What Is A Feeding Aversion?
I have yet to find a consistent definition of a feeding aversion. Feeding aversions can be difficult to diagnose as there is some debate in the medical community about who exactly should be the one diagnosing this disorder. Pediatricians, gastroenterologists, speech pathologists, occupational therapists, behavioral therapists...to some extent they may all have a hand in it. Our son was ultimately diagnosed with a severe feeding aversion by a speech pathologist/feeding therapist. His diet was not age appropriate. He is easy to gag, choke and vomit. He has oral sensory issues; he does not tolerate many textures/tastes. He has some difficulty chewing properly. He goes waaaaaaay beyond "picky"...he simply is not capable of eating many foods.
Feeding disorders present much differently in each child. Some can't eat solid food or even swallow liquids, they require feeding tubes. Some can only drink their nutrition. Some, like my son, will tolerate some solids but have a severely limited diet. This happens for a variety of reasons. For our son and for many others, the root cause is premature birth (this resulted in both severe reflux and some sensory processing issues). Others have severe food allergies, suffer from autism, sensory processing disorder or have other complicated long-term medical problems.
In short, if your child displays a refusal to eat an age appropriate diet, can not chew or swallow food correctly, refuses to self-feed, gags, chokes and vomits when trying to eat/drink, has poor weight gain, meal times last longer than 30 minutes or displays severe behavioral problems at meal times...your child may have a feeding aversion.
If take nothing else away from this website, please take this piece of advise: Have your child evaluated as soon as you suspect there may be a problem. The earlier treatment begins, the better. This can be a loooooong, long road. Years of road...a lifetime of road for your child. And the sooner you start down it, the better for your child and the rest of your family.
A great article that provides a detailed explanation of feeding aversions, written by a doctor at Children's National Medical Center.
http://main.zerotothree.org/site/DocServer/29-3_Chatoorv.pdf?docID=7961
A great article that provides a detailed explanation of feeding aversions, written by a doctor at Children's National Medical Center.
http://main.zerotothree.org/site/DocServer/29-3_Chatoorv.pdf?docID=7961
Here is a great article written by a speech pathologist about the difference between a feeding averse child and a picky eater.
Therapy
We use both of the therapies listed below with our son. There is no magic bullet. It takes time, lots and lots of time to slowly change the behavior of a feeding averse child. There are some common components to both styles of therapy. In a nutshell; it involves building a tolerance for new foods by using already accepted foods as a starting point. Introducing new foods that are a similar texture, color, smell and/or flavor is the most effective way to get a feeding averse child to try a new food. This process also builds trust. In this relationship between you and your child, trust is key.
Food Chaining Therapy
A feeding aversion therapy created by speech pathologists and a gastrointestinal doctor. For a brief description of this method, please see their website archive here:
http://cheriandlaura.blogspot.com/2008/01/food-chaining.html?view=classic
Sequential Oral Sensory (SOS) Therapy
Another widely used form of feeding aversion therapy. This is the method our son's feeding therapist uses and though it is taking time, he is making progress.
http://www.couragecenter.org/ContentPages/sos-feeding.aspx
“The SOS Approach to Feeding is a developmental feeding therapy that allows a child to interact with and learn about foods in a playful, non-stressful way. It helps increase a child’s comfort level by exploring different properties of the foods, including the color, shape, texture, smell and taste. The child is encouraged to progress up a series of steps to eating using “play with purpose” activities. Parent education and involvement are an essential part of this feeding program.” – couragecenter.org
There is a hierarchy to a child's willingness and ability to accept foods. I had never thought about it until I had to but there are steps that you must take in order to put food in your mouth, chew it ans swallow it. For a feeding averse child, each of these steps can be a HUGE challenge. These are these steps are part of the SOS approach.
1. Tolerate
First, the child has to be tolerant of being the presence of a food.
2. Interact
A willingness to use utensils, a container, plate or bowl...anything to interact with the food.
3. Smell
Lean into a food or bring it to their face and smell it.
4. Touch
Touch it with their fingers. Touch it to their face, cheeks, arms...any part of their body. Play with it. Touch it to their lips.
5. Taste
Lick, taste and ultimatly chew.
6. Eating
Finally, chew and swallow the food.
The last thing I'll say about this area is, if you are not comfortable with the therapist you have, don't be afraid to find a new one. We quickly got rid of the first speech/feeding therapist we had. I was nervous to do it but I'm SO glad we did. The second one was MUCH better equipped to deal with our son's problem and it was absolutely the right thing to do. We got to our third occupational therapist before we were happy. It is your job to be your child's advocate. Find the right fit and don't settle.
First, let me say, this is a VERY HARD thing to deal with as a parent. You love this little person more than anything else in the world and just want them safe and healthy. When something as simple as eating proves to be an enormous obstacle, it's very hard to accept and deal with like a rational human.
A feeding aversion therapy created by speech pathologists and a gastrointestinal doctor. For a brief description of this method, please see their website archive here:
http://cheriandlaura.blogspot.com/2008/01/food-chaining.html?view=classic
Sequential Oral Sensory (SOS) Therapy
Another widely used form of feeding aversion therapy. This is the method our son's feeding therapist uses and though it is taking time, he is making progress.
http://www.couragecenter.org/ContentPages/sos-feeding.aspx
“The SOS Approach to Feeding is a developmental feeding therapy that allows a child to interact with and learn about foods in a playful, non-stressful way. It helps increase a child’s comfort level by exploring different properties of the foods, including the color, shape, texture, smell and taste. The child is encouraged to progress up a series of steps to eating using “play with purpose” activities. Parent education and involvement are an essential part of this feeding program.” – couragecenter.org
There is a hierarchy to a child's willingness and ability to accept foods. I had never thought about it until I had to but there are steps that you must take in order to put food in your mouth, chew it ans swallow it. For a feeding averse child, each of these steps can be a HUGE challenge. These are these steps are part of the SOS approach.
1. Tolerate
First, the child has to be tolerant of being the presence of a food.
2. Interact
A willingness to use utensils, a container, plate or bowl...anything to interact with the food.
3. Smell
Lean into a food or bring it to their face and smell it.
4. Touch
Touch it with their fingers. Touch it to their face, cheeks, arms...any part of their body. Play with it. Touch it to their lips.
5. Taste
Lick, taste and ultimatly chew.
6. Eating
Finally, chew and swallow the food.
The last thing I'll say about this area is, if you are not comfortable with the therapist you have, don't be afraid to find a new one. We quickly got rid of the first speech/feeding therapist we had. I was nervous to do it but I'm SO glad we did. The second one was MUCH better equipped to deal with our son's problem and it was absolutely the right thing to do. We got to our third occupational therapist before we were happy. It is your job to be your child's advocate. Find the right fit and don't settle.
Some Basics For How To Deal
Over the past year of working with a very good therapist and doing no small amount of research myself, we have changed not just our behavior in dealing with our son's aversion but we've helped him change his attitude about eating and that has lead to....PROGRESS!!First, let me say, this is a VERY HARD thing to deal with as a parent. You love this little person more than anything else in the world and just want them safe and healthy. When something as simple as eating proves to be an enormous obstacle, it's very hard to accept and deal with like a rational human.
- Get professional help. Find an entire feeding team at a feeding clinic or feeding and/or occupational therapist in your area. (See Resources page)
- Know that it is going to take time. It can take years, even decades to deal with a feeding aversion. Celebrate the small victories as they come.
- It's very easy to be frustrated/upset with your child at meal times. This is much harder on your child than it is on you. Stop, take a breath. A child with a feeding aversion has negative emotion involved in the process of eating to begin with. Yelling, crying and throwing fits (I'm talking about you, the parent here) is not going to help. Ignore the bad behavior from your child and don't punish, especially if they are very young. They can't help it. He/she doesn't know how to deal with this process of putting food in their mouth and eating when their brain is screaming at them that they can't/shouldn't. It's something we will never really be able to understand as a person without this disorder. Instead, use positive reinforcement at every turn. It's hard, I've had many breakdowns and crying fits over this disorder. But your child needs you to make meal times a positive experience. Be upset later, away from your child.
- Try to make meals fun, eat together. Find methods of coping. For Buster, in the beginning we HAD to distract him from the process of eating to get baby food into him. We used cartoons and/or toys. Sometimes it took 2 people, a cartoon and a tray full of toys but we got him to accept some food. Some professionals will tell you this is totally the wrong thing to do. But, at the time we made the decision that we had to use any method we could to get nutrition into our son. I don't regret it.
- Every single meal is therapy. Support and praise any eating.
- Don't be afraid to try new foods. And, don't be upset it your child doesn't eat them. Just allowing it to be in his/her presence is progress. Maybe the next time, he/she will touch it. Just don't give up. Keep presenting it. Repeated exposure (even if it's being rejected) is important. On the other side of the coin, don't overwhelm your child with too many new foods in too short a window. Find a pace that will work. For some it might be one new food a month. For others, it might be a new food a week.
- Do not force your child to eat.
- Something that has worked for us as Buster got old enough to count is giving him a goal. "3 more bites and you can be all done!" He likes to count the bites or count down to "all done!" There is an end in site and he's proud of himself for getting there. We will eventually start some sort of reward system for trying new things, eating all of something...but he's not quite 3 yet and we aren't ready for that yet.
- Dipping. Oh how I wish this would work for us but it doesn't. Some children who find that they like a certain condiment (ranch dressing, ketchup, bbq sauce) will eat more things if they are dipped. Buster doesn't like combined textures or wet things on his food. So, it doesn't work for us. But if it does for your child it opens up an easy avenue for trying things.
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