Every week I see children with feeding difficulties of varying degree in my clinic. What I can tell parents is that it is common, you are not abnormal and that it is very difficult dealing with a child that does not want to eat. I do want to focus a couple of blog entries over the next weeks on this topic, as I think there are some simple tips that may help and most importantly its you as parents want to know when do you need to see a healthcare professional.
Lets start with what are feeding difficulties.Generally if a child has one (or a combination) of the below they are classified as having feeding difficulties
- extended mealtimes (if they take > 30 min)
- sealing of the mouth/pushing food away
- gagging on solids
- spitting food out – every meal and all foods
- dream feeding – so refusing to feed from the bottle if awake and only taking it whilst asleep
There is a lovely acronym summarising all triggers for developing feeding difficulties and it is called “STOMP”.
S – Size: the natural response to a child not achieving optimal growth is to try harder, to feed more, increase volume or frequency of foods and all of this leads to an increase in stress in mealtimes and as a result feeding becomes something your child (and you) want to avoid.
T – Transitioning: transitioning from breast to bottle, from puree to textured foods can can also lead to problems. For example the first time you provide some lumpier textures your child gags (which normally looks like they are choking but is not that bad), you get a fright and as a result do not move on with textures. If textured foods are not introduced by 10 months of age, it becomes very difficult as a critical window of opportunity has been missed.
O – Organic disease: there are many medical reasons why a child does not want to feed. That may be related to an anatomical problem with swallow/stomach, reflux or food allergies. It is therefore important to ensure that medical causes are ruled out. I will in a future blog highlight exactly the medical “red flag sign” that should not be ignored with feeding difficulties.
M- mechanistic feeding: the most common question from parents is that they want an exact schedule (including timing) for when their child should have a bottle, when they should have a snack and meal. So meal times become “mechanistic” rather than responsive to your child’s needs. Feeding a child or lets say trying to feed a child when they are not hungry but just according to the clock may also feed into the development of a feeding difficulty.
P – post traumatic: this can happen for example with a severe allergic reaction. For example your child had some egg, started swelling up in the mouth, was rushed to the emergency room and as a result is not only refusing egg but any foods that have a texture like egg. Another example is chocking (and I mean really choking) on food, which is very frightening for parents and the child and can put children off having pieces in future because they are scared of choking.
I will write next week on who size can impact on feeding difficulties and what you can do