Hi, my son Connor was diagnosed with Reflux at a few weeks old. He is now 14 months and still only eats a select few purees. He will not eat any solid foods at all and if I try to put them in his mouth he either gags or pushes them out. It's almost like he doesn't know how to chew them or what to do with them once they are in his mouth. He will put a graham cracker in his mouth and suck on it but once it breaks in half he spits it out. I'm not really sure if he has any sensory issues. He doesn't like it when his hands get dirty and will come to me to have them cleaned. He had an evaluation with a speech therapist but I'm not sure I am in agreement with her diagnoses. She seems to think his jaw is out of alignment and is causing his problems with eating. Any thoughts would be greatly appreciated! Thanks

Hi Kim:

I saw that Connor is almost done with his Doc Band at the bottom of his profile. When infants have plagiocephaly (head flattening) or torticollis (shortening of the muscles in the neck associated with plagiocephaly), the cranial sutures (bones of the skulls) and mandible (jaw bones) can shift. This, in turn, can cause misalignment of the jaw. When I evaluate a child for plagiocephaly, I always look at the jaw for asymmetry. I cannot tell, however, from just looking at Connor’s 2 pictures. I can see a little jaw asymmetry in the picture where he is wearing the red shirt, but don’t hold me too that. If he does have some asymmetry, it is most likely functional and does not need to be addressed. Pictures can also be deceiving. Regardless, whoever put him in the Doc Band should have noticed if he had a true asymmetrical jaw line. I am assuming he saw a craniofacial specialist. This is NOT what should be causing his feeding problems. By the way, he is precious!

Connor does have sensory issues related to feeding because reflux has done a number on him. My reflux patients typically develop a hypersensitive gag and have difficulties transitioning to new food textures. When they don’t, which is rare, we celebrate! Kim, this is a temporary problem. He will be eating Happy Meals at McDonald’s before you know it! Many kiddos do not like having their hands dirty. If Connor truly has sensory integration dysfunction, you would look for other manifestations such as: hypersensitivity to clothing tags or textures, noises, rigidity with routine, extreme clumsiness, poor fine and gross motor skills. If you think there is a chance he may have other sensory issues in addition to oral-motor, read The Out of Sync Child by Carol Cranowitz. I think, however, your focus should really be on sensory issues related to oral-motor and feeding. Keep him on the Prevacid as he transitions through food textures.

It sounds like Connor needs a feeding specialist who will teach you sensory and oral-alerting activities. He is already putting graham crackers in his mouth, which is a great start. I would start by pulverizing the crackers and putting them into sweet purees. This will change the texture slightly. Add more lumps and bumps as he can tolerate it. Make sure you bring out the bells and whistles the second the food goes into his mouth, as a distraction, so he is less likely to gag. See if your speech therapist has experience with feeding and can implement a sensory and behavioral feeding protocol with Connor. Connor has to like touching food before he will put it in his mouth. Strip Connor down and put him in the high chair before bath time. Put vanilla or chocolate pudding on his tray (NO DISH!) Make happy faces in the pudding with clean fingers. Try to get some on his lips playfully so he will take a taste. Kim, you are Connor’s model. He wants to see you tasting the pudding too J

Robynne