Café Cole: Oral Aversions
by Elias Malespin Marketing Coordinator
(We continue our interview series with Courtney Hescht, M.S. CCC-SLP and Cole’s feeding expert)
What would you like the parents of a child with an oral aversion to know?
At this point we are usually doing a speech and language evaluation and the thing we need parents to know and tell us is:
- How limited is the child in their nutrition?
- Are they able to consume foods out of all of the major food groups?
- Are they getting vegetables, fruits, meat, dairy and grains?
If they are only eating grains and not incorporating any fruits or vegetables or meat or dairy, then that’s a pretty severe oral aversion, because it’s not supporting their nutritional needs.
Sometimes we have a child come in that is autistic and all they will eat are crackers and potato chips. This is not a behavioral issue where you can wait until they’re hungry to feed them, because they don’t have that instinct/thought. They would literally starve to death. So you have to make a very clear, very detailed, step by step process for each child (because each child is completely different) to get them to where you can support their nutrition. (Our last article will cover some strategies we use here at Cole)
You may even start with increasing their milk intake in increments or maybe use Pedialite or Pediasure to balance out that hydration and get nutrients from the Pediasure that can at least sustain them. Sometimes we’ll even put them on a toddler formula that has DHA in it (the vitamins and minerals that deal with brain maturation) because brain maturation is our ultimate goal. If the kiddos are not getting good nutrition there will be issues with brain maturation and overall growth and development. They can’t live off Cheetos.
What are we looking for/what questions are we trying to answer when we have a patient with an oral aversion?
Some of the things we work on is finding the exact issue. What exactly is putting them off? Is it texture, is it temperature, is it taste? For texture, some children come in, they’re 5 years old and still only eating pureed food, like baby food. Well that’s not age appropriate and stage 2 is not going to support their nutritional needs. So we need to get them to where they can start eating finger food that have a broader span of taste and texture, thickness and temperature.
Is this just getting the child to wrap his/her mind around this different food?
Yes, and you slooowly work on that.
I feel like as an adult that normal food tastes better than baby food…
Correct, and it may be they’re stuck because they have a sensory aversion. They gag any time they get something that has any kind of solid mass in it. Stage 2 is fine because it’s still all pureed, but once you start entering Stage 3, where you have chunks food mixed in with the pureed, they can’t handle the mixed texture and they gag.
Another example would be some food getting past the tip of their tongue onto the blade, but at this point they gag. This causes an aversion to the food because they’re afraid they’re going to throw up. Now, they’ve made it a psychological thing. So you see how they can’t go to kindergarten on Stage 2 baby food. It’s not good for their nutrition; it’s not socially acceptable. Parents are frustrated by it, because how do you pack their lunch, how do you ensure that they’re eating at school?
OT would also do more of what we call ADLs, Activities of Daily Living and dealing more with the feeding of self. So if the baby or child is coming in, they’re 4 years old and they’re still in Stage 2 and not feeding themselves…that’s a problem. Not only still eating like an infant, but they’re also not feeding themselves which means they’re also below level with fine motor skills.
In our next and final installment, we will be discussing some of the therapy strategies we utilize here at Cole and how we can help you.