Common Problems

• › Arching or stiffening of the body during or after breastfeeding/bottle feeding.
• › Difficulty or inability to latch onto the breast or bottle
• › Coughing/choking or increased congestion during a meal
• › Frequent, recurrent respiratory infections or pneumonia
• › Inability to chew/swallow› Recurrent gagging or vomiting.
• › Food/drink refusal· Fear associated with food or swallowing
• › Excessive drooling or food spilling from the mouth
• › Food selectivity (by type or texture), resulting in few accepted food repertoire
• · Mealtime behavior problems (increased fussiness, crying, tantrums, lengthy meals)
• › Poor weight gain· Alternative means of nutrition (nasogastric or gastronomy tube dependent)

INFANTS

Although many infants seem to be born with an innate ability to suck and feed successfully, some may experience varied levels of difficulty ranging from mild fussiness, reduced intake (resulting in poor weight gain), to unable to feed by mouth that requires artificial means of nutritional support such as a nasogastric tube. Causes of feeding issues in infants are commonly associated acid reflux, inadequate oral muscular development (such as in premature infants), or immature neurological system (for example, congenital disorders or fetal alcohol syndrome/drug withdrawn). Children with complex medical diagnosis (Cerebral Palsy, Cardiac conditions, Craniofacial anomalies, genetic syndromes, metabolic disorders, etc) may also have accompanied swallowing disorders.

OLDER INFANTS

Most pediatricians now understand and advocate introducing semi-solid foods like baby cereals at around 5-6 months old, instead of anytime earlier, because a babyÕs gastric system does not mature until then to handle supplemental foods. Once semi-solids are introduced, progression over textures should occur over the next 6-7 months, allowing older babies to develop oral skills from munching increasingly thicker textures to chewing soft cooked foods that resemble cut-up table foods. Feeding difficulties at this stage typically result in rapid weight loss (if the baby also begins to loss interest in bottle or breast-feeding), or the child may exhibit excess gagging, vomiting, and food refusal behaviors and has a hard time transitioning to more advanced textures.

TODDLERS

For young children, feeding issues may become evident at this age as they previously have gained weight well on formula/breast milk and have been eating some baby foods or crunchy, quickly dissolved textures like crackers, cookies, and cereals. However, they did not broaden the food types they accept and often continue with a extremely limited foods relying largely on milk for protein and caloric intake, or their weight begins to drop and may later be diagnosed as Failure to Thrive. These children may have oral sensory dysfunction and oral motor delays that interfere with their ability to accept and manage wet, soft, or mushy textures. Some, however, may also have underlying neurological disorders such as Cerebral Palsy and Autism.

OLDER CHILDREN

Feeding disorder in older children often manifests as extremely limited food selectiveness, avoiding or omitting an entire or several food groups such as absence of vegetables or meats. Although the childÕs weight may be stable, it tends to be on the light side. Mealtime anxiety and struggles may also become common. Eating out with family sometimes becomes impossible.