{Professional Insight} When Your Preemie is Struggling to Eat

April 1, 2013

Laurie Layne, OTRMost people view eating as a simple task that occurs automatically. Unfortunately, for many premature babies, the trauma of their birth and medical procedures during infancy can lead to severe feeding problems as they get older.  A basic parenting task is nourishing one’s child, so if he/she can’t or won’t eat, mealtime can become an emotional minefield that affects the parent, child, and even other family members.

Readers may have experienced the trauma of having a baby in the NICU, being nourished via NG or g-tube.  Although these are life-saving devices, the lack of a proper developmental progression of oral-motor skills can create difficulties when transitioning off of the devices and onto “regular food”.  Advancing through each developmental stage is a must.  With motor skills, a child must first roll over, then crawl, and finally walk.  Likewise, a child must learn and progress through oral motor developmental steps.  Babies must learn to coordinate suck, swallow, and breathe sequencing to be able to nurse effectively.  They progress onward towards hand to mouth play, more stable head control and improved trunk strength for sitting, and maturing tongue and jaw movements that allow for munching and grinding foods.  Eventually, they begin using their fingers to eat and progress towards using utensils to eat table foods.

However, premature children frequently suffer from sensory aversions that impact their ability to progress through normal oral-motor development.  These aversions may have arisen as a result of gastrointestinal inflammation, swallowing disorders, breathing issues, or oral motor weakness.  Sensory challenges can include trouble tolerating different food textures.  They may also include an intolerance of particular colors, shapes or moistness of food, having extreme brand name preferences, and having inconsistent mealtime routines.  These challenges can result in food selectivity that becomes problematic when it impacts growth or nutritional status or when it is causing disruptions to mealtimes at home or school.

Basic Suggestions for Helping Your Child Tolerate Foods

  • feeding therapyReinforce the good.  Praise any positive interaction with food.
  • Allow your child plenty of time to explore and play with their food.Putting it in or on their hands is the first step towards them accepting it in their mouths. Many children enjoy “painting” with food and/or dipping foods into sauces such as Ranch dressing, ketchup, gravies, or yogurt.  This type of play decreases sensory aversions as the child interacts with the food.
  • Talk about foods in nonjudgmental language (i.e. “That noodle feels wet.” rather than “That noodle feels slimy.”)
  • Allow the child to be somewhat in control of the situation by giving him choices and always providing a safe food for him at meal and snack times.  A safe food is one that he readily accepts.
  • Provide structured mealtimes.  Follow roughly the same time schedule each day and eat meals and snacks at a table.  Turn off the TV and focus on the meal and family interactions.
  • Do not yell, criticize, or punish your child during mealtimes.  This provokes a “fight or flight” reaction, resulting in a drastic decrease in appetite.

Additional Information: Oral Motor Milestones & Feeding Tips

WebMD (feeding milestones)
Ellyn Satter Associates
SOS Approach to Feeding

If your child is not eating a good volume and/or variety of foods, it is best to seek professional help sooner rather than later.  The goal is to stop unwanted patterns of behavior from developing.  Trust your parental instincts.  If you are concerned, speak with your pediatrician to obtain a referral to a feeding specialist, who may be an occupational therapist, a speech language pathologist, or nutritionist.

This is not meant to take the place of professional, one-on-one therapeutic intervention.  Each child is different and will require individualized plans.

Guest Blogger

Laurie Layne, OTR, received her B.S. in community health from Texas A&M University and her master of occupational therapy degree from Texas Woman’s University-Houston.  She has fifteen years of experience in working with pediatric populations in early intervention, school-based services, and private outpatient clinics.  Laurie treats a varied caseload, including children with feeding aversions, sensory processing disorder, developmental delay, autism spectrum disorders,  neuromuscular dysfunction,  and genetic disorders. She is trained in various feeding methodologies and is Handwriting Without Tears Level 1 certified.  Laurie works at Seton-Pflugerville in outpatient pediatric therapy.  She has been married to Eric for 16 years and is mom to three awesome kids, ages 12, 10, and 10.