Question:  I've read your Food Refusal article, that feeding problems are usually related to oral motor or sensory problems.  But can it be psychological?  I’ve searched the internet and can find very little practical advice about addressing the fear of solid foods for an infant/toddler. Our son (3 and 1/2 now) is still eating pureed food and we’ve done everything our OT’s recommended, we use the Z-vibe, etc, but if he just sees a solid food and thinks that he might have to eat it, he will show a gag reflex. Before we knew he was allergic to gluten/dairy, we had given him something containing dairy as a first solid food and he immediately swelled, threw up, etc. He will play with solid food, even kiss it or lick it, and even take a tiny chomp on a teether with his mouth.  He will chew normally on the z-vibe as if he were chewing food.  But he will not take a bite or chew any real food.  Is this something that just can’t be addressed until he’s older and can understand more? Appreciate any advice you might have and thank you.

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It can definitely be psychological, especially if he’s had bad experiences with food in the past (like swelling up at the dairy products).  

Bad experiences can cause children to associate food with fear/pain/anxiety.  He doesn’t feel safe with food, and it’s a  very real fear. I can’t know for sure without seeing your child in person, but it sounds like you’re really on the right track.  Unfortunately, feeding therapy can just be a loooong process sometimes.  If medical, oral motor, and sensory issues have been ruled out, then it's about letting him become comfortable with food again, which can't be rushed.

Also, keep in mind that it can at times take 10+ exposures before a child will touch/try a food.  With one child of mine it takes 30+ minutes of the food being on her plate before she’ll touch/taste it.  With another child the secret was to feed him  with a twizzler instead of a regular spoon. With another child I put a piece of food on her plate and said not to touch/taste it, and lo and behold she did (because I said not to) and she thought it was hilarious!  Sometimes it’s about figuring out what motivates the child / what will jumpstart them out of their food jag. 

Try having him “brush his teeth” with food. Or just touch his teeth first and then work slowly from there.  Get him involved in the kitchen and have him help you prepare meals/snacks.  Since he’ll chew on a Z-Vibe /  teether, try dipping them in a tiny bit of puréed food (one that he likes) and see if he’ll still chew it.  Or, have him dip the Z-Vibe himself so that he can have some control over the situation (which can help decrease fear/anxiety). 

Keep following your therapists' suggestions - home follow-through is very very important.  Patience and no forcing will also be key.  Keep up the great work with on  food play.  If he is touching/licking food already then he is making tremendous progress – that is HUGE.  Everyone is doing a marvelous job.  Hang in there, he will get there! 

Debbie

Debra C. Lowsky, MS, CCC-SLP

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