Pediatric Oral Aversion

Pediatric Oral Aversion

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Summary

Oral aversion is the fear or reluctance to eat or drink.

Expanded overview

A child with oral aversion strongly dislikes or is afraid of anything touching their mouth. This can lead to a refusal to eat, drink, be touched, or an overactive gag reflex. If left untreated, children with oral aversion can develop serious, possibly life-threatening complications. 

Causes

There are several possible reasons that can contribute to oral aversions:

  • Choking episodes – a baby can develop an aversion after a particularly scary choking event
  • Discomfort/pain – any condition or sore affecting a baby’s mouth, throat or gastrointestinal tract can stop a child from eating due to pain
  • Force feeding – this stressful event often creates an unfortunate cycle, instead of helping the child
  • Intubation and other medical traumas – babies and children who have a tube or a suction down their nose or throat for long periods of time can become afraid to eat
  • Medical conditions in the neonatal intensive care unit (NICU) – some swallowing related issues can lead to oral aversion, including gastroesophageal reflux disease (GERD), congenital diaphragmatic hernia or tracheoesophageal fistula 
  • Sensory processing disorder – children with sensory disorders may be particularly sensitive to the feel, smell or taste of foods and drinks, including during breastfeeding

Symptoms

Oral aversion is common with premature babies, and babies typically exhibit symptoms within the first year of life. Symptoms include:

  • Appearing hungry/thirsty, but refusing to eat/drink
  • Pulling away and arching back while feeding
  • Feeding only when tired or sick
  • Fussing or crying when a bib is put on, put into feeding position or when a bottle/dish is present
  • Malnutrition
  • Only taking a few, small sips or bites
  • Poor or stunted intellectual development
  • Refusing to open mouth when a breast, bottle, spoon, plate or food is present
  • Skipping feedings
  • Stunted physical growth or failure to thrive (insufficient weight gain)
  • Throwing food

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