Hi All. I have recently had several children in my clinic that have presented with limited liquid intake but no overt signs of dysphagia. Remember, some children who self limit liquids (drink a bit and stop) have swallowing problems. With food, these little ones would take one or two bites with enjoyment and stop. Sometimes the kids would reach back in the mouth and pull food back out instead of swallowing. The food chaining intake forms I use to analyze what children eat (there is one in back of the Chaining book) revealed that these kids ate a variety of foods, just very small amounts. The parents all said that "picky" didn't quite describe their kids. They did not understand why their children seemed to have no appetite. Now, there are children out there (and it seems like they all come to see me, that no matter what you do, they have very little appetite) but these kids seemed to hit a wall and suddenly stop eating. Watching these kiddos eat, you felt like they would have eaten more, but something happened that was not swallow related or aversion. Liquid intake was higher than intake of food. Occasional cough after eating with some of the kids or when playing/sleeping. All the kids (one we still don't know yet) were 3-4 years old and it turned out that the children had raging horrible reflux esophagitis. This can also be a risk factor for reactive airway disease if you aspirate gastric content while reclined/sleeping. One boy told us there were "teeth" back there. After treatment with Prevacid solutabs, he doubled his intake. The kids did not complain of pain, but when we saw this type of response to food, we suspected esophagitis more than EE and knew we needed a trial of meds or a GI referral before proceeding further. Alicia saw active eating with enjoyment after Ewan was treated for EE. I have seen Luke struggle with the ravages of esophagitis from vomiting 65,000 and counting times in his life from 15 years of cyclic vomiting syndrome. Reflux can be silent. The child who refluxed like crazy in babyhood and it "stopped" at age one, may not have stopped at all. So, if you have a child you are treating who has this type of presentation, go back to the first step of food chaining: eliminate physical cause for the eating disorder.