When Your Infant Refuses to Eat, Feeding Aversion May Be to Blame

Contributions by: Carrie Becher, Pediatric Occupational Therapist, OTRL from the ATI Grand Blanc, Mich., clinic

When it comes to food, we all have our favorites - and those not-so favorites. And when hunger calls, we turn to these delectable delights to satisfy our cravings. Now, what happens when a negative sentiment towards a particular food, jumps out from the shadows and spoils your desire for that food? That’s an easy one, move on to something more appetizing or just brave it out and polish off that meal. While for most toddlers to adults, pursuing the current fare or choosing a more appetizing one without the negative undertones is doable, unfortunately, for infants, this process is a bit more complicated, especially when an underlying condition inhibits their ability to consume.

Often the case, a child’s unwillingness to eat may be the result of a feeding aversion. With a feeding aversion, a child will reject certain foods due to an unpleasant stimulus associated with that food. It’s been said that approximately 25 to 35 percent of children ranging from newborn to 12 months old, struggle with an aversion to food. And since their communication skills are still developing, trying to understand their needs can be rather difficult, leaving everyone feeling helpless. Thankfully, specific therapies, such as occupational therapy (OT), exist to help improve feeding skills without creating a more severe aversion or sensitivity.

Before we get into the values of OT, let’s take a quick dive into better understanding the causes and warning signs of an aversion to food.

What leads to an oral/feeding aversion?

While it is difficult to pinpoint one specific cause for oral aversion or feeding deficits, it has been reported that 40-70% of infants born pre-maturely or with chronic medical conditions experience severe feeding problems at some point in development.  A few of the more common conditions leading to an aversion or feeding deficit include:

•  Anatomical or functional challenges that make feeding difficult or uncomfortable
• Delays in initiation of eating associated with neurological disorders (infantile spasms, cerebral palsy, etc.)
• Children who had tubes placed, and have little experience with oral feeding
• Children who have sensory processing challenges can have difficulty with tolerating specific tastes and textures of food, and/or eliminate several food categories in early childhood.

How to spot a feeding aversion

In early infancy, one of the most common warning signs is a child’s inability to demonstrate oral exploration, such as putting things in their mouths (fingers, toys, keys, etc.).  If a child is not exploring in his/her mouth, and is having difficulty or refusing to accept stages of food beyond Level I infant puree, there is potentially a more serious problem evolving.

Age group(s) experiencing feeding aversions

Aversion or feeding difficulties typically start in the early infancy stages, but can go unnoticed during these stages of development.  A leading majority of aversion cases fall within 7-12 months old. Children with a feeding aversion are said to have difficulty in managing the transition from smooth puree baby food and formula to more lumpy textures or table foods. 

Within the ATI clinics, there have been several cases of children who were reported to be “picky” and/or have difficulty eating during that 7-12 month old development period, however the families were told they would simply “outgrow” it. Unfortunately, in these cases, the children were required to undergo therapy around 2-4 years old, as improvements were not being made. If this strikes home, it never hurts to seek consultation with an occupational therapist to better determine if your child has an aversion or if in fact they are just being a picky eater.

What does a treatment for this condition entail?

As we mentioned earlier, therapies such as occupational therapy (OT) can help educate the families on how to progress feeding skills in a positive environment to lessen the likelihood of enabling a more severe aversion. It is important to remember that negative experiences can cause a greater psychological and sometimes physical effect, so we want to do everything possible to prevent that from happening.

Treatment starts with an initial assessment, where an OT specialist will work with the parent to better understand their pregnancy with the child, birth experience and immediate feeding patterns (breast fed, bottle fed, tube fed, etc.). 

A specialist will also observe medical history, physical attributes, cognitive function and other variables that may be affecting feeding patterns and habits.  Following these steps, a feeding observation is made to determine which eating items are easily accepted and others that are posing a challenge, noting all physical patterns, behaviors and responses along the way. 

Once the underlying problem for the feeding difficulty is identified (aversion or a physical condition such as ankyloglossia, delayed swallow reflex, aspiration, etc.) the OT specialist will develop a plan specific to that child’s condition. Treatment may range from either one to five times per week, which again, is determined by the family, child and the necessity. As for duration of treatment, this varies depending on the child and family’s commitment in working on the feedings outside the clinic.

Steps a parent can take to enroll their child in occupational therapy

The first step is to have a conversation with a pediatrician about the difficulties your child is having. And come prepared with the right questions, including ones that cover feeding aversions or the physical conditions mentioned above.

To enroll in OT, you will only need a prescription from the physician and a medical diagnosis.  Before making an appointment to see an occupational therapist, our experts suggest reaching out to your clinic of choice to ensure that not only is OT offered, but their OT team is experienced in feeding and swallowing dysfunction.  At some facilities, it is also not uncommon to have a speech language pathologist (SLP) on site as the feeding dysfunction expert.

What does post-graduation from occupational therapy consist of?

A child with an aversion typically is not discharged until they are eating a sufficient amount of food to sustain proper growth and nutrition. A family can also make the decision to discharge their child if they are comfortable enough with the progress and treatment techniques and feel they can continue making gains at home without the direct guidance of the therapist.  Along the way, there may also be new food jags or setbacks that can prolong a program, which is why our experts encourage families to re-visit the tools provided through therapy or return to treatment as needed.

Is your infant refusing to eat? ATI may be able to help

If you are concerned about your child’s unwillingness to consume food, we first suggest connecting with your pediatrician to determine the next course of action. Should physical therapy be required, please don’t hesitate to contact your your local ATI physical therapy clinic to see what pediatric occupational therapy options are available for your child.