Author: Krisi Brackett MS SLP/CCC
Michael was referred for a feeding evaluation at the age of 3 ? years due to a long history of poor eating. He had attended oral motor/sensory therapy for over a year with no change in his eating habits.
Medical history:
Michael is a 3-? year old boy with no known medical problems. He was referred for severe food refusal (he had not swallowed a new food in 2 years) and failure to progress in oral-motor/sensory feeding therapy. At the time of referral, Michael was accepting 3 foods; goldfish crackers, French fries, and vanilla custard.
Michael?s medical and feeding problems began in the first year of life with chronic ear infections, ear tube placement at 7 months, limited food intake and irritability. At 9 months, he began refusing foods and showed no interest in textured foods. From the ages of 1 to 2 he would accept 6 foods (3 baby foods, goldfish crackers, cheerios and French fries). At 2 he started in oral motor sensory feeding therapy (play in food, oral exercises, etc.) which he attended on a weekly basis for over one year with no success in the acceptance of food. His Mom expressed great frustration with his feeding issues. At 2 ?, he was seen by a Gastroenterologist (stomach doctor) and underwent an endoscopy (small tube with a camera looks at the food tube and stomach) which was normal. He was also seen by an Ear, Nose and throat doctor who removed his adenoids (adenoidectomy) because of snoring and a 2nd set of ear tubes were placed.
Examination: Michael appeared to be a well-nourished boy with weight in the 90th percentile. Oral exam was unremarkable with normal motor function.
Progress: We referred Michael back to pediatric gastroenterology to try some acid suppressant medication because of his history of subtle gastroesophageal reflux (GER) (ear infections, food refusal, and picky eating can sometimes be caused by GER). After placement on Prilosec?, his mom felt that he was sleeping better and eating larger amounts of his preferred foods but still would not accept new foods. The doctor repeated the endoscopy and ordered a pH probe (a small tube placed in the food pipe that reads acid levels). Results from both were normal, however the probe test caused him so much discomfort that he did not eat well during the test and stopped taking one of his few food choices (vanilla custard).
A structured behavioral feeding plan was put in place during which Michael would receive a reward for accepting a spoon with food on it in his mouth. Over time he learned to take applesauce but would not accept any other foods. Mom followed the protocol 2 ?3 times each day at home. With the introduction of a new food, he would throw a tantrum, refuse, and cry. At this point he was referred to the intensive-feeding program at a specialized children?s hospital.
Outcome: His medication was increased and he went through an intense 4 weeks of structured feeding sessions along with physical therapy for subtle shoulder rounding and decreased trunk rotation. Structured feeding sessions consisted of a reward for taking food. The beginning was rough but his Mom said later that it was nothing she hadn?t seen before (tantrumming, spitting, refusal, even vomiting) and that he turned a corner with the increase in Prilosec?. After 4 weeks at the intensive program Michael was eating 30 foods. Today, Michael continues to progress and is no longer followed in therapy. He is monitored each month by a local psychologist.
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