My B is almost 3 and a half years old and is a very picky eater. She was diagnosed with reflux at just a few weeks old and has had feeding issues ever since that time. She is currently on prevacid and zantac. A meal time goes something like this, everyone sits down and I dish out supper, she doesn't like most vegetables, but does like potatoea. So with a little potatoe and a bit of meat we start the i'm not hungry, or she'll eat two bites really good and starts gagging on the next bite and supper is over. Whenever she sits down to eat she has to touch, and smell everything she is going to eat, if the smell makes her gag she is done. It is very aggrivating, she drinks very well at this point, i think too much but it is helping her grow. She drinks two or three cans of pediasure a day. She is constantly constapated and very cranky. Temperfits are a must at mealtime. I have been told to just let her go and not fight over feeding but if i don't nag then she won't eat and that's all there is to it. Any suggestions would be great, thanks so much for your time.

Hi Darlene:

Most little ones with a history of reflux do not care for mushy textures, which conveniently includes fruits and vegetables! Those foods tend to set off the gag of a child who has a hypersensitive gag very easily. Potatoes are typically a safer food with a smoother texture and less pungent. Meats can also trigger the gag with their aromas.

Again, I credit my mama’s, because they know their babies the best J One concern I have, like you Darlene, is that she is filling up on PediaSure. My reflux patients prefer liquids because they are smooth going down, don’t smell usually, are filling, and feel good on the throat. Why eat? Does B exhibit hunger behaviors or do you have her on a feeding schedule? Does she snack or graze in between meals?

Another concern I have is her constipation. If she is not moving her stools, her tummy is not going to feel good on top of the reflux. This will make her more hypersensitive to food textures. I would address the constipation issue with her pediatrician. Several of my patients do well on Miralax or natural foods or liquids.

You also mentioned that B needs to smell and touch her food, which often makes her gag. Many children with reflux can also have sensory issues that can be addressed in therapy with an OT. Some questions to think about are: Does she dislike having her hands dirty, walking bare foot, do sounds such as the dish washer or vacuum cleaner bother her, do clothing tags bother her, or does she like a specific food texture (ex: only crunchy foods)?
If you said yes to many of these questions, consider reading The Out Of Sync Child by Carol Cranowitz. It is a quick read and will tell you if B does indeed have some sensory issues that would benefit from treatment in therapy with an OT.

Darlene, if you address the constipation issue either naturally (apple/prune juice) or with medication, address her possible sensory issues, and you cut back her liquid intake and her appetite does not appear to increase, I would consider talking to your pediatrician or pediatric GI about Peri Actin. This is an appetite stimulant that has been used to treat allergies. I have seen other patient’s do extremely well on this medication. Please do not think I am a medication pusher, because I am not. I am a firm believer in a combination of therapies. As parents, we will stand on our heads to get our kids to eat. Remember though, the worst thing you can do to a child with a feeding issue is push or force them to eat. Please write back with questions.

Robynne

here are some answers to your questions. First of all we have never seen a GI. My ped kepps telling me to wait it out, and here we are three and a half years later. I am going to try the juice to see if it helps with the constipation, however B prefers water and then pediasure. Yes she is hungry she sometimes cries for over an hour that she is hungry but won't eat anything. I will try different foods and she'll say "I don't eat that", or take the spoon and push it off her plate. She prefers very plain dry foods like potato, toast with nothing on it, plain pancakes (if they're cooked in grease she won't tough them) white pasta with no sause, and rice. I am trying to cut back the pediasure but she screams for it, and i feel she needs it because she's hungry. I hope this answers some of your questions. thanks so much for your time.

Darlene:

Did the pedi put B on PediaSure because of poor weight % or did you start giving it to her on your own? I know you said she likes bland foods, but do you put anything on the food you are giving her (i.e. salt, pepper, a little butter)?

Do you need a referral from your pediatrician to go to the pedi GI with your health care plan? If B's weight % is within a resonable range, I bet your pediatrician is considering this to be a "picky toddler" issue. I would argue that because of the limited daily intake of food and preference to rely on PediaSure in addition to her ongoing reflux issues.

Time to put your foot down and use your "mama instincts." Don't be afraid to ask for a GI consult. He/she can help regulate the stool issue as well. You are right, this has gone on TOO long. Keep me posted.

Robynne

It depends on the food and what kind of mood she is in. She will usually except a bit of butter on her potatoes and sometimes on her toast but not always, if we put a little too much she gags and that is it. It is definetely a trial situation. As for pancakes and waffles, etc. they have to be cooked in a non stick pan with no grease and have absolutely nothing on them, the sight of syrup makes her gag, as well as jello, and puddings which is quite a challenge since her prevacid has to be given in a food she won't chew.
I need a referal for a GI consult because there are no pediatric GI's in the province in which I live. We are canadian so there is no health care plans here. Even health plans to cover perscriptions are next to unheard of, we have to pay for our own. Anyway I think i'll call and make another app. with the ped and see if I can get anywhere because I was just talking to the dietician from my area and she has no suggestions where to from here.