Feeding Disorders, Picky Eater

Quality vs. Quantity

Isn’t this an age-old question?  Is it more important to have less with better quality or have more with so-so quality?  Less is more…isn’t that what we say?

Well, when it comes to bottle feeding an infant with gastrointestinal difficulties, this is a very important question.  We need quantity (or volume) for weight gain and healthy development…but we need quality in order to avoid oral aversion and heathy oral development.  Oral aversion is fear, reluctance, avoidance, or fear of eating, drinking, or accepting sensation in or around the mouth.  In other words, they may stop eating if we force volume when their tummy is not happy.

What do I mean by gastrointestinal difficulties?

The more common gastrointestinal difficulties I see are reflux, constipation, diarrhea, or intolerance to certain foods.  In each of these diagnosis, food can be a trigger to discomfort.  It does not take a child long to pair food with the discomfort in their stomach.  It is easier to cause oral aversion than to remove oral aversion.

How do gastrointestinal difficulties cause oral aversion?

The more volume a child eats, the more symptoms they experience.  The more symptoms they experience, the more they tie feeding to discomfort.  The more they tie feeding to discomfort, the less they will want to eat.  The less a child eats, the less weight they gain (or the more weight they loose).  The more difficulties a parent experiences with weight gain, the more they “encourage” their child to eat and increase volume.  This cycle continues until a the gastrointestinal issue is resolved/managed.  However, management of the medical issue may not be all that is needed.

Getting to the other side of oral aversion

Often times, by the time a speech therapist gets involved, the mealtime behaviors are quite out of balance and it can be challenging to find the initial cause of the feeding difficulty.  Fixing or managing the medical issue that caused the oral aversion may remove most of the oral aversion.  However, there may be some remaining behaviors requiring help from a trained feeding therapist.  Check out my other blogs for tips and tricks of overcoming those various behaviors.  My Blogs

So do we want quality or quantity?

The feeding therapist in me ALWAYS prefers high quality feeds over higher quantity feeds.  I believe firmly in listening to the patient’s cues and pushing them just to the point of success and teetering on the edge of what they tolerate to encourage the next step in their development.  However, we cannot underestimate the need for appropriate calories and nutrition.  Without appropriate nutrition, development can’t happen.  So we need both…that’s the answer…they are both equally important.  In order to get both good quality feeds and adequate quantity feeds, the speech therapist MUST work with the child’s entire medical team.

I hope this was helpful.  Feel free to comment below on your experiences with quality vs. quantity in the feeding world!

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