thank you lorraine for this well written text!

nina

2010/6/12 Loraine Hamm <[log in to unmask]>:
> As SLT/IBCLC working with children with eating, drinking and swallowing disorders my experience has taught me a few things.
>
> Children want to eat and most children will show interest in food at some point around the age of 6 months. Those who do not ALWAYS have reasons for not wanting to eat.
>
> I think declining a child food for some reason if they show real interest is never a good idea as it is through experience that motor skills involved with eating are refined and the child can progress to eating more and more challenging textures.
>
> Also textures other than milk need to move over the tongue to decrease sensitivity and if this does not happen the tongue will remain and even become hypersensitive to any new textures that are introduced resulting in gagging and at times even progressing to vomiting, which can become habitual and a problem in itself adding a behavioral element to an existing problem.
>
> It is possible that the development of hypersensitivity for texture is the basis for people recommending that solids is not introduced too late.
>
> Children with a history of reflux frequently has particular difficulty with accepting texture. It is as if the mouth is sensitized and it takes lots of experience with carefully graded texture to overcome this.
>
> I think unless there is very low tone the motor skills to chew and propel food to the back of the throat will not be affected if solids is introduced later, but hypersensitivity to texture can be more challenging to overcome.
>
> Pushing food upon children is also never a good idea, but it is difficult at times to distinguish between disinterest and inability. A child who takes a few tastes and bites and sucks on this or that may be a bit disinterested, but he is getting a bit of experience with food passing over the tongue and we expect that over time the interest will increase.
>
>  A child who eats but then pushes everything out again is not disinterested. He is not able to manipulate the food sufficiently to feel safe swallowing it or eating hurts or is experienced in some negative way.
>
> Children are tremendously perceptive in knowing what is safe and comfortable for them to swallow and will push food out of the mouth if they do not feel comfortable that they can swallow it safely.  It is therefore very important from my perspective to put as much control with the child when it comes to eating. A child who has not progressed to the stage of managing something like bread, quite a challenging texture, will almost certainly choke if the bread is placed in his mouth by a feeder. If the child holds it he will probably just mouth it and spit it out and only bite and chew it when he has had lots of experience of bringing it onto his molars and chewing it himself.
>
> From very early on soft foods can be offered as finger food and that gives the best basis for the child to discover what he can manage to swallow or not.
>
>
> It is always important to take a good look inside the mouth as well. I recently saw a child who has had tremendous
> feeding difficulty since the introduction of solids and who refused to swallow anything other than soft food. She had
> huge tonsills almost occluding  her airway and I think she was aware that swallowing large chunks of food was just not
> a good idea for her from a breathing perspective.  If someone was to close her mouth after she chewed, which she did pretty well, that would have been a sure recipe for choking.
>
>
> Regards from New Zealand
> Loraine Hamm
> SLT/IBCLC
>
>
>
>
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