Help with Oral Adversion

• By kyliesmommy1
• Posted November 30, 2008 at 2:03 pm
• Report post

I don't have any advice as to how to get your son to eat solids as we are having the same problem. My daughter is 12 mon actual 10 months adjusted and has a feeding tube because she refuses to eat or drink by mouth. I am writing to find out how you were able to get your son to accept the bottle again. My daughter hasn't drank from a bottle since May and all the feedings until May were forced feedings. She will allow us to put a bottle or sippy in her mouth, but has completely forgotten what to do once it is there. She takes a pacifier fine, but will not suck from a bottle. How were you able to teach your son to drink from a bottle again? Any advice would be greatly appreciated.

• Reply

• By Mama_2_Justin
• Posted November 30, 2008 at 3:01 pm
• Report post

Hi hun,

My God all I can say is don't give up and be tough. I think we bought EVERY different nipple, bottle sippy cup you name it. Justin took to the Playtex Orthodontic nipple the best but to get him "re-started" I had one of the small plastic bottles they have in NICU and every hour I went at him, when he would give up there is a spot on the side of the bottle that you can squeeze ans squirt some milk in... he screamed & wiggled but we did it. We even tried holding his tube feeds for a bit so he would get hungry. It was a LONG process & I think I shed more tears then he did...lol I remember I called the unit one night because he drank 90cc for me (it took about an hour but he did it) I was crying on the phone, his nurse was crying because they were just as proud. :) There is a bottle out there ( I found mine on ebay) that has a soother which attaches to a straw that attaches to a bottle... It's great!!! Please let me know how you make out. I'll be thinking of you. :) Don't get up... There is hope :)

Stacy

• Reply

• By angvbc
• Posted November 30, 2008 at 9:44 pm
• Report post

i also can't give you any advise because my son is 100% tube fed due to refusing (has been for over 6 months now). have you checked into maybe speech therapy instead of occupational? when dealing with little ones both therapies are about the same. maybe you could get into seeing a st sooner than an ot.

how long did he refuse the bottle before accepting it again?

• Reply

• By M-and-D-Mommy
• Posted December 1, 2008 at 1:21 am
• Report post

My twins have had the same issue (we had refusal, projectile vomiting, choking and gagging - it was a nightmare:). I just offered the baby foods over and over. I am trying desperately to remember anything specific that I did to help....I think with the stage one baby foods...I just never gave up. I would always stop when the vomiting started, but then the next feeding - I was at it again. It was tough, but we got there. Now I have been working on table foods...well at least thicker baby foods (stage 3) and things like the "puffs". They were doing better and then were hospitalized for RSV and we had to almost start over again. Now they refuse most things they ate before - even baby foods. They are currently on pediasure (still in a bottle and they are almost 17 months old/about 14 months adjusted). So, all I can say is I feel your pain and don't give up! Oh and you can't get upset. It will make eating a bad thing. Be calm and happy while feeding no matter what (even if you are crying inside or even crying on the outside --> been there;). If I can think of anything special I did for the baby food I will write in again (sorry - I have lost my memory most days). Mainly just work on textures in his mouth outside of mealtime. I used things like the finger tip baby tooth brush to TRY and desensitize their mouths some (rub it all over). We have more recently started working with a ST and she is helping with the feeding issues we have now (we still choke and gag, but it is not due to actual choking...it is the oral aversion issues etc).
Oh, I almost forgot...have you tried your states "ECI" Early Childhood Intervention program for help? You may or may not qualify for free services, but in some cases they can charge your insurance or you can pay cash if you prefer. They charge our insurance for all services the girls have had. They have had a PT for a long time and now they have a ST also. You may already know all about this, but I just wanted to suggest anything that may help you guys! GOOD LUCK and don't get discouraged:)

• Reply

• By katek
• Posted December 1, 2008 at 2:59 am
• Report post

Stacy,

My son worked with an OT who specialized in feeding habits at 2.5 months adjusted. His work with her lasted until about 9 months adjusted. I believe working with her as we introduced our son to solids helped us sidestep some issues. Our son now gets evaluated by her every couple months, but we discontinued weekly therapy. Our son didn't come home on a tube, but I wanted to share some things that we did, just in case some of the OT's techniques might help until you are able to get your son to see one in person.

Does your son eat any "solids"? Or does he completely reject them? If he completely rejects them, I wanted to suggest putting oatmeal or rice cereal or whatever on whatever teething toy that he likes to have in his mouth. We introduced our son to rice cereal from our finger and then from a teething toy before we used the spoon.

If he eats purees but not thicker "solids," one thing that we learned was that mushy textures are more challenging for kids to understand what to do with than are harder foods like Gerber puffs. While puffs don't have much nutritional value, they provide good "feedback" on the gums that tell the child that an object is there (as opposed to mushy Stage 3 pastas or mashed fruits, which made my son vomit for a long time b/c of the texture). Nice thing about puffs is that they give feedback but then dissolve pretty easily. We pretty much skipped Stage 3 altogether once we realized that the texture was too confusing. I suppose my son could try them now, but given that he's eating table foods, we don't really see the point.

Our son's OT recommended giving baby frozen fruit wrapped in a cheese cloth that baby could suck on, but not have to worry about dealing with swallowing the fruit. The idea was to get baby used to having the fruit to chew on and getting comfortable with the feeling of food flavor in mouth. You can get net pacifier looking things at Babies R Us, which are similar to the cheese cloth idea. You fill the net pacifier with the fruit and then baby can chomp on the net.

OT also recommended using a really thick carrot or celery stick (thick to the point where baby won't chew it off) to scoop foods into mouth. The idea is that the child will get the flavor of dips off the carrot while sucking and chewing on it, but not have to deal with the swallowing part quite yet. Once baby begins to accept and enjoy new flavors and not mind having object in mouth, then one can working on the swallowing of pieces of food.

Does your son have any interest in reaching or grabbing foods off your plate? We were encouraged to eat around baby as much as possible. Make "mmmmm" sounds while eating so that baby got the picture that eating is an enjoyable activity.

Our son's OT encouraged us to let our son eat off our plates and to discover what particular tastes appealed to him (as everyone has individual likes and dislikes). With preemies and children who are inclined toward having oral aversions especially, staying away from the "you will eat this, you will like it, and you will finish your plate" authoritarianism parenting approach is important. If child doesn't like cream sauces, don't give child anything will cream sauce. Respect their boundaries. Through giving things off our plates, we discovered that our son really likes strong flavors. Our son likes Middle Eastern and Indian foods. He dislikes foods with basil (e.g. pesto) and cinnamon. It's a shame, but maybe he'll like those flavors when he is older. He outright rejects plain food. Unfortunately, a lot of baby food is not awful, but it is blah. When I first introduced chicken to him (pureed it myself), I thought he didn't like chicken. Turned out that I just didn't add spice. He likes spice. When my husband has made it for him, sauteed in garlic, son loves it.

Do you allow your son to make a complete mess while eating? If so, that's good. Our son's OT said that doing things like scrapping food off the chin with the spoon during meals has been empirically shown to increase the likelihood of oral aversions. Let baby make a mess. Food down chin. Clean it up at the very end of the meal.

Does your son play with utensils? I bought our son some plastic baby forks and spoons from Babies R Us. Around 13 months adjusted, our son started asserting a lot of independence around the meal. He wants to control what goes in his mouth. And he wanted to try to use utensils, even if he didn't use them as efficiently as we would. He is now 15.5 months adjusted, and I can tell that "Independence" is going to be a continued theme for the next several months to come. He'd rather go hungry than not be allowed to do it himself. Incidentally, around 13 months adjusted, he went through a projectile vomit phase (projectile vomit at least twice a week). We noticed that these vomits occurred when nanny or grandparents were feeding him. They tended to give him baby food and were the ones controlling the feeds. My husband and I were giving primarily table foods, letting son control the foods. We didn't have the vomit episodes. So, we told everyone to move to table foods. Projectile vomit has only happened once in the last two months.

Even though the wait list is long in your area, I would go ahead and get your son's name on those wait lists. You never know when a cancellation might move him ahead on the list. Also, I recommend trying to find an OT both through your insurance as well as through your state's early intervention program (EIP). Is your son currently enrolled in your state's EIP? If not, they may be able to find an OT more quickly than you can. I also think that angvbc's suggestion about finding a speech therapist (ST) is a good one. There are a lot of STs who specialize in feeding habits as well as OTs (overlap in the feeding area). That may increase the possibilities for your son. Also, if you are only working to find a ST or OT through your son's EIP, I would go ahead and try to find one through your insurance. We had to do this for my son's physical therapy (PT). The EIP couldn't find any openings on their PTs' schedules. I got my son on some wait lists through the EIP, but then my husband found a PT through my insurance. She worked with my son for 5 months until another PT finally had an opening through the EIP. The insurance was willing to pay for a specified number of visits, given that there were no PTs available in our area from the EIP.

Anyway, I hope that the oral aversion resolves soon. Best wishes.

• Reply

• By SkyDiamond
• Posted December 1, 2008 at 7:35 am
• Report post

I am going through the same with Marissa. She is 11 month old, 8 months adjusted. She has been tube fed since birth. She did suck for the first few months but was a non-nutritive suck and only took a max of 20 ml per feed. She stopped sucking in June when she was admitted for bronchiolitis and we stopped feeding her because she was so tired trying to breathe. When we started a month later she just didn't know what to do anymore.
That brings us to now. I have been trying twice a day since with no luck until last week, when she actualy took 20 ml consistently for a few days! Now she's refusing to open her mouth for the spoon though so win one, lose one. The OT thinks its pointless now to try the bottle because in her opinion liquids are harder to move around than solids.. but my instinct tells me otherwise. She's making incredible progress with the bottle, why stop now!

I've been spending lots of time looking up oral defensiveness, oral hypersensitivity and oral motor toys to help her out.
I found a really cool bottle that i wish i had found months ago at
http://www.new-vis.com/cart/detail.php?Item=CMF-03-01
along with great toys to stimulate the mouth. I just ordered it so i'll write back when i start using it.
My OT is absolutely useless. She sits and watches a feeding without giving me advice. I really wish i had help with Marissa! But since i have to do it myself, i'm going to read on those subjects until my brain bursts and hopefully come up with a good plan. Here is a book i'm ordering:
http://www.dysphagiaplus.com/prints-home-program-oralmotor-skills-p-154.htm l
I think its worth the money to get all these things because she's getting older and still not eating.
One of the things i'm ordering too is called the Z-Vibe. It has neat attachments like spoons and there's a great book that gives techniques on how to use it. Again its expensive but i think it'll be worth it.
Good luck and please everyone, keep posting on the subject, its so frustrating to have a little one that doesn't eat, we need all the advice we can get!!

• Reply

• By lts1
• Posted December 1, 2008 at 8:25 am
• Report post

We bring our son to a feeding clinic, and here are some things they suggest (if he eats any solids at all):

1) Let him reject foods. It is hard, because ours doesn't like fruits or vegetables. But, if you put any pressure on him, he gets defensive and starts to refuse all foods.
2) Eat with him.
3) Don't offer him food off your plate. Wait until he shows interest, then give him a taste.
4) Don't give snacks. They say for babies that don't eat much, a handful of puffs can spoil their appetite.
5) Don't give juice. The sweet flavor tends to make them prefer the taste over others.
6) Make him comfortable in the high chair. Support his feet with a pillow so they don't dangle.
7) Ask him to kiss a piece of food, then praise him, and don't pressure him to eat it.
8) If he does eat something, don't praise overly, and make a big to-do.
9) Get a GI consult, to make sure he doesn't have silent reflux.
10) If he can hold a fork, put a piece of food on one, and hand it to him. He may eat things off a fork that he wouldn't otherwise.

I know it is very frustrating to deal with this - we are still struggling with it. I hope some of this helps you out!

• Reply

• By Mama_2_Justin
• Posted December 1, 2008 at 3:11 pm
• Report post

OMG you ladies are amazing!!! We can't thank you enough for all of your words of advise, I will try everything!!! :) I'm going to try and find that book as well SkyDiamond and just my opinion.... don't give up on the bottle if you feel she is making progress.... nobody knows better than mom!! :) Again, I will be keeping you all posted and thanks sooooo much!!! :)

Stacy

• Reply

• By M-and-D-Mommy
• Posted December 2, 2008 at 3:24 am
• Report post

I wanted to say thanks too. I actually got some good info to help my girls also. I have tried some of it, but there were some new things for us to try. It is also nice to know that I am not the only one out there almost in tears at meal time now days...1 step forward and 2 steps back, huh? Thank you - Thank you - Thank you!

I do have a question...what is the length of time given by your OT/ST's for feeding? In other words...how long do they suggest you TRY at each meal? I am just trying to compare to what our ST says. It just seems with twins we spend the entire day getting ready to TRY to eat, eating (well maybe not eating anything) and cleaning up from eating. Any playing and educational stuff has been put on the back burner these days because of the time spent with the latest feeding issues. I am not complaining - It just makes me sad:) I also wonder if the length of time might be making things worse for them in this area????

Oh and you guys might find this funny...one of my girls has started to "pretend eat" now. She pretends to pick up the food and pretends to eat it - then smiles at me. CRAZY girl:)

• Reply

• By katek
• Posted December 2, 2008 at 6:29 am
• Report post

M-and-D-Mommy,

What are your children adjusted ages?

When we first started feeding, we'd stop shortly after our son would refuse bites. And if he only had a few bites for the entire day when he was 9 months adjusted, so be it. I believe around 9 months adjusted, we tried for three meals a day. But we didn't push. And he did reject his fair share of food. Luckily, we didn't waste too much b/c we only used a couple table spoons rather than feeding directly from tubs.

Now that he is older, we put food in front of him. He may refuse. But if he does, we leave food in front of him and eat our meal when at the table. We sometimes offer another choice or two to see if it is the particular food he doesn't want as opposed to not wanting to eat in general. I read somewhere that you shouldn't be too accommodating OR clap and stuff when baby takes bites b/c then they know that's what you want and will make a show out of it. I confess that we did clap when son would eat sometimes, but it hasn't hurt his willingness to eat. And, for my son, it is often the particular food choice that he doesn't want, but he will find something else more appealing.

If I'm in the kitchen feeding him and he is refusing, I'll sometimes let him sit in the high chair looking at the food he has initially rejected while I put away the dishes and straighten up. On occasion, I've noticed him taking bites when I'm not looking. It can sometimes take15 minutes before he decides that he wants to eat. Also, utensils are a big deal. Stick a bite sized piece of french toast on a child fork and give the fork to our son, it suddenly becomes a tasty dish. But if he outright refuses after that, I figure he doesn't want to eat. And the more we push, the more he asserts his independence by refusing.

I never asked our OT about how long a meal should be. It is a good question. The above is just what we happen to do.

• Reply

• By M-and-D-Mommy
• Posted December 3, 2008 at 1:27 am
• Report post

hi katek,
Our girls are a tiny bit over 14 months adjusted. We had issues with the original introduction of baby food in general. We had lots of projectile vomiting, choking, gagging and refusing. It took FOREVER to get through that and then it was time to start with the "big girl" foods:) I am not sure if I mentioned this before, but they are still on a bottle too. They have to have pediasure during the day (to make up for the lack of eating - per the ped). They will usually play with the variety of cups, but not much drinking going on. And they will not drink the pediasure out of it no matter what! With the food issues I have not worried toooo much about the sippy cup at this moment. I figured it was better not to overwhelm them. We go through spurts...sometimes they will eat baby food after we try and try and try with other food for a while. Then other times they won't eat that either. We finally learned to eat "puffs" (that was a major issue at first too:). I have found what someone said (maybe you:) to be true...they seem to have started to take to the crunchier foods (puffs or tiny bits of cracker - sometimes with gagging etc) and mostly refusing the smooshier foods (like the graduates carrots or fruits). One of them will sometimes eat a tiny bit of the smooshy stuff if I feed it to her with my finger. Eventually she refuses. The other one refuses completely. I just offer the foods and we sit (or I clean up in the kitchen or I eat etc) and they just sit and stare or sometimes push the food around. Or the one that always refuses will do the "pretend eating" bit. I offer it with my fingers (per the ST), sometimes with untensils or I give them utensils to eat with (not often - they mostly just throw them on the floor). We eat in front of them. If we offer anything they MAY take it as a toy, but don't want to eat it. I know this message is all over the place - sorry:) I am just trying to give some overall info on them (and I am sure I am leaving something out!). Oh and we have been told (by the ST) to offer at least 2 of the foods (like the carrots etc) at each meal. Basically they just make a mess and eat nothing. Oh, my "pretend eater" (the one that always refuses) will now give me the "sign" for more...which means "puffs" to her. I feel so bad in the morning when I know she is hungry (the bottle is always offered last) and she is staring at this food and almost begging me for puffs or at least something else. I don't give her the puffs with every meal or upon request (unless she is eating puffs and needs more:). We have actually started only offering puffs once a day to try and nip this in the bud. The other odd thing I might need to mention is that the "pretend eater" actually had just started to eat things like the carrots with her hands before she/they got sick (hospitalization for one - RSV, pneumonia etc). The other was crying and not eating before and after (she is the one that will eat SOME things off my finger SOMETIMES now), but she has pretty much stopped the crying etc - unless I push tooo much. They will both eventually cry if I try toooo hard. All of the feeding things have been very difficult so far and I just don't see the light at the end of the tunnel yet:) Oh and I do let them play with spoons and textured spoon things while not eating too. Boy, am I all over the place again??? ha ha! All this seems to take about 1 1/2 hours and we do this 4 times a day...sometimes 3 if mommy is having a melt down or if mayb naps run over a feeding etc. I hope that my message is not tooo hard to follow. Any suggestions would be great!! Thanks for taking the time to try and help! I mean that!!!

• Reply

• By M-and-D-Mommy
• Posted December 3, 2008 at 1:31 am
• Report post

I just accidently hit the "post" button for the above message without re-reading it. Sorry for the typos etc:) ha!!! Thanks again for ANY help!!!

• Reply

• By M-and-D-Mommy
• Posted December 3, 2008 at 1:44 am
• Report post

Darn it - I was sooo NOT ready to post that message (ha! ha!)! I forgot something that may need to be factored in...They have very slight sensory issues. The "pretend eater" seems to have it a little worse. She has improved quite a bit, but thought it was worth the mention. I have figured that this is contributing at least a little to the oral aversions and feeding issues. She has just recently started to hold the bottle a little bit (she is very funny about her hands etc etc). Thanks again!!!

• Reply

• By katek
• Posted December 3, 2008 at 2:16 am
• Report post

M-and-D-Mommy,

I can certainly relate to one's child changing likes and dislikes so that it is hard to come up with a consistent game plan in the kitchen. Our son loved avocados the first three times I offered them to him. Since then, he has refused. Sometimes he wants baby food, other times won't touch it. Lately, he's been great on getting his carbs (puffs, cheerios, crackers) but is more picky about fruits and veggies (fresh strawberries and banana only exceptions). Went through a three-month period of loving asparagus, but wouldn't touch it the last few times I made it. He also changes up whom he will allow feed him. I was initially the best at getting him to eat. Then, he went through a couple months of anyone but me. At the moment, he'll eat for me but not Dada. But he prefers doing it himself. Also at the moment, he'll take his bottles from Dada and not me. We're still giving bottles too.

His feeding in the solid arena picked up a little bit when his current nanny was hired. She brings her daughter who is 1 month older than his adjusted age. Her daughter was a petite thing, but I think that she has gained weight since being around Henry. They have little competitions in the kitchen when they see the other one has something that they don't have. Stimulates the appetite. Luckily, it appears that my son has outgrown his baby cow's milk allergy (no bloody stools). His bottles are still breast milk or goat's milk, but we've been able to feed him yogurt and cheese (although he's rejected cheese until today). This is important b/c I think that he actually has an "intolerance" as opposed to a real "allergy" when it comes to cow's milk (soy is still a question mark), so we can give him things with milk as an ingredient and he is able to eat some of the same things as nanny's daughter.

In the past week, my son has discovered how he can actively spit solids out of his mouth and hand them back to us. He could dribble liquids out before that, but I guess he didn't realize that he could do the same thing to solids. On the one hand, it is a good skill to have. Not fun when he was sputtering and gagging on a piece of something but didn't have the understanding to just spit it out. Now he can spit it out. On the other hand, I suspect that refusing food and spitting it out are going to be just one of the "fun" ways that he decides to assert his independence, taking control of his own body. I can see why kids (even FT babies) don't gain as much between ages 1-2 years old. So very active, but not much consumed.

I'd be curious if there are many parents who feel that their children are definitely consuming the recommended number of fruits, proteins, and carbs each day without a problem. I'm quite sure that my son doesn't. Every day is different. He's not losing weight, he just isn't gaining (at least not in the past 3 months).

Talk to you soon.

• Reply

• By Christina4
• Posted December 3, 2008 at 9:05 am
• Report post

Have you talked with your pediatrician about supplements such as pediasure or vitamins with iron? You probably already know that severe iron deficiency can lead to many serious health problems. I hope you are able to get some help, and that you son will make progress in his eating!

• Reply

• By nikkibaf76
• Posted December 3, 2008 at 10:03 am
• Report post

I have the same problems with my triplets and they will be 2 in February. While it has gotten better, they still don't eat like they should. We work with several OT's and found that my girls have low muscle tone in their mouth so it takes than A LOT longer to disolve any food put in. By the time they can clear it, they usually gag or spit it out. So, some of the things we do are:

1) Give them a book, toy or fork/spoon to hold while we feed them. They don't think about what's in their mouth and they eat.
2). Stimulate the mouth before a meal with something chewy to chew on or rub the gums with a toothbrush. They even suggested putting some Tang or something flavorful on the brush to wake up the mouth.
3.) My kids do better with crunchy. They are very specific on texture. We put everything in the toaster over. Hash browns, potato pancakes, waffles, anything crispy.
4.) We try new foods in the playroom. When they are not in their normal environment for eating (highchair/kitchen) they are more open to trying and not spitting out new foods. That way we can see if they like it.
5.)Give sips of water in between bites to help clear their mouth (if that's a problem).
6.) Try to have fun. Many of times I want to scream and yell but I just need to walk away. Try putting on music in the background.

Good luck!

• Reply

• By M-and-D-Mommy
• Posted December 6, 2008 at 4:29 am
• Report post

Thanks to everyone for sharing all of the great advise!!!! :)

• Reply

Add to the discussion