This was originally posted by Luke-n-Me, but we seem to have lost the original thread
. I know if anyone has any questions about this then Nancy (Luke-n-Me) is more than happy to be PM'ed with questions, or just post a reply here and she'll post back.
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I have read many posts regarding babies who are difficult to feed. Many are contributing this to colic, GER or formula intolerance. I just want to let you know of another possibility that is little-known. A swallowing disorder called DYSPHAGIA-something that can occur even in "typical"children.
My son is now 14 mos., but at about 9 weeks of age, he started to scream when presented with the bottle and refuse to take his bottle. I was lucky to get a couple of oz. in him. I went to the dr. week after week trying to figure out what was wrong. He did have reflux (which nearly all infants have) and at first it was contributed to the reflux. But after a trial of zantac with no improvement, I went back to the dr. Our next step was to try switching formulas(intolerance?), we tried soy-no help; then onto nutramigen-again no help. He was starting to slow down in weight gain, so then we thickened up his formula with cereal, it helped a minimal amount, but because we had to cross cut the nipples and make the hole larger, it was just creating the same problem. We also had a barium swallow to look for reflux-nothing significant was found. Finally, Luke lost a few oz. in weight and I was referred to a gastroenterologist at a Children's Hospital a few hours away. Nearly before I walked in the door, he knew what the problem. Here were the questions that he asked me:
1) Does he eat better when he's sleepy?
2) How long does it take to feed him?
3) Does he scream and when he sees the bottle/before he starts to feed?
4) Does he seem fussy while he eats vs. after he eats.
5) Is he congested or had any other respiratory problems.
My answers were:
1) He definitely eats better when he's sleepy
2) It takes at least 45 minutes to feed him
3) He does fuss/scream when he sees the bottle/breast
4) He is only fussy when he eats. As soon as the bottle is taken away, he's fine.
5) He's been chronically nasally congested for weeks.
**watch for coughing/choking and lots of gagging during feeds as well.
These are all signs/symptoms of dysphagia. 1)They eat better when they're sleepy because they aren't as aware of the liquid entering their airway;2) It takes forever to feed them because they are screaming and fussing trying to protect their airway; 3) They learn that the bottle/breast is something to be afraid of; 4) They fuss when they eat due to the liquid entering their airways (aspiration), if it's reflux, then fuss after feeding (drinking soothes reflux, it's after eating when they are burping up the formula/breast milk that the pain begins); 5) Anytime foreign particles enter the airway it can lead to upper respiratory issues.
He immediately told me that he was going to refer me to a pediatric speech therapist for a modified barium swallow (MBS) (x-ray of swallow function). I was immediately shocked because I AM a pediatric speech therapist and I had never heard of this-a "typical" child having a swallowing disorder. It's something that many medical professionals are unaware of, including pediatricians and obviously even speech therapist's who deal with swallowing disorders every day!
Sure enough, the MBS was completed and he instantly aspirated the liquid. I cried of course when I realized that all along we could have just had this study completed and gotten on with life. At this point he had been struggling to eat for 2 months!
THe therapist used some thickeners to thicken his liquid to a nectar consistency and immediately, he latched onto his bottle and started taking it with no problems. We had to thicken his liquid from then on (and still do). He is getting better, we did another MBS when he was 10 mos. and the liquid still got very near the airway, thus we still thicken. He will have another MBS in a few months and we will continue them until he no longer needs the thickener.
When we first started to thickener, it took him about a week to feel comfortable taking the bottle and knowing that it was safe for him to do so-his airway was no longer being compromised. He now drinks from a cup with thickened liquids and does great-no sippy cups though. He will eventually outgrow this and the way that he will outgrow it is by learning to compensate appropriately-he will learn to gage his drinking so that he can handle the liquid without it going into his airway. There is no therapy, it's purely a timing problem with the sucking/swallowing. Thickening helps.
If this sounds like your infant, talk to your dr. about it and request a prescription for a MBS. Be sure to find a speech pathologist who is used to and does MBS's for pediatrics on a regular basis-they are very different from adult studies.
Do not try thickening without first having a MBS as each child may need a different amount of thickening (honey or pudding thick, etc). If this goes on undetected it can lead to oral aversions, picky eating and sometimes refusal to eat. It can also lead to non-stop respiratory issues including congestion, ear infections, bronchitis and pneumonia.
I know how frustrating it is to feed a fussy eater and how desperate you can get to get them to eat. I decided to post a sticky because I've been replying and seeing so many women who are describing babies with this problem that I can't keep up with writing to them. I could continue, but instead if you have any questions, please post a message or a private message and I will get back with you ASAP.
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Nancy
