Maggie is 3 yrs old (39 months). She has GERD and had a pylorotomy at 8 weeks for pyloric stenosis. Her main problem is she doesn't eat. We tried feeding therapy a few months ago to be told they could do nothing for her. They suggested a G-tube and eat for pleasure only. The only thing they got her semi-past is chewing and spitting but she's started doing that again too. She also trys hides food or throws it away.

She has no physical abnormalities, no texture issues, no dysphagia, properly chews... she just chooses not to eat.

She acts like a typical toddler, eating one day and nothing the next but to an extreme. A good eating day can consist of 5 grapes and 3 cups of milk.

She asks for food over and over again but then won't eat it.

She refuses any and all supplement drinks. She is refusing her vitamins now too.

Do you suggest trying feeding therapy again? Or should we give up and go through with a fundo and G-tube?

Do you have any suggestions of what I can do at home to get her to eat?

Lena:

Answer these questions for me and I'll get back to you:
1. What is her current weight?
2. WHat kind of feeding therapy program was she in? Outpatient? How many times a week? Which discipline(s) did she see? Were you involved in the treatment?
3. Give me an inventory of the foods she eats including textures and amounts.
4. Does she exhibit hunger behaviors? DO you know she is ever hungry or does she care less about eating?
5. Does she sleep through the night?
Is she spitting up/vomiting on her volition?
6. Have you tried an appetite stimulant?

Get back to me :)

Robynne

I want to thank you for taking the time to contribute to this website.

She is currently 27.5# and 38 in.

She was in outpatient once a week. I'm not sure what you mean by disciplines. I was for the most part involved. She tried kicking me out a few times to see if Maggie would act differently without me there.

She will eat anything when she does eat but never much. The most we ever get her to eat is 2-3 bites at a meal on a good day. She doesn't throw temper tantrums or play with her food, she just sits there and says no thank you. I think she hides food because she can sense how stressed I am at meals. She usually only chews and spits now if I ask her to take a bite.
Yesterdays eating went like this:

breakfast
drank 2-3 oz of water with medicine
oatmeal (she asked for) never picked up the spoon
nutrigrain bar (she asked for) never touched it
drank 4 oz of milk

snack
grapes- she ate 4 or 5

lunch
soup- she licked the spoon a couple times
drank 8oz milk

snack
fruit snack pack(asked for)- only ate one

dinner
chicken noodle casserole- she never touched it
slowly drank 6oz of milk through out the rest of the night

She says she's sooo hungry but then when I give her food she won't eat it. I think it's more of a game or trying to act like other kids. This is pretty recent that she's started asking, before she never said a word or acted hungry. She will get really excited about getting a happy meal or pizza, sit at the table with her brother or friend and just sit there smiling watching them eat.

For the most part she does sleep through the night, she wakes up about once a week retching.

She doesn't vomit on volition. She only vomits about once a month now, she's very much so a silent refluxer now.

We've tried periactin and erythromycin with no luck.

I forgot to add that she complains that her belly hurts when she does eat a decent amount.

Sorry to butt in here, but by "diciplines" she means OT, PT, SLP, feeding skills, feeding skills psychology, etc.

Sorry to butt in here, but by "diciplines" she means OT, PT, SLP, feeding skills, feeding skills psychology, etc.

Ah Thanks! I was reading it wrong.

She saw an OT who was also an RD.

Hi Lena:

I'm sorry it has taken me a few days to get back to you. Texas has been keeping me busy!

I have plotted Maggie given your information and she comes out as being in the 25% for weight and the 75% for height ( 27 lbs, 5 oz and 38 inches). By disciplines I meant was she just seeing an OT for treatment, or was she seeing a team (i.e. psychiatrist, speech therapist, pediatric GI).

I am going to give you my opinion here and take it as that. Maggie is in the 25% for weight. Ideally, we would like to see that number a little closer to her height. However, in the world of pediatric feeding aversion and reflux, health professionals typically do not get worried unless a child falls under the 5% for weight. Some physicians do not get worried if a child is under the 5% for weight if they are growing at the same rate and not falling off of the curve.

I understand Maggie had outpatient therapy one time a week. In plain terms, that is not enough time/treatment to help a child with a feeding aversion. No wonder she didn't make any improvement. We have kids that come 1 - 3 times a day 5 days a week if need be. Maggie needs a more intensive feeding program. She needs a behavioral program.

Would I think about getting a Nissen and a g-tube? Heck NO! She vomits 1 time a month. Kiddos who receive a Nissen have 30% chance of developing retch syndrome (and a worse feeding aversion). Having that tube there will be an even easier "out" for her not to eat. Lena, you have a small window now to get Maggie into a good program with a trained feeding therapist. My suggestion would be to put a hold on the Nissen and g-tube until you try a more intensive therapy. If therapy doesn't work, THEN get the Nissen and g-tube.

Hope this answers your questions.

Robynne