I have a 7 month old little girl, Emma, who has Milk/soy protein allergy, GERD, and has physical therapy once a week due to hypertensive muscle tone (has greatly improved). She is currently our foster child, but we will be adopting both her and her twin brother.

She eats wonderfully with a bottle (Neocate thickened with Earth's Best Rice Cereal). Unfortunately, I have not been able to get her to eat with a spoon. The first spoon goes into her mouth fairly well, but she will tongue thrust the food out and then "locks" her tongue against her palate making further spoons unable to enter.

She was born 7 weeks premature, cocaine exposed. I had mentioned to the developmental therapist (who comes once a month) the possibility of her needing therapy to learn to spoon feed. Would it be a benefit to her and what type of "exercises" can be done?

Her brother has no problem with spoon feeding, and actually prefers solids over the bottle.

Any help/advice would be appreciated!

I think therapy with an experienced feeding therapist (OT or speech) is an excellent idea. I would recommend treatment once WEEKLY, not once a month. I would ask your pediatrician for a prescription ASAP. It is often difficult to get services more frequently without a prescription.

Emma is approximately 5 months corrected age (7 months chronological age). Tongue or lingual thrust is typically integrated (disappears) by 4 months of age. Given her history of drug exposure, premature, hypertonicity, GERD, and milk protein intolerance, I am not surprised she is experiencing some difficulty with the spoon. All she may need is some oral-alerting activities and stimulation techniques that a therapist can teach you before she is eagerly eating food like her brother.

Emma may have some lingual retraction (tongue to roof of mouth) for various reasons. Many preemies retract their tongues as a protective mechanism after having a NG or OG tube down their airway for such a long time. It also looks as if Emma has increased upper extremity/trunk tone from her picture. Fluctuating or increased tone can absolutely affect voluntary movements and make feeding difficult. Lastly, that reflux does a number on our little ones. It can occasionally cause feeding aversion. I see many patients retract their tongues to block their esophagus or food entry.

If Emma coughs, chokes, or sounds more congested during or after a bottle or eating pureed foods, consider asking your pediatrician for modified barium swallow study. These signs may indicate dysphagia, or difficulty swallowing, which requires fluoroscopy with an OT or speech therapist and a radiologist. If you have any other questions, please write back.

Thanks,

Robynne