Why won’t you eat?
First I would like to take a moment to apologize for not getting my blog out last week. One of the "hazards" of working with wee ones this time of year is that the cold bug is often in one or more of the houses you visit. It doesn't always matter how careful you are either, once the bug has taken a liking to you - you are stuck with it for awhile. It was my turn last weekend to hide under my covers, catch up on my sleep, take extra vitamin C and try to convince the lil ole cold bug that it just wouldn't be happy staying with me. After 4 days it finally left and although I'm still a bit tired and get a foggy head from time to time (some may say that is a normal state of affairs for me! LOL) I am finally feeling a little normal and ready to start blogging once again. So, with that said let's get back to one of my favorite subjects...eating!
Trying to figure out why a child won't eat can be an overwhelming task. As I mentioned in my previous blog there is just so many things to be aware of. So let's go through this from top to bottom. The first thing I always check is to see if there is a medical condition that may be preventing the child from eating. When was the last time they had a visit with the dentist? Are they able to close their mouth properly to allow them to bite/chew? Are they tongue tied? Are there signs of reflux? What is their muscle tone like? How is their suck- swallow coordination? These are just a few situations that can cause a child to be reluctant to eat though I'm sure we could all name off a few more if we stopped to think about it.
I'm going to touch on two things right now because they are often over looked but can cause quite a bit of delay with oral motor skills. The first one is having a child who is tongue-tied. If you have a child whose tongue is tied to the point that they cannot move it around in their mouth to help them clear off their teeth or move the food from side to side you will usually have a child who is reluctant to eat anything that would require them to need to use their tongue. These children will more often than not stick to the types of foods they can swallow easily - yogurts, oatmeal, pudding, etc. However, you may also find that some tongue tied children are eating all types of food but as soon as they take a bite of the more challenging food groups they will be the ones to put their hands in their mouths to help dislodge or move the food around because they are not able to do it with their tongues. So if you hear a parent say "they always have their hands in their mouths when they eat" - one of the first things to have a look at is their tongue. It may not even be that they are tongue tied; it could be that they have a processing disorder and need help to figure out how and where to move their tongue when they are eating. If the child is tongue tied the parents will need to discuss with their pediatrician what their concerns are (speech and/or eating delays) and see if they would recommend having the tongue clipped. There are been many advances in this area and several places will now use lasers to "clip" the tongue which may result in a less painful procedure and a quicker healing period.
The second one is acid reflux which is often a "silent" problem that goes undetected too often. I was called to work with one family who had a darling little boy who was continuously vomiting after he ate. This family lived their day to day lives trying to get this young one to eat only to then have to clean up after him because he rarely kept anything down. In order to keep him nourished they would feed him every 30-60 minutes ... every day. They did this because they were initially told that this was something their son would eventually out grow - and when he wasn't they were told (are you sitting down for this?) by the O.T. that their son would have to "learn to live with the vomiting because all kids throw up"!! In my very first visit I watched him take a little food. He turned his head, arched his back and forced the swallow down. I asked if they had him checked for acid reflux and they shared with me that it was never mentioned as a possible cause for his behavior either by their pediatrician or the previous O.T. who had been working with him. I asked them if they could call and have him checked for that and also to have a swallow study done to see if there was anything else going on. That week they took him in and, sure enough, he had severe acid reflux. A swallow study was also scheduled and would come to show that he had a condition where his stomach was slow to empty. He was put on one medication for the acid reflux and another to help his stomach empty quicker. Within a few weeks his vomiting was down to maybe once a week (as opposed to 3-5 times a day) and within a month he was like a different child. He began to eat more, vomiting occurred now only when he was sick and the family could finally have a day that was not focused purely on when he needed to eat and how long before he threw it up.
I've touched on just a couple of things on the physical side of what may be causing some children not to eat. It is important to try and remember to get a complete picture of what is happening before and after a child refuses food. It is also important to remember that one of our most basic ingrained functions is that of survival. A child is not eating because they are "bad" or trying to "get back at their parents" but because there is something going on that is stronger than their basic need to survive - and that usually is something that is hurting or scaring them and because of that it is then causing them not to want to eat. It is our jobs to find out what that is and how to remedy it. Sometimes it is up to the doctors to find the cause and up to us to help the children overcome the habits and defensive behaviors they have acquired due to the medical condition.
Next time we'll look at home routines and how they can sometimes deter a child from getting into good eating habits. I'll also try and offer a few strategies that I have found to be successful and, as always, I welcome any suggestions, comments, observations you would like to share!