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Food Refusal

Sometimes a child refusing to eat is a phase. Sometimes it’s Dysphagia.

How many of you have had the nightly struggle over dinner where your child refuses to eat? Perhaps your child doesn’t like the texture of the food, or perhaps they become increasingly difficult or irritable over dinner? Or maybe they gag, cough, drool, gurgle or just take an extremely long time to eat? If any of this is resembling a common occurrence you experience at dinner time then it may be time to see a paediatrician because your child may be suffering from a feeding or swallowing disorder known as dysphagia (dis-FAY-je-uh).

Aside from the obvious risks of malnutrition and/or dehydration, dysphagia can cause food to enter your child’s airway which can cause aspiration or choking. It can also lead to increased chest infections and even pneumonia.

The causes of dysphagia vary. It can be caused by something as simple as medication causing loss of appetite or lethargy. Or there could be a more serious reason such as autism, nervous system disorders, heart disease or cleft or palate issues, to name just a few. This is why we recommend you seek medical advice as soon as your child begins to show consistent refusal to eat.

As a generalised guide, the steps for diagnosis and treatment of dysphagia will be:

• Initial consultation with the paediatrician who will ask you a series of questions including an extensive instruction of your child’s medical history;

• Performing clinical swallowing and feeding evaluation looking at the way your child swallows and the movements of chewing;

• Perform special tests, if necessary, to evaluate swallowing, such as:

  •  modified barium swallow – child eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
  •  endoscopic assessment – a lighted scope is inserted through the nose, and the child's swallow can be observed on a screen (American Speech Language Association, 2016).

• A decision will then be made on who to refer your child to in order to develop treatment plans;

• Families will also be provided teaching and counselling where necessary

Most causes of dysphagia are treatable and oftentimes your paediatrician will refer your child to a Speech and Language Pathologist. Because everything from the child’s posture at dinner time, to the way in which they react to food, are considered when diagnosing and treating dysphagia, the Speech and Language Pathologist will work with a number of other physicians when gauging a treatment plan.

We don’t want to sound alarmist, because your child may just be going through a phase of not wanting to eat. But if your gut is telling you that there is something more sinister at play, begin by taking notes of your child’s behaviour at dinner time. Then make an appointment with your GP to discuss the possibility of dysphagia.

References:

American Speech Language – Hearing Association. (n.d.). Feeding and Swallowing Disorders (Dysphagia) in Children. [online]

American Speech Language – Hearing Association. (n.d.) Roles of Speech Language Pathologist in Swallowing and Feeding Disorders: Technical Report. [online]

Mayo Clinic (n.d.) Dysphagia. [online]

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