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Our precious son

Many children & adults have feeding problems. It is not just isolated to premature babies although because they are born early the risk is greater.

Corey was fed for 21 months via a NasoGastric or NG tube.

What is a NasoGastric tube?

A tube that is passed through the nose and down through the nasopharynx and oesophagus into the stomach. Abbreviated NG tube. It is a flexible tube made of rubber or plastic, and it has bidirectional potential. It can be used to remove the contents of the stomach, including air, to decompress the stomach, or to remove small solid objects and fluid, such as poison from the stomach. An NG tube can also be used to put substances into the stomach, and so it may be used to place nutrients directly into the stomach when a patient cannot take food or drink by mouth.

                         

 

Today, although we are tube free we constantly battle with oral and food aversion

Mealtime Hints for Children with Food Aversion

By Rachel Browne

My almost 2 year old surviving triplet has always had some feeding problems but when they suddenly got worse, I was panicked.  He went from eating anything that had chunks up to the size of a grain of rice and anything crunchy, to only being able to eat the smoothest purees and a limited amount of crunchy things.  I started collecting as much information as I could to try to overcome these sensitivities. This is a compilation of that information.

*Let him play with the food (even if he throws it) as much as possible because feeling the textures on his hands may help him.

*Try offering one bite only of a food that makes him gag at the beginning of the meal (before there is less in his stomach to throw up).  And then, regardless of how he does with it, move on to the purees.  If he does well, praise him a lot.  If he doesn't do well, downplay it and say that's okay, etc.

*Brush therapy and joint compression.  This is supposed to help with feeding aversions (and also sleep!!!) in addition to other things.  The OT said to try it for a week because if we hadn't seen a difference in a week or so, then it probably wouldn't help.

*Try letting him have more control over what he eats.  The OT has provided us with a tray with a built in plate that straps onto the highchair so Colin can't throw it.  This is to give him more control over the food and to give him more chances to feel it.  He loves it!!  (But my kitchen is paying!!  He may not be able to throw the plate, but he can throw the spoon and throw handfuls of food!)  He does seem to be eating more textured foods this way.

*Try grinding "real" foods for him.  (I mean the foods you the parents are eating!) We use the Happy Baby food grinder which says it makes a puree, but it really doesn't.  The better flavors may entice a child to get used to the textures.

*Colin always needs to be distracted to eat.  We have found that reciting stories that he is familiar with from his books (though not actually reading the book) helps immensely. 

Suggestions from other parents of children born prematurely, on the preemie-l mailing list:

*Try a lot of oral stimulation using a toothbrush, a washcloth, a nuk brush, the rubber toothbrush that fits over your finger, or just your fingers alone.

*Try branching out from similar foods--if he eats one type of cereal easily, move on to another one.

*Try adding wheat germ to add texture to the food.  Start off by adding 1/4 tsp of wheat germ to 4 oz of pureed food.  Every three days or so add another 1/4 tsp. of wheat germ as tolerated. If he gags then wait another day or two and try to increase again. (Make sure your child doesn't have a wheat allergy first.)

*Proper positioning is very important.  Try to make sure your child is not slumping in the high chair.  Use rolls or cushions as necessary to help your child sit up straighter.  (Also, there are high chairs that recline a bit and that may help some, too.)

Copyright Rachel Browne

Reflux

Reflux can be a common cause of feeding issues and sickness in babies and small children, not even necessarily preemie ones.

Gastroesophageal Reflux (GER) or Reflux is the medical term used to describe a condition in which stomach contents - food and gastric acid - frequently flow back up out of the stomach into the esophagus. The food that comes up may or may not flow all the way out of the mouth. It may be forceful vomiting which rapidly and completely empties the stomach, or it can be more like a "wet burp" that doesn't reach the mouth

There are many different symptoms of GER. Your child may only have a few of these symptoms. The most common symptoms include:

    • pain, irritability, constant or sudden crying, "colic"
    • frequent spitting-up or vomiting
    • vomiting or spitting-up more than one hour after eating
    • not outgrowing the spitting-up stage
    • refusing food or accepting only a few bites besides being hungry
    • poor sleep habits, frequent waking
    • "wet burp" or "wet hiccup" sounds
    • bad breath
The less common symptoms of pediatric GER include:
    • constant eating and drinking (to soothe a sore throat)
    • intolerance of certain foods
    • poor weight gain; weight loss
    • swallowing problems, gagging, choking
    • hoarse voice
    • frequent red, sore throat
    • respiratory problems; pneumonia, bronchitis, wheezing, asthma, nighttime cough, apnea, aspiration, noisy or labored breathing
    • ear infections
    • constantly running nose; sinus infections
    • tooth enamel erosion
    • excessive salvation, drooling
    • peculiar neck arching, Sandifer's Syndrome

If you think your child may have GER, please contact your child's doctor. It is also very important to let your doctor know if your child develops new symptoms or if the symptoms change.
Many young babies (about 65%) regurgitate a small amount of milk occasionally, especially when burping after meals. This "spitting up" is normal. Others vomit a large portion of every feeding. The severity of the reflux itself is not what matters. Reflux only becomes a problem when the child is showing signs of complications. When babies develop complications they are said to have Gastroesophageal Reflux DISEASE or GERD.