How can I help my toddler with feeding difficulties (swallowing solid foods) and a hypersensitive gag reflex?

Question

My child is 19-months and has difficulty swallowing textured and solid foods. He either gags/vomits, spits out, or refuses altogether. He drinks Pediasure for nutrition/calories and some pureed foods (though he's losing interest in these.)My understanding is this could be behavioral, poor oral motor skills, texture sensitivity or all of these. (we've ruled out most medical concerns like reflux). I'm looking for a treatment method that works. What should be done? Who are the experts to help us? How long will it take for my child to eat normally? He also has a hypersensitive gag reflex. In addition to its role with eating difficulties, he also gags and vomits from crying. He cries, coughs/gags and then vomits (within seconds!). This affects sleeping (if left in crib without being fully asleep he vomits) as well as with temper tantrums -- just about anytime he's very upset. We try to avoid these scenarios, but it's impossible. How do we address this gag reflex problem?

Answer 1

The person you need to find is a pediatric behavior analyst, who can help you learn ways to teach your child proper eating behavior. At this age, it could simply be your child would prefer to eat soft baby foods, or even remain bottle fed. Drinking from a bottle is the easier way to eat, even drinking from a cup is easier than chewing. Chewing is a little hard for them at first, as they don't have enough teeth to really give some foods the workover they require. Most toddlers can gag themselves, and can learn how to do it almost on cue if they want. If you have eliminated all the medical reasons, that only leaves a behavior problem, and that takes some work with a specialist to be able to teach him better and break the habits. I imagine he's learned already that if he makes eating an ordeal, then you will come across with the Pediasure or foods he prefers to eat. Gagging and vomiting would do that pretty well. Crying until he vomits when put down for sleep is definitely a behavior problem, and the reason I'm inclined to believe the rest is as well. By vomiting he manages to get out of whatever he's not liking, it's a behavior that has worked well so far, so he's not going to give it up until it quits working for him. That's where the behavior analyst can help you. They can identify the behaviors and give you some tools to try to change them. Believe it or not, even at his age, babies are quite bright and they learn what gets a reaction from the parents and how to manipulate things to get what they want. You as a parent have to learn to control the reaction so they don't get it. When the behavior doesn't work anymore, and you provide the positive reactions to behaviors you do want, they do change their actions. Currently he's got no reason to change because he gets out of doing what he doesn't want to do. Your baby has learned what buttons to push to get you to react, smart-huh? It sounds pretty much like you have a very intelligent child, with a very strong will. Parenting him is going to be an ongoing challenge, so I strongly suggest you find the pediatric analyst for advice. It will feel really cruel at first, but I think it will make both of you a lot happier, healthier and saner.

Answer 2

Difficulty Swallowing Solids

Answer 3

I'd recommend seeing a pediatric neurologist, an occupational therapist who is a specialist in sensory integration, and a medically-based speech pathologist who is highly skilled in swallowing disorders. You might also consider a pediatric ENT. You don't say just HOW it was determined not to be reflux, but if it wasn't determined by a pediatric gastroenterologist, it really needs to be.
A hyperactive gag reflex in response to new textures and gagging/vomiting during crying is unlikely to be behavioral, but competent professionals are well-able to sort it out. Your best bet, usually, is a pediatric swallowing disorders team (found at most teaching hospitals).

Answer 4

I don't think the problem is as unusual as it seems...if you google "toddler gagging" or "gag reflex toddler" you will find stories from lots of different parents about having the same problem. None of them seemed to have any solutions, though.

You should talk with your pediatrician about how concerned you are by this, and they should offer suggestions or a referral to a specialist...a dietitian, pediatric psychologist, occupational therapist, speech language pathologist, or pediatric gastroenterologist would all be my guesses of who to see for it. Not all at once, of course...start with one, and if they don't have any answers, ask who they think you should see next. If your health insurance won't cover it or you don't have any, look for WIC clinics in your area and ask if they can help with the problem.

One of my friends had a son who was autistic and he had, even at age 6, severe trouble with his gag reflex. His mother was told to wipe the inside of his mouth with a washcloth several times a day to help accustom him to the feeling of textures in his mouth. I'm not sure how much it helped...but that was an extreme case.

Do you let your son try to feed himself? If it's behavorial, maybe he's reacting to not being the one to put the food in his own mouth. The only reason I'm thinking that could be it is that my 5 year old used to really freak out when I tried to give her medicine...she would gag and vomit. Once I started handing her the dropper of medicine to take herself, she quit having trouble with it. She had some trouble now and then with baby food, but I assumed it was because she didn't like the tastes. She still won't eat nuts or seeds (not even strawberries because they have seeds) but otherwise she's eating normally.

Try feeding him yogurt as a change from pureed food. Get a yogurt that doesn't have bits of fruit in it. Ice cream might work too. You can also make your own pureed foods for him...cook fruits or veggies in water until soft, then put them in the blender with some of the cooking liquid. You can freeze it in ice cube trays to make a bunch of servings at once...just put them in a gallon bag once they're frozen solid, and store in the freezer, taking out what you need for each meal. When I was trying to get my younger daughter on solid foods, I was making my own baby food and decreasing the amount of liquids I added each time.

You could also try the fruit puffs they sell in the baby aisle, that dissolve in the mouth...my youngest did really well with those, until everyone else in the family discovered how good they tasted and started taking them all.

Answer 5

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