Thursday, April 17, 2008

Practical Help for Picky Eaters: Part IIIb

There are two common medically-based issues that your child may have that causes them to be a picky eater. They are others, but these are by far the two of the most common.

1. REFLUX: Also called gastro esophgeal reflux. In the medical profession, it can be called GER or GERD and is in the family of digestive diseases. Lay people refer to it simply as reflux or acid reflux. Let me explain what reflux is.

When we eat, if everything is working as it should, food passes through the esophagus and into the stomach. Once food has passed into the stomach, a muscle which sits at the bottom of our esophagus closes. This muscle is called the lower esophageal sphincter (LES). By closing, the LES helps to direct food and liquid into our stomach. When the LES does not close as it should, the contents of our stomach, which includes acid, can travel back up into the esophagus. This is what is known as reflux. Although I am not physician, it is my understanding that reflux can be caused by a number of factors, the most common of which in infants and young children is poorly coordinated muscles in the gastrointestinal tract.

When the contents of ones stomach and its acid go up into the esophagus or higher, the acid burns. This is where the problem lies and where children start making negative associations with eating....they have a burning in their throat.

The most common symptoms include of pediatric reflux include: 1) pain, irritability, constant or sudden crying,"colic", 2) frequent spitting-up or vomiting, 3) vomiting or spitting-up more than one hour after eating, 4) not outgrowing the spitting-up stage, 5) refusing food or accepting only a few bites, 6) poor sleep habits or frequent waking, 7) "wet burp" or "wet hiccup" sounds, and 8) bad breath.

The less common symptoms of pediatric reflux include: 1) constant eating and drinking, 2) intolerance of certain foods, 3) poor weight gain or weight loss, 4) swallowing problems, gagging, choking, 5) hoarse voice, 6) frequent red, sore throat, 7) respiratory problems; pneumonia, bronchitis, wheezing, asthma, 8) nighttime cough, 9) apnea, 10) noisy or labored breathing, 11) ear infections, 12) constantly running nose, 13) sinus infections tooth, 14) enamel erosion, and 15) excessive salvation, drooling.

My picky eater has reflux. I believe he has had reflux since he was an infant. What symptoms did we see? Very little. I knew what to look for and was actively looking for symptoms, and there just weren't very many visible signs. If you would have directly asked me at the time if I thought he had reflux, I would have said no. He showed symptoms of excessive drooling, a constant runny nose, and kind-of poor sleep habits; the most obvious symptom was that he was a picky eater. That's it.

Here's the thing. We didn't know he had reflux until we put him on a trial of medication to treat reflux.

2. SENSORY INTEGRATION DISORDER or SENSORY INTEGRATION DYSFUNCTION (SID): Previously known as sensory processing disorder, but has undergone a name change in recent years.

Let me try to explain what SID is. Everyone receives input all day long through through our senses. We are continually bombarded with sights, sounds, tastes, touch, and movement. Everyone interprets this input differently, but some people are overwhelmed or have difficulty interpreting these sensory experiences. This difficult interpreting sensory experiences is what is known as sensory integration dysfunction or disorder.

This is what Wikipedia says about it: "Sensory Integration Dysfunction (SID) is a neurological disorder causing difficulties with processing information from the five classic senses (vision, auditory, touch, olfaction, and taste), the sense of movement (vestibular system), and/or the positional sense (proprioception). For those with SID, sensory information is sensed normally, but perceived abnormally. This is not the same as blindness or deafness, because, unlike those disorders, sensory information is received by people with SID. The difficulty is that information is processed by the brain in an unusual way that may cause distress or confusion."

Here's the bottom line: Children who are picky eaters and fall into this category are typically children who do not like the touch or feel of certain things, or have what is called sensory defensiveness. Their senses are interpreted through a highly aroused nervous system, which actually views sensory information that most people would consider harmless, with a "fight, flight, or fright" response. They are preparing their bodies for survival and not recognizing that the thing they are touching is actually nonthreatening!

Let me give you a concrete example. For my son, who has SID, he does not like slimy things, slippery things, grass, or sand to name a few. He does not like the touch on his hands, feet, or anywhere on his body actually. Taking a texture that he does not like to touch with his hands, and then putting it in his mouth, that is taking his aversion to a whole new level. That is where the picky eating comes into play.

Let's take jello for instance. If you would place a piece of jello in your mouth and ignore the taste, what does it feel like to you? It might not even be something you have thought of before. To a child with SID and does not like slippery textures, putting this slippery piece of jello in his/her mouth will cause serious "willies". He will not actually taste the flavor of the jello, because he can't. The texture is so disgusting to him, and the aversion is so strong, that he is simply "grossed out" and wants nothing more than to spit the jello out as fast as he can. Has that ever happened to you? Most likely yes, but with a different food. Clams perhaps? To children with SID and are picky eaters, this happens with the majority of food items we place before them. They do not have just a few items bother them. The majority of things bother them.

A comprehensive checklist of symptoms is available to you at this website. It will help you understand more if your child falls into this category.


That was a lot of information. Take some time to process it and then prehaps even re-read the article. Chances are, if your child has a problem with either reflux or SID, you just read something that sounded awfully familiar and/or made perfect sense to you. Help is available. There are professionals who treat children with medically-based feeding issues. Knowing about these two medically-based issues will assist you in obtaining the professional assistance your picky eater needs.

What questions do you have for me? Please ask me because I want to answer them.

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