For many of us, there’s something intensely satisfying and comforting about eating. But what if your baby’s eating mechanism goes wrong? When food, or the merest touch against your baby’s mouth and face, sends them into a frenzy?
A baby or child with an oral aversion has a sensitivity to — and perhaps even fear of — food or drink taken by mouth. They may even refuse to allow anything to touch their mouth.
A baby with an oral aversion will refuse both the breast and the bottle. While they may forget themselves and start sucking, they’ll quickly turn their head away, gag, or vomit.
An older child with an oral aversion may protest more vocally and object to any attempt to have their face washed or their teeth brushed.
Or an oral aversion may be more subtle. But whatever the case, it leads to feeding problems and needs addressing if it doesn’t quickly resolve on its own.
Newborns, babies, toddlers, and even older kids can sometimes develop an oral aversion. In fact, one report estimates that
Newborns and babies
Let’s go back to the beginning. Premature babies are
That’s because many premature babies initially aren’t sufficiently developed to manage the physical and cognitive steps that have to take place to feed successfully — muscle tone, swallow-breathe coordination, and simply having enough stamina to eat. Thinking of all the steps that have to happen before you swallow is enough to take away your appetite.
Premature babies in the NICU (neonatal intensive care unit) may undergo certain life-sustaining procedures to ensure that they thrive and get the nourishment they need:
- They may need intubation and suctioning for optimal breathing.
- They may be fed through an NG-tube (through the nose and down the back of the throat) or an OG tube (directly into the stomach).
This means that the mouth area may have been either traumatized by painful touch or not stimulated at all — and therefore super-sensitive to touch.
Another reason that your baby may develop an oral aversion is gastroesophageal reflux disease (GERD). With this condition, stomach contents and digestive juices rise up from the stomach, and that may hurt. A baby’s inflamed esophagus will give them an unpleasant burning sensation.
It won’t take much for them to make the association between feeding and pain. The result? An oral aversion.
You may be dealing with an oral aversion if your baby:
- becomes unsettled and distressed when you put them into a feeding position
- arches their back to try and move away
- starts to eat as if they know that food is good, but quickly pulls away with fear
- refuses to eat when awake, but does settle down to eat when drowsy
- doesn’t meet growth expectations
Toddlers and young children
Sometimes, toddlers and young children may have the same no-entry-here reaction as babies. It could happen if your child:
- has mouth ulcers
- has trauma in the mouth area
- has had a prolonged period of vomiting
At this age, your child will be pretty adept at making it clear that they won’t eat. If they show distress as soon as you put their bib on, or they run a mile when you bring out their plate, you may be dealing with an oral aversion.
A note about avoidant/restrictive food intake disorder (ARFID)
This isn’t just your picky eater. Children with
- low weight
- nutritional deficiency
- dependence on supplemental feedings
- possible impaired social functioning
Here’s what ARFID looks like:
- Your child avoids eating certain foods (meats, vegetables, fruits) and complains that they taste, feel, or smell bad.
- They may eat only small amounts because they simply aren’t interested in food or have a teeny appetite.
- They refuse specific foods after a traumatic experience such as choking, vomiting, an upset stomach, or something like finding the embryonic cord in a scrambled egg.
Eat up so you’ll grow big and strong. The familiar refrain will drive you crazy when you’re cajoling your little one to open their mouth to eat. Something. Anything.
To add to the agony, as noted in a
Babies
The strategies below are mostly things that will be done in the hospital — usually in the NICU — with the guidance of your baby’s care team. You may be instructed to continue at home, as directed, by a doctor.
- Swabbing. If your preemie is being fed with an NG or OG tube, be proactive and ask the medical team to swab your baby’s lips and mouth regularly so that the areas remain stimulated despite the fact that your baby isn’t sucking.
-
Non-nutritive sucking. Your baby started sucking way back as a
14-week-old embryo . Babies don’t suck just to get nutrition; they like sucking. By letting your baby suck on a pacifier, your (clean) pinky, or your empty breast, your baby gets good practice for the real thing. They also feel calmer and their heartbeat slows down. A calm baby is more likely to eat when offered breast milk or formula. - Cue-based feeding. This is about quality and not quantity. So instead of stressing over the amount they eat, focus on how to make eating a positive experience. Put your baby in an elevated side-lying position (if their medical condition allows it) and use a controllable flow rate so that your baby doesn’t gag. Don’t wiggle the nipple in your baby’s mouth to try and convince them to take more.
- Oxygenation. Your baby needs to take in sufficient oxygen to remain alert. Preemies often struggle to synchronize breathing and sucking patterns, and this can lead to low oxygenation. Is your baby pausing to catch their breath? By paying attention to any changes in breathing sounds and to the pattern of sucking, you can help your baby to learn how to regulate themselves. And that means learning how to eat successfully.
- An infant self-pacing (ISP) bottle. Not all bottles are created equal. This specially designed bottle lets your baby set the feeding rate by eliminating the internal vacuum build-up in the bottle.
- Go for the cup. Sound avant-garde? Not really. Research shows that preemies who are offered a cup have lower heart rates and higher oxygen saturation levels than bottle-fed babies.
Toddlers and young children
True oral aversions are very rare once your child has outgrown babyhood and is into their toddler years. For a diagnosed aversion, you’ll need to rely on your pediatrician’s guidance.
For a mild, temporary oral aversion — such as after a viral illness that caused mouth ulcers — offering different temperatures and textures of foods and plenty of liquids may be enough to do the trick.
And if you’re dealing with a picky eater, the following may help:
- Food preparation. Your child is more likely to eat food that they’ve helped to prepare, so let them help in the kitchen.
- Eating as fun. You can interest your child in eating by making meal time a fun time. That means putting your phone away, switching off the TV, and talking to each other.
- No more pressure. Your child will learn to listen to their body’s signal of hunger if you turn down the pressure. So don’t cajole endlessly; put the food on the table and leave it at that.
- Play with tea sets. Playing meal times is a great way to gently get your child used to the idea of eating.
- Art and crafts with food. Use food items in your art and craft projects. Think popcorn necklaces, edible play dough, mosaics with beans and seeds, and painting with spices.
- Step-by-step. Let your toddler get used to the feeling of something in their mouth by offering them teething toys to chew on. They may surprise you and even enjoy a fruit feeder.
Despite your best intentions, you may find that your child is among the rare group affected by a severe oral aversion. In this case, you’ll need to turn to your medical provider. This is especially true if your child is being fed via an NG or OG tube.
Today, severe oral aversions are often initially treated with intensive behavioral intervention at a day treatment center or as an inpatient at a hospital program.
You’ll be working with an interdisciplinary team (pediatrician, pediatric gastroenterologist, dietitian, speech-language pathologist, and clinical psychologist) that will use several approaches.
Behavioral intervention
Behavioral intervention may start with the Behavioral Pediatric Feeding Assessment Scale (BPFAS), a 35-item questionnaire that assesses just what happens at mealtimes. From here, your team will map out a plan made up of small measurable steps that lead toward that coveted goal of eating.
Treatment sessions start off short (10 minutes), but increase to about 20 to 25 minutes, which is typically how long we take to eat a meal.
The therapist will follow a set routine so that your child feels most comfortable. They’ll offer a choice of foods with different tastes and textures. After watching, you’ll take over the role of feeder.
An oral aversion isn’t just about eating. Unfortunately, there can be long-term effects.
If your child isn’t eating optimally, the chances are high that their growth and overall development will be impacted negatively. Research shows that preemies with feeding challenges remain in the hospital for a longer period and are more likely to be readmitted.
In addition, babies without enough protein at certain stages of development can have long-term short stature, organ growth failure, and neuronal deficits. These may lead to behavioral and cognitive challenges.
When your child has an oral aversion, both of you may be dealing with constant stress. You may find that your ability to bond with your child is lessened. Fortunately, by getting help, you can likely decrease the stress and bump up the bonding.
Did you ever think about how many of our social interactions center around food? You want your baby to have positive eating experiences not only because they need good nutrition for their health, but also because these experiences impact on their future relationships.
Take a deep breath. Reach out to your medical team if you have any concerns about your baby’s eating habits. There are many options for getting your child on track for a healthy and happy period of development.
