Pediatric Feeding Problems
Children Who Show No Signs of Hunger
There are different types of feeding / eating disorders in children. The most obvious problem is when kids don't eat or drink enough. This can cause extreme weight loss and dehydration among other issues.
Many of these kids fail to show signs of hunger and will go without food or drink for long periods of time if given the choice.
When left untreated, many of these children receive feeding tubes in the nose (a nasogastric, or NG-Tube, which is non permanent) or in the stomach (a gastric, or G-Tube, which is more permanent). Typically formula is passed through these tubes to supply the necessary nutrition for adequate weight gain and hydration.
There are children who will only eat certain food groups such as starches or fruits. Some will only eat foods with certain colors. Others consume foods with particular textures.
Although picky eating is common in young children, kids with feeding disorders may eliminate entire food groups or eliminate all but two or three different foods that they are willing to eat. Some will only drink water or eat goldfish crackers. This can cause severe malnutrition or weight loss.
Sometimes these toddlers, children or adolescents have a combination of not eating enough and being picky. Some toddlers will take only a small amount of crackers or other soft foods that dissolve easily in the mouth, or drink only tiny amounts of water. It is often difficult to classify a child as a picky eater because they often do not eating enough as well. It is more useful to categorize only by volumes consumed, types of foods consumed and refusal behaviors exhibited during mealtimes.
Not Drinking Enough Volumes of Appropriate Drinks
Sometimes children have problems related only to drinking. Problems with drinking can lead to dehydration or malnutrition.
Some children will only drink water. These children may not be eating any meaningful volume of food. In babies and toddlers this can lead to malnutrition because drinking only water precludes the drinking of formula-based drinks and/or breastmilk, which have nutrition and calories.
Other children will eat meaningful amounts of food, but will not drink any liquids. This is commonly referred to as adypsia. This drinking disorder can lead to dehydration.
Sleep Feeding / Dream Feeding
Some babies refuse their bottle or will only drink in their sleep. They will not take any food or drink while awake.
When they become hungry these infants will cry in order to be rocked to sleep. Once asleep they drink from a bottle or breastfeed.
It can be very taxing on parents to spend so much time getting their child to sleep and to constantly be feeding small amounts of drink at a time.
Sleep feeding becomes a more significant problem when a baby reaches the age of 6-8 months, when some calories need to come from solids. This can cause lower intake of calories and the possible omission of necessary nutrition which come from solid foods.
Vomiting and Gagging
Many children with feeding issues gag and vomit their food out, causing very low levels of food being ingested.
This may result in picky eaters or children who completely refuse to eat.
It is also common among children with feeding tubes. In many cases, when environmental causes are eliminated, so, too, goes the vomiting.
Dealing with vomiting is not only important from a poor intake perspective, but also because the stomach acid that comes up can irritate or scar the lining of the esophagus.
Chronic Expelling of Food and Drink
Expelling occurs when you place a bite into your child's or toddler's mouth, and the child spits out the bite. When spitting food out occurs throughout the meal at every meal throughout the day, it can lead to long meals, lasting 1-3 hours each several times every day.
This can be extremely frustrating for anyone feeding the baby or toddler. Chronic expelling also usually leads to poor intake.
Refusal to Take Solids
Some babies will only take formula. They turn their head, shut their mouth, cry and bat at the spoon at the sight of solid foods. As mentioned in "Sleep Feeding / Dream Feeding", at a certain age babies cannot get all the calories needed from formula or breast milk alone.
In severe cases these children or babies will drink large amounts of water, but drink or eat little or nothing else.
Toddlers and Children Eating Food and Drinking from Inefficient Utensils or Syringes
Some toddlers will only take food or drink from a syringe, which is extremely inefficient due to the long duration of time necessary to get volumes in.
Children may not learn self feeding or eating food with a thicker texture. To feed with a syringe, the parent or caregiver must put the syringe in the child's mouth and squeeze out the food or drink. This process stops the child from learning to suck independently. Further, thick textures of food cannot be fed through a syringe, because the syringe will clog with food.
These children don't learn to take food from more appropriate utensils, such as a spoon or cup, because they are not exposed to such utensils.
There are other children who can't or won't chew or do not eat age appropriate foods. They typically will eat only mashed or pureed foods. If given normal textures, they may spit the food out or swallow it whole, which can be a choking hazard.
Having to provide food with the correct texture may limit what and where your family can eat. Sometimes eating in a restaurant or going on vacation can be extremely difficult. The stress of dealing with severe feeding issues can strain the entire family.
Some toddlers or children will only drink or eat from a bottle. This usually entails blending food into a liquid or smoothie form. Some children as old as 7, will only take nutrition and caloric intake from a bottle. While the consequences are not as severe as using a syringe, it can lead to alienation from other children because it is not an age appropriate device to consume food. Further, these children do not progress to table texture foods.
Implications of Feeding Tube Dependency
There has been much anecdotal evidence to show that children and babies who receive their feedings by tube have global developmental delays. They are slower to talk, crawl, walk, and socialize well among other key developmental delays.
Children, toddlers and babies may also change physically, such as not growing, changes in hair color and thin hair, and an unhealthy skin tone. This is one of the many obvious downsides to tube feeding.
Other downsides include surgical complications, huge increases in vomiting, increased susceptibility to illness, decreases in the amount of food they will take by mouth, increase of mucous and phlegm, and tube site maintenance, among other issues.
Imagine yourself drinking only Gatorade and Ensure all day. Or imagine hardly consuming anything. How do you think you would feel mentally or physically? How much energy would you have? How focused do you think you would be? How do you think you would perform at any given task?
Importance of Feeding Tube Prevention
It is important to exhaust all avenues before resorting to a tube placement, whether NG-Tube or G-Tube (unless your child is not safe to eat by mouth).
In many cases once an NG-Tube is placed, eating by mouth completely stops, leading to a G-Tube placement.
It is much easier to work with a child without an NG-Tube or G-Tube placement.
Beyond the many issues with tube placement mentioned in the "Implications of Feeding Tube Dependency" section, there is also the issue of putting a child through anesthesia and a surgical procedure.
There are some feeding therapists / specialists who will recommend a feeding tube. This is unethical unless the child is unsafe to eat by mouth.
If a feeding therapist cannot make progress with the child, the feeding therapist should notify the parents before tube placement becomes imminent.
The feeding therapist should state that they do not have an answer for the ongoing feeding problem, and to try a different therapist, clinic or approach. There is nothing wrong with saying, "I don't know." On the other hand, there is a huge ethical problem when the feeding specialist does not know how to deal with a particular feeding issue, and does not convey this to the parents.
When your child has a feeding problem, time is never on your side. Always make sure to demand competence from your feeding clinic or feeding therapist / specialist.