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April 15, 2014

Ask: What to do when your infant refuses to eat

When an infant refuses to eat, try to remember any changes or events associated with food, and consider whether reflux or a food allergy may play a part.

Q: My almost-12-month-old decided to stop all solids about three weeks ago. Now, she sees a spoon and turns her face and cries hysterically. She was eating Stage 3 jars fine and suddenly stopped that, too, even purees. All she may take is plain yogurt. Not sure what to do as she ends in tears — and eventually I do as well. I feel so bad. I tried letting her feed herself and she plays with it but won’t eat more than one piece. She has reflux, which she’s been on Prevacid for, and that’s not helping. She did eat since since she was 6 months old so I’m unsure why she stopped like this. I’m taking her to a feeding doctor, but he isn’t helping. Please advise! Thank you so much. — Anita

A: Anita, it is very stressful when your child suddenly stops eating and even worse cries hysterically at the sight of a spoon or food.

Several things …

1. What happened three weeks ago? Most children do not stop eating without a reason. Think back about any change or event that may have spurred the feeding refusal.

2. Make sure that your child is on the correct dose of Previcid. Your pediatrician or GI doctor (if you have one) should be able to check this out for you. We find that often children are on a dose that is too low. Positive changes in feeding desire occur when children are on the correct dose.

3. Make sure that you give the medication 30-45 minutes before meal time. This can significantly increase the effectiveness of the medication.

4. Do you think that your child has an allergy?

5. Understand that children with reflux are at significantly higher risk for feeding disruptions/disorders. Your daughter’s presentation is a complaint that we see often at Carolina Pediatric Dysphagia.

I am not sure what you mean by a “feeding doctor.” However, if you feel that this doctor isn’t helping, you may need to switch to a different one. If the “feeding doctor” is providing feeding therapy, you need to check out the person’s credentials. Recently, there have been many professionals that claim that they are “feeding therapists.” Take the time to ask what their training is, how much experience they have and how many kids they currently have in their caseload. Working with infants and children with feeding/swallowing disorders requires a high level of expertise. Research has repeatedly shown correlation between progress in therapy and therapist knowledge. Incorrect information or incorrect therapy techniques can cause harm or really complicate the problem.

In addition, try to think back and see what has changed recently. A small choke, food getting stuck, food that’s hard to swallow, a reflux episode, vomiting or stress all can cause a child (especially one with reflux) to not want to eat. The smallest change could make the biggest difference in a child’s willingness to eat.

So what can you do now?

1. If your child is not in feeding/dysphagia therapy, get that set up now (even if your child has started back eating). If your child’s feeding skills/desire were so fragile that she stopped eating with no known reason, this could happen again. And the next time could be worse.

2. Consider the use of probiotics to support GI health. Research indicates that children on a PPI (Previcid is a PPI) need to take probiotics because of the changes that the medication makes to the gastric flora.

3. Work on reducing your stress level. Your child can feel your stress, and your stress can increase her anxiety. Your feeding/dysphagia therapist will find ways to reduce your level of stress about feeding.

4. Do not get into a feeding battle, or you will make things worse. Your child’s body will tell her when it is safe to eat.

5. Feeding is an internal process; be careful that you are not accidentally rewarding behaviors that you do not want to reinforce.

6. Do not force her to eat anything. If she is refusing, just place some food on the tray and go about eating your meal without drawing attention to anything that she is doing (eating or not).

Feeding and swallowing problems are the number one parenting concern. Research reports that up to 50% of typical children experience feeding difficulties. That number significantly increases with a medical diagnosis such as reflux. You are not alone in your frustration and stress regarding your daughter’s difficulty. Feeding difficulties and refusals like what your daughter is presenting are best dealt with under the guidance of a speech pathologist specializing in feeding/dysphagia disorders. Make sure that you get help as soon as possible.

Joan Dietrich Comrie of Carolina Pediatric Dysphagia (; 919-877-9800) has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia.

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