Casey was a 16-month old girl who had never eaten by mouth when she came to our clinic for help with oral feeding skills. She was born slightly premature and had a twin sister who ate fine. She did not have any medical problems at birth except that she did not progress to eating. She never latched on to the nipple and showed a poor suck, so a few weeks after birth she received a g-tube (a gastric tube into her stomach so that she could receive nutrition). Along with her g-tube, a nissen fundoplication was done (a surgery to prevent gastroesophageal reflux or backflow of stomach content into the food tube) as a precaution.
At this point, Casey looked like a healthy toddler except that she would not accept food. She was interested in holding and licking crackers and salty foods but she would gag and retch if they came near her mouth. She had also been receiving oral motor therapy since 6 months without success in transitioning to oral feeding. Her g-tube feedings were given every 3 hours to simulate a normal feeding schedule in hopes of making her hungry and want to eat. Unfortunately, she often gagged and retched with tube feedings.
We made several changes in hopes of getting Casey to oral feedings. First we slowed the rate of her tube feedings down to a continuous feeding for 16 hours of the day. We also changed her formula several times trying different kinds of predigested formulas. It seemed that a slow rate helped her tolerance of the tube feedings but the type of formula did not make as much of a difference. With the slower rate, her gagging greatly decreased although she continued to have gagging once a month. We noticed that after several weeks of not gagging, she would begin to be interested in food and start to eat. This would all stop, however when her gagging returned. Next, after a visit to a gastrointestinal doctor (stomach doctor) and a doctor who specializes in feeding, a few more changes were made. Her g-tube was changed to a jejuenal tube or a tube going into the intestine. This would hopefully eliminate reflux and the retching. She was also placed on a medicine called Baclofen which relaxes muscle tone in hopes that it would decrease spasms in the digestive tract. These last two changes seemed to work for Casey and her retching stopped. A few weeks later she began to eat and in a few months she was off the tube feedings completely.
Casey?s quick recovery was unusual but the key to her success was making her stomach feel comfortable. Luckily, she had not lost any interest in eating and when her gagging and retching were eliminated, she started to eat. We will not remove her g-tube until she has gone through the winter months just in case she were to get sick and stop eating again. But so far so good!
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