most kids are not aversive to EVERYTHING or EVERY food. Define the aversion. The child that happily eats chicken nuggets is not aversive to eating nuggets. What else can we give that child to increase the happiness factor while eating a wider range of foods. Why are chicken nuggets ok and other foods are not? There are reasons why children do this. That is what Food Chaining is all about. Forming a chain between what you eat well and what you can't eat well...yet.

WHAT ARE THE KEY FACTORS IN DIAGNOSIS AND TREATMENT OF A FEEDING DISORDER? FIND OUT THE FOLLOWING...
-What does your child eat? What does he enjoy eating? Are you still offering new food or did you give up? He can't eat it if you don't offer it. Offer it in a fun way, don't pressure. Think of how you learn to eat a new food (oysters on the half shell, frog legs, sushi)...did pressure help you eat it? Did anyone force you?
-Do you feel something else is going on? Listen to your instincts as a parent!
-Is his health ok? This is huge. Health issues, medications all impact eating.
-Is the child constipated? If so, is he on Miralax or some other treatment regimen consistently? These things only work if given daily. Reduce amount but give daily when weaning off.
-Does the child have reflux? "Silent" reflux? This is like we adults have, we don't "spit up" but we reflux and have heartburn and discomfort. On Prevacid or Zantac?
-Weight/growth ok? Too low and food can taste funny and odd after-taste. Some of our little ones are built up a bit with Carnation Instant Breakfast or Pediasure.
-Portions ok? Kid portions at this age are a T per age. So a two year old child would eat 2T of fruit, 2T of veg and 2 T of meat for a correctly portioned meal. Too much can overwhelm.
-Are you on a schedule of meals and snacks or does your child graze (nibble or sip food all day?)
-Juice should be limited to 4 to 6 ounces per day. Juice kills appetite and is no more nutrition than soda (unless you are doing Pomegranate juice, V-8 splash, tomato juice or a real juice). Get rid of soda, tea and Kool Aid. Water between meals and snacks. Flavored water is ok.
-Milk where it should be (for example a toddler needs 16-24 ounces) per day? Too much milk can lead to anemia and kill appetite too. Give milk with meals and snacks. Flavored milk or drinkable yogurt is just fine too.
-Eczema or red rashes that may indicate food allergy? Eczema, vomiting and constipation during the first year of life? These are big red flags for allergic processes. See a peds GI or pediatric dietitian (not a nutritionist, a dietitian)
-Congestion or limited intake of liquid (example: won't take more than 4 ounces of liquid no matter what) that may indicate problems with swallowing?
-Sensitive to tags in clothing, noises, smells, textures, touch, difficulty tolerating stimulating environments or seem to always be on "crash and burn" mode, climbing the walls that may indicate a sensory issue?
-Is his behavior ok, all the time except at meals?

Children refuse for a reason. Always. My job is to listen to their reasons.

Now, many of the things I suggested for Z in earlier posts would likely work for many children. Just taking the pressure out of this, using a divided plate, learning about food, no pressure at meals...(sounds impossible, I know, when you feel such stress at each meal to make sure he eats.) But look at it from his perspective, does coming to the table bring him joy or discomfort and fear? Is he the focus of every meal? Does he eat better in one environment over another?

These are the things you need a firm handle on before starting therapy. You need to keep looking at these issues and not just assume the child has a behavior problem. Behaviors can rise out of a physical, emotional, oral motor or sensory based feeding disorder, but that is not the root of the problem.

THERAPY SESSIONS: Do I need therapy? That depends on what is going on with eating, is it typical picky eating that does not interfere with life or is it more problem eating. More on this in this blog posts and in the Food Chaining book. There is no substitute for assessment by a skilled feeding team. These disorders are very challenging and I know I need my team members to help me when I evaluate children. Now, not all therapy is good therapy and parents need to be a major part of the treatment program. Who is treating? OT or Speech? Hopefully both! How experienced is the team? What is their treatment philosophy? Are sessions fun? Do they respect the child? There should be no crying, gagging or vomiting in a session. Is the session length kid friendly (about 30-45 min which about 25 of that is a meal), therapist eat with your child, are they cooking with him? Is someone poking around his mouth like a dentist chair session or letting him chew on fun things that help desensitize his mouth? Is there a reason behind what they are doing? Are you seeing gains after a few weeks of treatment? Months of treatment, no report of or sign of true progress? Something needs to change.

ABOUT THE FOOD CHAINING BOOK: Parents ask me about the book a lot. We wrote this for parents but it benefits therapists too. The book is also on Amazon or see if your library will order it for you. I am not in the "book selling" business, we wrote this to give parents a very affordable guide from all of our team (peds GI, dietitian, OT, ST, psychology) to help parents negotiate that wild and twisting road that is "Feeding Aversion." I did not get the help I needed for my Luke until he was 6 years old. My job, while God lets me live on this earth, is to stop that from happening to other children and their parents.

Hope this helps!
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