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Children's Health

HELP!! My son wont eat `big boy` food

11/09/2009

Question:

my son is a year old and since he was born he has had problems eating and drinking. My son at a week old was drinking his bottle of formula he then projectile vomited and began choking. This has happened several times! i began feeding him pureed food and he would gag and throw up and start choking and stop breathing. I have been trying to feed him small pieces of turkey,small pieces of fruit, cheerios ect. he will not eat it, i set it on his tray and he will pick it up but drop it on the floor, i try putting pieces of it in his mouth and he gags and throws up. i have been trying to get him to use his sippy cup and he will not!! my son is 29 inches long and weighs 19pds he is a year old the dr is concerned because his head is in the 75th percentile where his body itsself is only in the 5th percentile i have tried everything! my sons previous dr. said that my son had GERD well i need to know of anyway to get around this i want my son to be healthy and eat PLEASE help me!!

Answer:

I know this is frustrating for you! Let's take a look at your son's growth. At 19 pounds he is close to the 10th percentile for a 12 month-old boy. This means he is lighter in weight than 90% of age mates but weighs more than about 10%. In terms of length he is at the 25th percentile, so he is longer than 25% of boys his age but shorter than 25%. He is thin for his length. However, the danger zone is usually considered to be a child at or below the 3rd percentile.

However, I am seeing only one set of measurements while his doctor is seeing a pattern of growth over time. We worry when children cross downwards over 2 major growth percentiles. I don't know if that is true for your son or not. It would be good to ask to see the growth chart and have the doctor explain changes in growth pattern of concern.

His biological father and you also influence his growth. You can judge if there is a growth pattern if you consider his predicted average final height and plot this on a growth chart. If this predicted final height percentile and his length percentile match, it is less likely there is a growth problem.

However, you report feeding problems since birth. In addition to GERD, there may be a problem with a narrowing in your son's food tube, or esophagus, or with a hole between his breathing tube, or trachea, and his esophagus. If these problems have not been checked for already, they are worth asking about.

Other things that might lend perspective include: children typically triple their birth weight by 12 months of age, they also slow  in their growth velocity at 6 months and again at 12 months. Because they are growing more slowly, children eat less. In addition 12 month olds become toddlers and toddlers all about declaring what they want, usually the opposite of what parents want. This often leads to food battles with the young child, something parents are well advised to avoid.

Another problem that fits your description is autism. Many autistic children have extreme sensitivities to changes in flors, food thickness, and food texture. They tend to growth poorly in weight, but well in length. They often have unusually large heads for their length. You may want to ask his doctor to conduct a screening for autism or to refer you to a behavioral and developmental specialist at the nearest children's hospital.

If the problem is the average, healthy but challenging toddler, books that are helpful to many of us include Ellyn Satter's Child of Mine, and Dietz and Birch's Feeding Behaviors of the Young Child.

Pediatric occupational or physical therapists as well as speech and language therapists all can help with improving the young child's tolerance of diverse foods. The feeding clinic at the closest children's hospital is also a great resource.

Unfortunately, these problems are not quickly solved, but there is help available. You have worked hard since infancy to help your son thrive. So great job! The toddler years often call for some extra help. Try to stay calm and positive, focus on what is wonderful about your son, and avoid all power struggles and upset as you work with his doctor to solve his eating issues. I wish you well on this difficult journey!

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University