Feeding Issues and the Possible Medical Causes ...
There are numerous medical reasons why a child might not eat and it is very important to rule these out before beginning any type of feeding therapy. If the underlying cause is medical there is very little chance of having a successful outcome if we begin to start sensory, strengthening, or adaptive eating strategies. Once a medical condition has been diagnosed we can then work on our therapy course of action.
Some medical conditions to be alert for are:
- Cleft Palate - although this condition is diagnosed more often than it is over looked I have had the opportunity to work with a young child whose cleft palate was not detected because it was far back in his upper palate. Our concern was that the child would continually try to eat and have pieces of the food/liquid come out his nose. After a more thorough check by a local children's hospital the cleft palate was detected and later repaired. Once the healing had taken place this young child began taking part in oral motor and feeding therapy and did really well. There are cases where the opening in the palate may be in such a position that it cannot be easily repaired until the child is older. Therapy in this case will consist more likely in teaching the child how to chew and swallow so the food does not go up into the hole. It would also include helping to teach the family how to clean out the mouth and hole thoroughly after they eat. In very rare cases the child might be found eligible for an oral motor/cleft prosthesis but it is very rare for young children to be eligible for these as the child may need to be sedated in order to have the mold done and then therapy strategies are needed to work on getting the child to accept this strange feeling object into their mouth and into the hole to "plug" it. Very few young children will allow this to happen so doctors/surgeons tend to be reluctant to turn to prosthesis as a solution. The prosthesis works better on older children who can understand the importance of using it.
- Broken, chipped, infected teeth - Children often fall down or bump into things which could result in a broken/chipped/damaged tooth. Some children even have what is known as "soft teeth" and get cavities very easily. Because a young child may not be able to explain that their tooth hurts, this condition can be easily overlooked. It is a good idea to recommend that a child be seen by a dentist if other possible conditions have been ruled out. It's also important to remember that a child who is actively teething will sometimes go off their eating schedule because their mouth is sore due to the teeth coming in.
- Throat infection/sore throat - With young children it is hard to know if they have a sore throat because they cannot always communicate what hurts. Untreated acid reflux can also turn into an infection in the throat due to the rawness/erosion caused by the acid moving up the esophagus. I recently worked with a young child who was eating very well and then suddenly stopped. We tried a few sensory strategies to see if that might be a concern but it wasn't. The family used some over the counter gas remedy and that worked well for a couple weeks and the child was eating again but it was short lived. When the family went to their family doctor he did not see any sign of acid reflux. After several weeks they went back to their doctor for another check as the child was still not eating and the doctor found that the little one had an infection in his throat that had gone undetected until then. The child was treated and is now beginning to eat better.
- Kissing tonsils/Enlarged Adenoids - when these two conditions are combined you will usually find a child who has trouble swallowing. If it is too difficult or painful for them to swallow they will turn away from anything solid and respond more to soft food, or more than likely, fluids. Often once the tonsils and/or adenoids are removed the child will turn around quickly and begin to eat again once they are feeling well.
- GERD/Acid Reflux - this is one of my most frustrating conditions as many pediatricians will tell families that this condition is normal in young children and the child will often just out grow it in time. The "wait and see" method for me is not one I am fond of when I start working with a child that I can tell is showing all the signs of having acid reflux (turning their head up, down, sideways, frequent burps, frequent spit ups, vomiting after eating, refusing to eat anything.) UCONN Hospital in CT feels that acid reflux has become such a concern that is going untreated that they have actually started a study on newborns to try and find ways to assist doctors in diagnosing it and treating it earlier. I tell the families often to just keep asking the doctors for a referral until they get tired of hearing about it and do it. In all the times I have felt there was a true and valid concern and have pushed for further studies to prove/disprove acid reflux is present I have only been wrong once and that was when it turned out to be an infection of unknown origin in the throat.
- Food Allergies - If a child eats something they end up being allergic to they may develop a rash around their lips or even inside their mouth. They may also have an upset, acidy stomach and be cranky. If eating something is causing them to be uncomfortable or in pain they will not want to continue eating. The most common food allergies in children are milk, dairy, and/or wheat. Even a young child can go to an allergy specialist and have simple allergy tests done to determine if they have allergies or not.
- Low Tone/High tone - What a child's tone is like has a lot to do with how they may be eating. If they have low or high tone they may not be able to bite down on food properly, chew the food well or even have proper suck, swallow coordination during bottle feeding. Tone issues often play a part in a child who is diagnosed as "failure to thrive". If they are taking too long during bottle feedings because they don't have the strength or endurance needed to finish the entire bottle they will often just give up and then start losing weight.
If a medical condition is diagnosed we can then work with the family to see what type of therapy would be the most beneficial to the child and family. This could include sensory input, strengthening exercises and/or adaptive techniques to assure that the child is getting the best and most out of their feeding sessions.
These are just a few medical conditions that would prevent a child from wanting to eat. If anyone has come to work with others please feel free to share what they were, how they were diagnosed, and what therapy you found to be successful afterwards.
Eating/Feeding difficulties with children are always a challenge. Families get discouraged and frustrated and therapists only have a short amount of time to try and figure out what is happening and why and what can be done to help correct it. I hope this blog and the next several will help lessen some of the frustration and detective work and offer strategies that would help our picky and problem eaters become happy eaters.
Thanks for stopping by - hope to see you again next time.
~Wendy