Hi,

My daughter is 23 months old. She is now taking mashed foods but simply refuses taking liquids. If she sees the cup coming towards her she will cover her mouth, pushes the cup away or just walks away. She acts like if she wants to drink from our cups but once we put the cup close to her mouth she will do the above.

What shoud I do? She will be 2 soon and all her liquids go through her G-tube.

Any suggestions will help.

Thanks

Ada

Hi Ada:

First of all, I need to know a little more about Gabriella. Has she had a modified barium swallow study before and do you know if she is safe on thin liquids? Does she have a history of coughing or choking when drinking? Did she have a Nissen fundoplication with her g-tube surgery? Have you tried taking the end of a straw and placing a little liquid in her mouth with it? What about a sippy cup (free flowing) or a honey bear straw cup? Please write back and we can figure out what we might be able to try next with Gabriella.

Thanks,

Robynne

Hi Robyyne,

Yes, she has had two barium swallows before she was 7 months old and both came out normal. When she was born she had really bad reflux and she has been diagnosed with having low muscle tone throughout her entire body. She started walking at 21 months and climbs the furniture and has done very well in catching up on that end but the feeding is our major problem. She did not get a fundo with her g-tube surgery (thank God!). I have tried putting the end of a straw with liquid in it but as soon as the liquid hits her tongue she gets defensive. I have tried giving her adult water bottles the sippy cup she can't even see it coming her way before her hands are covering her mouth. She used to take the sippy cup before she turned 1. She took maybe 2 or 3 sips at the most out of the cup but that was the most we got. She never choked or coughed as she drank. She does eat yogurt and I make her lots of soups because they are easy to mash in her mouth. She has tried sucking on her thumb since she was an infant but she doesn't close around her finger to suck it she pretty much just moves her tongue around with her mouth open.

I am at a stop sign with no light at then end of the road. Any suggestions that you may have will be great. Also, she hasn't had any OT for over a year now. I had to stop them because she was not tolerating and we were getting no where. Now that she is older should I start that up again?


I am sorry for the long response but I really hope that any info. that I give you will help you so that I can help her.

Thanks for your help.

Ada

Hi Ada:

Gabriella is trying to tell you something is not right. Most reflux babies prefer to drink because it feels good going down, that is if they don't have an aversion to bottle feeding. The "red flags" with Gabriella's case that concern me are as follows:
1. She does not want to drink liquids, but will eat solids, which are thicker and protect the airway from aspiration.
2. Her overall hypotonia may be indicative of underlying dysphagia (diffiiculty swallowing) with thin liquids. Little ones do not have to cough and choke, they can silently aspirate.
3. From what you are describing, she has poor oral-motor strength, which can contribute to oral and pharyngeal phase dysphagia.

I would highly recommend that you consider having your physician write a prescription for a speech therapist or occupational therapist to conduct a modified barium swallow study in radiology. I would also look into having a trained feeding specialist re-evaluate Gabriella. She must have liquids for hydration and it is so important to find out why she has an aversion to drinking. I hope this helps.

Sincerely,

Robynne

Hi Robynne,

Thank you so much for the advise. If this is the case that she has difficulty swallowing what would have to happen so that she can better and does this get better?

Thanks so much again.

Ada

Ada:

Most likely it is as simple as thickening her liquids with a commercial thickener such as Simply Thick or Thick It. It may take a few trials for her to "trust" a sippy, cup, or straw again, but once it feels "right" going down, my patients learn to like drinking again and take off. I hope this is what has caused her drinking aversion. Often when I have had a scenario like Gabriella's, dysphagia is usually the culprit. Thank goodness it is very treatable. It does take a little time for the transition though. A modified barium swallow study should be able to tell you if this is the problem.

Robynne