DEAR ERI COMMUNITY:
Client with Feeding Difficulties:
I am seeing a child who is now 15 months of age. She was born at 36 weeks gestation, with very low birth weight and a very weak suck – was never able to breast feed successfully. After transitioning from hospital to home, mom found that only one orthodontic nuk nipple would work for feeding her 50/50 mix of breast milk and formula. The child was very sensitive to different bottle nipples, many of which would make her gag and vomit. Since 1 month of age, the child has been vomiting almost daily (previously was after every feed). She was diagnosed with reflux (GERD) and put on medication (Prevacid), which was recently discontinued due to doctor’s belief that the reflux has improved now. The child was able to take in enough with the frequent liquid feeds, and she is still currently an age-appropriate weight. Mom has been trying several strategies and for over a few months to transition her to accepting anything solid (started with trying pablum, which child could not accept without having a gag and/or vomit response). Mom has applied all recommended sensory strategies (z-vibe introduction and exercises, tactile exploration, sensory play, introducing new smells/tastes in graded steps, and use of wilbarger oral protocol, etc.). The problem now is that the child’s transitioning to solid foods and thickened liquids is ongoing, but slow. As well, the child has been vomiting daily since 1 month of age. Now, when the child coughs too much, gets too upset, or has something stuck in her mouth that she can’t get out with her tongue, she uses vomiting as a default strategy for getting anything uncomfortable out of her system. The mom would like to know if there are any strategies/tools or approaches that can be used to 1) stop the vomiting from occurring once she can see early signs of that response in the child (i.e. if the reflux is just starting, the mom can sometimes stop it if she distracts child by putting her feet in water — she would like more strategies like this); and 2) prevent the child from developing a voluntary behavioural issue with vomiting, as she matures.
Any advice, recommendations, feedback from other health professionals familiar with these issues would be greatly appreciated!!!!! Thanks