Feeding issues part 1

Please note, the ideas in this article are based on my own experiences with Adam (18 months old at the time of writing) and the research that I have done to help him to overcome his problems. You should always check with your doctor before making any changes to your baby's diet. At some point in their lives, many babies and children with reflux may experience some food aversion.

For most sufferers, once their pain is resolved, their appetite returns and they start to enjoy their food again. At the other end of the spectrum, some children and babies may need tube feeds to augment or replace feeding by mouth. With specialist help, many of these children will learn to eat again.

This article deals with the middle group: babies and children whose medical or physical problems have been largely resolved, but they still don't want to eat. This can go on for months, or even years. In many cases the reasons are psychological, the child or baby simply associates eating with pain.

Forcing a child to eat does more harm than good and can build on an aversion. What can help, however, is gentle persuasion, combined with patience, some tasty foods and, occasionally, a little bit of guile.

Weaning

For some babies weaning marks a recovery from reflux. The theory behind this seems to be that heavier foods sit better in their stomachs, whereas liquids are easily regurgitated. These babies generally do well if fluids are given at the same time as solids, and/or their bottles are thickened.

As with all babies, weaning a refluxer is best done slowly. Your doctor or health visitor should advise you on a first food. We started with baby rice, mixed with formula. It tastes familiar and Adam had no problems with it. However, some people suspect that rice triggers reflux. As with all trigger foods, all you can do is try it, and make up your own mind.

Once you move on to fruit and veg, do make as much of your own food as you can - apparently jars are very low on calories. Not a big help when so many refluxers are also failure to thrive. Making your own food also gives you greater control over the foods that you are introducing to your baby - enabling you to spot allergies or reflux triggers. There are few jars available that only contain a single food. Heinz and Beechnut offer the best ranges that I've found.

Helping older babies and children to eat

For some reason I refuse to play the 'choo choo down the big red tunnel' game. But I'll try just about anything else. Here's a list of some techniques that can help. I've tried most of these at one time or another!

Have more than one thing on offer

Sometimes Adam feels like eating with a spoon (usually it's me that has to operate it), sometimes he wants to eat himself. I've got no way of predicting this, so I try to be ready with a couple of things - even if the finger food is just toast. Sometimes he will swing from one food to another several times during the meal. I try a maximum of three things, then the final clincher of a biscuit, and if he doesn't want eat after that, I'm pretty sure that he really isn't hungry!

More than one sitting

Sometimes refluxers need a little extra time to let the food settle safely into their tummies. So it can help if you give them more than one opportunity to eat. A baby that was screaming in the high chair will sometimes gets back into it with enthusiasm after a half hour break with some toys.

Grazing

When a baby hates the high chair and refuses to sit in it, simply leaving food out around the house can help. Messy, but it goes in where and when it's wanted. Sometimes once a baby has got used to the idea that eating isn't all that bad, they will go back in the high chair.

Distraction - toys, books, tv, video

I never thought that I would be encouraging my child to watch television at mealtimes, but it's one of the most the most powerful eating incentives that I've found! A dose of the Tweenies to accompany Adam's rice krispies guarantees that he eats well and is set up for the day. Some mothers say that reading books has the same effect. Another good trick is to keep a few toys (wipe-clean toys!) only to be used in the high chair. Change them regularly and hide the others away so that they seem like new when their turn comes round again.

No distractions

This seems like a complete contradiction of what I've just said, but all babies are different and some may react better to eating in a peaceful environment, so that they can concentrate on what they are doing. Keep external stimuli to a minimum, put the dog out and park older children in front of a video in another room. Enjoy a little quiet one-on-one time with your child and some food.

Music

This can be a tremendous help. Any kind of music - childrens' songs, classical music or even rock. Some children need to be soothed at mealtimes, others need to be cheered up by a lively tune. Music helps to reduce a mother's stress too!

Playing with food

Allow, even encourage your child to play with their food, particularly new foods. This enables them to get used to the texture and smell. Eventually the hands will find their way into their mouths. (This one drives me mad, but it does work.)

Different feeder

Adam generally eats better for me than for anybody else, but sometimes he gets fed up with my haggard old face. Wheel on Daddy, Grandma or just a friend and sometimes it will give a child's appetite a boost. New face, new chat, new games - mealtimes are exciting once again.

Food from your plate

This is where the guile comes in. Most babies are desperate to have what is on an adult's plate. Even if it's the same as their food, it always tastes better from your spoon. I use this to my advantage, by making sure that whenever I eat there is something on the plate that is safe for Adam to eat too. I make a great show of reluctance and then eventually hand it over. It works a treat! It's particularly useful if he hasn't eaten very much of his food - I just add it to my plate, go and sit down, and he's immediately by my side to see what I'm eating. It doesn't matter at all that it tastes the same as what he's just refused, as long as it's Mummy's it's got to be good.

Get out of the house

When it all gets too much, take the eating somewhere else. Go to the park and let your baby eat what he wants and throw the rest to the ducks or stamp it into the grass. Go to a restaurant (McDonalds?!), where sometimes he will be so fascinated by watching other people that he will keep eating. Adam will eat loads in his pushchair, sticking up his little hand for more as I wheel him along. The fresh air and change of scene is great for me too.

Eat with other babies and children

Sometimes reluctant eaters can be inspired by seeing other little people eat. They want to be part of the gang and eat just because everybody else is eating. Invite a friend round for tea, or arrange to eat at somebody else's house for a change. This is also a good way to introduce new foods - if a baby sees another baby eating something, he is more likely to give it a try.

Concentrate the nourishment at the best meal

Babies have different timetables. Adam's has changed several times over the last year. For a while he refused breakfast point blank, now it's his biggest meal. For a while he threw up lunch, every single day, no matter what it was. Then ate a huge tea! If your baby has a clear schedule, then you can manipulate it to make sure that he is eating a balanced diet. For example, I'll sometimes give Adam a little ham or tinned fish at breakfast - that's one portion of protein taken care of, so if he refuses it later in the day I don't need to panic.

Take a step back in time

This is pretty drastic, and probably one to talk to your doctor about, but short term this really helped us. When Adam was finally diagnosed at seven months he was prescribed Zantac and Domperidone. At the time he was hardly eating anything and would cry as soon as he saw the high chair or spoon. So I decided to start right back at the beginning again. I tossed out all his mixed foods and we went back to baby rice, pear and squash. These old favourites got him used to the experience of eating solids again and once I saw that he was enjoying eating a bit more, I started to re-introduce the mixed food. It only took just over a week, and I thought that it was better than having him not eat at all.

Foods that may trigger reflux

This is Prilosec's (Losec's) list of foods that can trigger reflux episodes:

• Spices
• Onion
• Citrus
• Peppermint
• Carbonated beverages
• Tomato
• Pepper
• Chocolate
• Alcohol
• Coffee

Some mothers have reported problems with rice, which is worrying, as it is often recommended as a first food. It is also a staple of some children's diets, particularly children with allergies, as rice is often used in products that can replace, for example, gluten, dairy, soy and corn. Again, personally Adam had no trouble with rice, and in the early days he ate a lot of it!

Fried and fatty foods are also notorious for acid rebound. This is another tricky group. A low fat diet is not recommended for babies and children. Plus, fat is a good source of weight gain for failure to thrive refluxers. I ploughed ahead with the frying pan and didn't notice any ill-effects.

At the end of the day, all you can do is use your own judgement. It's not a good idea to automatically exclude any food as you could be denying your child valuable nutrients. Just be aware what the suspect foods are, and watch closely for any reaction

Introduce new textures slowly

Many refluxers are very sensitive to different textures. New food textures should be introduced slowly. It helps if the taste is something that they already like - so, for example, if you are introducing cake and you know your child likes apple, try and find a recipe for apple cake. Start with small bites; even just one bite for the first few times. Don't worry if your child mouths the food and then spits it out - just try again the next day. You may find that after a few attempts, the mouthings become chewing and then swallowing. However if you see any signs of an allergic reaction or choking, stop immediately.

Puree with pride

If your baby has a problem with textures, don't be ashamed to puree food. If your child eats a good balanced diet this way then that's fine. Ignore the mothers of eight-month olds who are swallowing big chunks; just give your baby the extra time that he or she needs to achieve this too.

You can also introduce texture very gradually by controlling the thickness or lumpiness of the puree. We added baby rice to everything to make the purees smooth, but thicker and thicker. Once Adam had got used to working a fairly thick puree around in his mouth we were able to move on to lumps. I've also read that adding wheat germ to purees is a good way to introduce lumps slowly: 1/4 tsp to each 4oz, and move up a 1/4 of a teaspoonful at a time as your baby adjusts. (Not suitable where a baby is too young to have gluten products).

Finger foods are another good way to introduce more lumps. It's odd, but some babies who will only eat the purest of purees will also chomp happily on anything that they can hold in their own little hands. Adam was one of these. It's been suggested to me that this is because refluxers like to be able to control the rate of consumption. Also, when they chew a finger food they are prepared expect it to be more difficult to swallow; whereas with their sensitive throats, unexpectedly lumpy food from a spoon can catch them out, leading to choking, gagging, pain and eventually, refusal. In due course, these babies put together the lumpiness and the spoon and the problem is solved.

Whatever you do.add lots of positive reinforcement

Let your child know how pleased you are when he/she eats. Do your best to ignore tabletime bad behaviour and food refusal, and praise the good behaviour and any food consumption at all - even just a tiny mouthful. Loving attention is an incredibly powerful incentive for all children.

Supplementing foods

There are a few 'little extras' that can help a child that simply needs to put on weight, and fast. Please note, these are not everyday measures and you should speak to a dietician or a doctor before implementing any of these.

Duocal - this is a prescribed dietary supplement made up largely of fats and sugars. It's a powder that you mix into food. Duocal is only given on prescription, where a medical practitioner considers it to be necessary. The homegrown version is to add a teaspoonful of oil to foods. Beware, though - there is a danger of making a diet too fat- or carbohydrate-heavy, at the expense of other essentials, such as protein. This is why you should always seek expert advice.

What you can do, however, is when you are cooking for your baby or child, that you have a slightly heavy hand with the butter or cooking oil. Also, always give young children full-fat products - not skimmed or reduced-calorie. Incorporate foods that are naturally fattening in your child's diet - for example, banana is more fattening than apple, avocado is more fattening than cucumber and cream cheese is more fattening than marmite. However, make sure that you still offer plenty of variety, don't restrict your child's diet to purely fattening foods!

This page was written by a fellow member who has very kindly put some of her knowledge, ideas and experiences together. Please always remember to check with your medical professional with regards to any of the above, this page has been written based on a personal experience and may not be suitable or apply to every Infant/child.

Written by Tracey (Chairman)