Having worked in NICU & Peds for 16 years, I have
participated in the care of more than a few children
who react just as that 4 mos. old does.  The infants
can have so many negative oral experiences that they
refuse to let anything even near their mouth much less
food.  I have also cared for an infant who would eat
from near sleep state but at no other time.  He
eventually required the placement of a gastric feeding
tube so that all of his nutritional needs could be met
& the child could truly lead his oral feeding skills.
Needless to say, this child had several other chronic
conditions.  It was only after 8 years that his family
was able to stop the tube feeding & the child was able
to maintain adequate intake orally.  Unfortunately,
some "professionals" do not realize the damage they do
by trying to force the feeding issue.  We had a
detailed care plan in place, but there were a couple
of people who would brag how they could get him to
take a full plate of food & then not be around for the
subsequent 3 days when no one could even approach him
with food.  He'd gag if someone even put a cup or a
french fry in his hand.

The full workup of the 4 month old is essential since
he also has hypotonicity to go along in step with his
feeding difficulties.  The feeding difficulties alone
would warrant it since it is a red flag that there is
a serious problem going on.

There is a time & place after the complete workup to
decide if it may be a better course of action to
temporarily place a feeding tube to defuse the tension
surrounding the infant & food.  He can then get his
nutritional needs met & work on his oral aversion.

Linda Madsen, RN, IBCLC


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