Many people are not aware that a Speech Pathologist may be able to help when their baby or toddler is difficult to feed, having difficulties chewing, food refusing or is a fussy eater. Often babies or toddlers with reflux will have difficulties related to eating. Very early on, babies with reflux associate eating with pain and discomfort and begin to fuss or even completely refuse feeds.
Many families get turned away by the GP or early childhood nurse, told to persevere with feeding and that some babies are just unsettled. Reflux symptoms include back arching, crying at feed times, waking from sleep screaming, taking very small amounts of milk and then refusing more, fussing at feed times and being unsettled after feeds. Many babies with reflux have silent reflux and never vomit though some vomit frequently.
Reflux symptoms usually appear around four to six weeks though can appear earlier. If a baby is showing signs of reflux it is worth seeking help early rather than adopting the “wait and see” approach. Parents are often reluctant to medicate young babies; however, correct diagnosis and early medication can often prevent ongoing difficulties with eating and the impact on other areas of development that reflux can cause.
Due to food refusal or fussy eating, delays can occur in chewing skills. Children with reflux can also have delays in their speech and language development due to reduced chewing practice as well as the body focusing on the underlying pain and discomfort rather than on development of communication skills.
Once a child is diagnosed with reflux and started on medication, it is very important to ensure that they are correctly medicated as strategies given to improve their feeding skills will not work if there are ongoing underlying feelings of pain and discomfort. This may include seeing your GP, a paediatrician or a paediatric gastroenterologist. It is important to remember that you are your child’s advocate and you have every right to seek a second or even a third opinion regarding your child’s reflux and medication.
It is often recommended that babies with reflux be started on solids early in an attempt to reduce vomiting and increase their intake. In my experience, most babies do not have the oral motor skills to manage solids earlier than four to six months and this results in increased stress for both baby and parent with minimal impact on reflux due the small amounts of solid food the baby actually swallows.
If your baby is not yet on solids and fussing at or refusing milk feeds, I would recommend seeing either a GP, paediatrician or paediatric gastroenterologist. Milk refusal can be caused by reasons other than reflux such as allergies to cow’s milk protein. It is important that the process of finding out the reason for your babies fussing be started as soon as possible. It may also be beneficial to see a Speech Pathologist for assessment of sucking and swallowing skills.
If your baby has started solids and is difficult to feed or food refusing, I would recommend a Speech Pathology assessment to assess chewing and swallowing skills and to advise you regarding strategies to develop chewing skills further.
Strategies that may help encourage a child to eat more are:
- allowing the child to do messy food play where they are given food to explore with their hands and faces. The messier the better!
- encouraging your child to practice chewing by giving a rubber toothbrush trainers for them to hold and chew on
- allowing your child to feed themselves. Many babies prefer to feed themselves. This can involve allowing them to hold the spoon, or giving them foods they are able to pick up with their hands
- never force feed your child
- Nutritional management and meal time management and oromotor skills of children with GORD – Nicole Dennis, Dietician and Sandra McMahon, Speech therapist – introductory clip. Buy full presentation here.
- How Sensory Processing Affects Meal-Time Management – Vivienne Williams, Occupational Therapist – introductory clip. Buy full presentation here.
- Tube feeding in infants with GORD – Looi Ee, Paediatric Gastroenterologist – introductory clip. Buy full presentation here.
Written by Debbie Alvarez, Speech Pathologist 2012. © Debbie Alvarez
If you would like to contact Debbie for further information please send an email to RISA Inc at info@reflux.org.au
With the exception of speakers presentations which are their own work.
Further reading
Gastroesophageal reflux: one reason why baby won’t eat; Hyman PE, J Pediatr. 1994 Dec;125(6 Pt 2):S103-9.
Feeding resistance and gastroesophageal reflux in infancy; Dellert SF, Hyams JS, Treem WR, Geertsma MA.; J Pediatr Gastroenterol Nutr. 1993 Jul;17(1):66-71.
Infant colic and feeding difficulties; Miller-Loncar C, Bigsby R, High P, Wallach M, Lester B.; Arch Dis Child. 2004 Oct;89(10):908-12.
Food refusal: A Sign of nausea?; Richards, C. A.*†; Andrews, P. L. R.†; Journal of Pediatric Gastroenterology & Nutrition: February 2004 – Volume 38 – Issue 2 – pp 227-228