Sam is 11 and a half months old, born two months premature. He has been diagnosed with reflux and is on 30mg of Losec a day, which seems to be doing him good. He's growing pretty well, but is about 20 percentile for weight. Until 8 and a half months he had quite a severe bottle aversion, we could only get him to drink even 1 or 2 oz at a time by distracting him. That has since improved; although he by no means likes drinking, he can finish a 7 or 8oz bottle in about 3 "goes" on a good day. He uses Dr Brown bottles with the #3 teat. We have not tried to wean him off his bottle, or even tried him with a sippy cup or normal cup. We have presented him with a sippy a few times, but he has never wanted to suck it, let alone got anything out, drink-wise.

He started solids at 4 and a half months, little bits of pureé and cereal, often mixed. He was always a reluctant eater, but generally the little solids we got down him stayed down. After a bout of rotavirus at 10 months he has started to vomit up solids on a regular basis. Often, it is in reaction to us giving him meds, but often he just vomits up a feed for no reason. He has also vomited up whole feeds after being given something more solid than pureé to eat. Before his illness he didn't vomit his solids, but coughed if offered anything more "solid" than pureé.

And this is my real issue: Sam's food diet consists of yoghurt mixed with finely seived avocado, and mixed grain cereal mixed with vegetable pureé. If we offer him anything with more texture he coughs and sometimes seems as if he wants to choke. I have given up giving him teething biscuits since he vomited when he got some stuck in his mouth and couldn't seem to swallow it. Even a piece peeled grape made him vomit.

He doesn't want to eat anything, really. He just doesn't like eating. He's never shown interest in any of the food, table food or baby food, that we have offered him. He is reluctant to eat even the pureés/yoghurt. He often doesn't open his mouth to eat (closes it very tightly), and even if he does open his mouth, he doesn't swallow - either at all, or for minutes. He has sometimes kept his meds (beads from a capsule mixed with apple pureé) in his mouth for 20 minutes plus, and even sucking a pacifier doesn't make him swallow! Sometimes we give him his bottle to get him to swallow his pureé, which he does, but he often vomits after feeds like that, so I don't want to do it. No food interests him, he can't wait for mealtimes to be finished... We get enough food into him as best we can, but surely there's something wrong here? Shouldn't he be able to tolerate / be interested in food by now? And what's with the vomiting in reaction to anything more solid than pureé?

Please give me your honest advice - what should we do? Should we let things carry on as they are, or does Sam have a real problem? Thanks in advance.

Hi Mary:

What gorgeous big blue eyes Sam has! First of all, your little guy’s corrected age is technically 9 ½ months. Many preemies do have feeding aversion. We start feeding them in the NICU so much earlier than they are truly ready (or even coordinated) to eat. Babies do not develop suck-swallow-breathe coordination until around 34 weeks (or even later depending on medical status) gestational age. Term infants typically do not eat until 38-40 weeks. I have seen NICU’s feeding babies as early as 32 weeks :sad3: . Mary, you should not be trying to wean Sam off of the bottle yet. In fact, slowly introduce the sippy to him. You are in no hurry. He will not be going to kindergarten with a bottle and do not let your pediatrician worry you about getting him off the bottle so fast. I get worried when they are not off around 18 months corrected age.

Rotovirus does a number on a baby’s GI tract. It can upset the villi or hair-like extensions that line the intestines and make them very sensitive to various foods. It can also take weeks for the GI tract to regulate after this virus. However, there is something else going on with Sam that needs addressing. He obviously has a real texture aversion to foods. This is common with my preemies and GERD babies. What also concerns me is his limited formula or breast milk intake. This is a red flag for a feeding therapist! Usually GERD babies prefer to drink because it makes their irritated esophagus or food pipe feel better.

Here are some questions for you:

Does Sam do any of the following when he drinks? (arch, flail, gulp loudly, cough, choke frequently, pull off the bottle nipple, cry)
Does he sound gurgly after he drinks or does his nose sound congested?
Does his chest rattle after he drinks?
Has he had many upper respiratory, ear, or sinus infections?
Is he miserable when he drinks? Remember, eating should be pleasurable! :drinkalot:
GERD is also no stranger to our preemies. They all seem to have it to some degree. GERD can make a child not want to eat or drink. However, some children also have a condition called dysphagia, or difficulty swallowing. This is why I am asking the questions above. Mary, if you answered yes to a few of the questions above, it is important that Sam have a modified barium swallow study with a speech or occupational therapist. I would highly recommend taking your sweet guy to a feeding specialist (OT or speech) for an evaluation.

The most important information I can offer you is please do not force feed Sam, not that you do at all. As parents, we are desperate to get food into our GERD babies who do not want to eat. When they do not exhibit hunger behaviors or when eating is not pleasurable, there is a problem that needs to be addressed by a professional. Thank goodness he is in the 20% for weight. He is trying to tell you that something does not feel right when he eats. Write back with questions J

Hi Robynne

Sorry I haven't replied sooner, I didn't realise you had written back. Thanks for your response. Since I wrote there is good news. Sam went back to the ped GI and his weight is now about up to the 40th percentile for his real age, which is amazing. The Dr is still worried about his feeding issues, though. He referred Sam to a physiotherapist who specialises in eating issues, and we are seeing her today. The Dr says if she can't sort things out he will do a scope to see if there is anything else physical contributing to Sam's negative attitude to food.

I fear I inadvertently misled you regarding the amount Sam drinks. He probably has a good few bottles a day - over 20oz most days I would guess - which is excellent compared to how he was a while back. He was the classic reflux bottle refusing baby - arching, crying, pulling off the teat, refusing to open his mouth, etc. We could only get him to take his bottle with much distraction and after "tying" him down on a little cushion so that he didn't bat the bottle away with his hands. Now, he generally takes the bottle pretty well. He stops drinking every so often, and won't start again until every burp is out, but at least he drinks for longer and he does start drinking again, no distractions required. So that's all excellent.

As regards your questions: Although I can't say Sam likes to drink, he doesn't choke or cough when he does so, and his chest doesn't rattle. He has not had any respiratory ailments apart from one bronchial virus which he had when he had rotavirus, and he recovered fast. He's a bit gurgly sometimes, but once he burps he is OK, and he doesn't have as many wet burps as before.

What really gets us down is his attitude to solids. He hates eating, and it's never been pleasurable for him. It's as if he's a different baby, all subdued and gloomy and rubbing his eyes and turning away, etc. when we put him in his high chair. He shows no interest in eating at all, so I suppose technically speaking we do force feed him :oops:. But we never put the spoon in his mouth unless he opens it voluntarily, and we wait until he finishes swallowing (often a long time) before giving him his next bite, entertaining him all the while... He gets it down in the end (although sometimes it comes up again, grrrr).

I will let you know what his therapist says today, I am really hoping that it's not the impossible dream to have a baby who looks forward to mealtimes!