Feeding Difficulties in Toddlers: When to Seek Help

Dislike eating and forcefully swallowing can sometimes lead to vomiting?

Hello, my daughter is one year and ten months old and was born at 36 weeks as part of a set of twins.
She weighed only 1306 grams at birth and has always had difficulty breastfeeding, often spilling milk from the corners of her mouth.
The doctor said this is normal.
As she grew older, introducing solid foods has been very challenging because she refuses to eat anything, including milk.
The nurse suggested that if she doesn’t want to eat, I shouldn’t force her, and to try feeding her again when mealtime comes.
However, she can go several meals without eating and seems indifferent, preferring to have low blood sugar and lack of energy to play.
This has been the case until now; she often keeps her mouth slightly open and reluctantly allows me to put food in her mouth, but she just holds it there without swallowing.
I sometimes have to pinch her nose to make her swallow, and occasionally she will vomit.
There are times when she even chokes and the food comes out of her nose.
I have asked doctors about this issue, and they mentioned that some children have shorter vocal cords, which can lead to vomiting when stimulated, and that sometimes she chokes because I am feeding her too quickly.
Recently, I have noticed that when I feed her porridge, her tongue seems to be very tense and arched in her mouth, making it difficult for the spoon, food, or milk to enter.
Each bite is very small, and she doesn’t swallow, which prolongs mealtime significantly.
Sometimes she even vomits.
This issue is quite distressing, but the doctors I have consulted have indicated that she will likely outgrow it.
Is this true? I would appreciate any clarification from the doctor, or should she be examined in person? Thank you.

mei, 0~9 year old female. Ask Date: 2005/08/27

Dr. Jian Huangqi reply Otolaryngology

You should visit a medical center to see a specialist in person.
Thank you.

Reply Date: 2005/08/27

More Info

Feeding difficulties in toddlers can be a significant concern for parents, especially when it comes to ensuring that their child receives adequate nutrition. In your case, your daughter, who was born prematurely and has a history of feeding challenges, presents a unique situation that requires careful consideration.

Firstly, it is important to understand that feeding difficulties can stem from various factors, including physiological, developmental, and psychological aspects. Given your daughter's premature birth and low birth weight, her feeding issues may be compounded by her early experiences and the developmental milestones she has reached. Premature infants often face challenges in feeding due to underdeveloped oral motor skills and a heightened sensitivity to textures and tastes.

From your description, it seems that your daughter exhibits signs of aversion to food, which can manifest as refusing to eat, difficulty swallowing, and even gagging or vomiting. These behaviors can be distressing for both the child and the parent. It is crucial to approach this situation with patience and understanding, as forcing a child to eat can lead to further aversion and anxiety around mealtime.

Here are some strategies that may help improve your daughter's feeding experience:
1. Create a Positive Mealtime Environment: Ensure that mealtimes are relaxed and free from pressure. Encourage family meals where everyone eats together, as this can create a sense of normalcy and comfort for your daughter.

2. Offer a Variety of Textures and Flavors: Gradually introduce different foods with varying textures and flavors. Start with smooth purees and slowly progress to more textured foods as she becomes comfortable. It may take multiple exposures to a new food before she accepts it.

3. Incorporate Play into Feeding: Allow your daughter to explore food through play. Let her touch, smell, and even play with food before eating it. This can help reduce anxiety and make her more willing to try new foods.

4. Use Positive Reinforcement: Praise her for any attempts to eat, even if it’s just a small bite. Positive reinforcement can encourage her to be more adventurous with food.

5. Consult a Feeding Specialist: If her feeding difficulties persist, it may be beneficial to consult a pediatric feeding specialist or a speech-language pathologist who specializes in feeding issues. They can assess her oral motor skills and provide tailored strategies to address her specific challenges.

6. Monitor Growth and Development: Keep track of her growth and development milestones. If she continues to refuse food and shows signs of inadequate nutrition, it is essential to seek further evaluation from a pediatrician or a nutritionist.

7. Consider Medical Evaluation: Since you mentioned that she sometimes chokes or vomits, it may be worthwhile to have a thorough medical evaluation to rule out any underlying conditions that could be contributing to her feeding difficulties. This could include an assessment of her swallowing function and gastrointestinal health.

8. Be Patient and Consistent: Feeding issues can take time to resolve. Consistency in offering meals and snacks, along with a patient approach, can gradually help her become more comfortable with eating.

In conclusion, while it is common for toddlers to go through phases of picky eating, your daughter's history and current behaviors warrant a closer look. If her feeding difficulties persist or worsen, seeking help from healthcare professionals who specialize in pediatric feeding can provide the support and guidance needed to ensure she receives the nutrition she requires for healthy growth and development. Remember, you are not alone in this journey, and there are resources available to assist you and your daughter.

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