Oral Eating and Aversionsadmin2020-03-12T14:59:22+00:00
Many children with feeding tubes are able to eat orally. As long as a child has been cleared to safely eat orally, oral feeding should be encouraged. There may be limitations on amounts, certain foods, consistencies, textures and liquids. Children who aspirate food or liquid into their airway should not eat orally without guidance from medical professionals.
Oral eating may look different for each child. Some children may only be allowed tastes. Others may eat orally during the day and only require tube feedings at night. Some eat only a small percentage of calories by mouth, while others may eat the majority of calories orally.
Oral eating may also change over time. Some children will gradually increase their oral eating or oral eating skills, while others may only be able to continue with tastes. Children with progressive or degenerative disorders may lose the ability to eat as their conditions change or worsen.
Oral Feeding Tools
Reduced flow bottles or special feeders such as the Haberman Feeder
Nose cut-out cups
Honey bear squeeze bottle
Straws that don’t flow back down
Mesh bags for safe feeding
Toothbrushes, such as regular toothbrushes, the Nuk toothbrush, vibrating toothbrushes
Chewy tubes and P tubes
Vibrating probes, such as the Z Vibe or Vibe Critters
Other sensory input methods such as brushing, joint compression, massage, therapeutic listening
The vast majority of children who are tube fed develop oral aversions. This is particularly true of infants who are tube fed early on. Prior to tube feeding, many children start to limit their oral intake because of medical issues — reflux, food allergies, motility issues, aspiration, or a lack of energy to eat enough. Essentially children have learned that food hurts. Many children receive feeding tubes after everything else has been tried to get them to eat and drink enough. By this point, many have nutritional and growth challenges, along with oral aversions.
Moreover, if a child doesn’t tolerate tube feeds well, it can contribute to him not wanting to eat. Who feels like eating if she is experiencing discomfort, nausea, or vomiting? Tolerance of tube feeds can be a first step in improvements in oral eating.
We highly recommend working with a feeding therapist to help your child overcome oral aversions, begin to form a positive relationship with food, and learn the oral skills necessary for eating and food progression.
There are many techniques that can be used by your therapist. Often you need to work on desensitizing the mouth. It is not uncommon for children to seek out oral stimulation by mouthing non-food items and then completely reject bottle nipples, or having food on their lips or in their mouth. The mouth is very sensory. We get a lot of input from eating and our children may need some help awakening the mouth. See some suggestions in the sidebar.
Infants and toddlers who have issues with poor suck, aspiration of thin liquids or dysphagia may have a much harder time with bottle feeding. This is a point where many parents worry if their child will be able to eat. But, these children may have an easier time with spoon feeding or drinking from cups.
For more information on the types of feeding therapies and articles related to feeding therapy, see our page on Feeding Therapy.