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Questions & Answers - Behavior Concerns
My husband and I just adopted a 17 month boy from Russia. He is
at the 25 percentile for both height and weight. However, since arriving
home he has begun refusing to drink or eat. He acts hungry, but then
only takes a few sips or a few bites then turns his head, arches
away from me, seals his lips shut and cries. I'm tracking his intake
and he is only getting 500-600 calories a day. I will be weighing
him tomorrow at the doctor, but last week he had lost half a pound
since adoption ( 4 weeks ago). He also only has accepted pureed baby
foods and a bottle from me. He will take sips from an open cup.
Children who were raised in orphanages, even if they are still very
young, can come with a unique set of challenges when it comes to
feeding. Unlike typical children raised in loving and nurturing
environments, your son may not have been accustomed to having an
adult pay attention to him and actually feed him during meals. Babies
learn early on that food brings comfort and relief from hunger.
Unfortunately, babies who spent their first months or years of life in
institutional care often did not learn this and may have only received
their formula by propped bottles or by a caregiver feeding many children
at a time. Also many children learned to eat to a set time and schedule
and not their own hunger pangs. Children adopted from institutions or
other places where they were served extremely bland food may display
pickiness with regard to their food selections. These children may need
to become accustomed to the many new tastes you serve; pressuring them,
engaging in a power struggle, or taking it personally will only create
future problems in your mealtime experience.
It is great that he will take sips from an open cup, and I would
suggest moving toward using the open cup and/or a straw cup (which
is better for oral motor skills than a sipper cup with a spout) for
meals if he can manage it. Here are some suggestions:
Keep mealtimes positive and pleasant. Always have a family
mealtime, so your son can observe everyone else happily eating.
Do not force him to eat or drink or express displeasure or anger
when he does not eat or drink.
Praise him for simply touching a food or bringing it to touch his
lips, even if he did not taste, chew or swallow it.
Make sure you are partaking of some of the same foods on your
son's plate.
Allow him to self-feed using his fingers if needed, so he can
explore the texture and taste of foods on his own, which he may not
have had experience with.
Use meltable foods, such as cheese curls or Gerber puffs that
dissolve easily when he puts them in his mouth, so he can finger
feed.
Gradually thicken his purees using crushed up crackers or other
additives to build up the texture and thickness of his food, since
he may not have been served any solids or table foods in the
orphanage and may be unaccustomed to handling textures in food and
have no experience with chewing.
To help him practice chewing, you can buy a mesh food bag and
place flavorful fruit or other foods inside to let him practice
these skills.
He may not have had access to teething toys and may benefit from
some oral motor play with toys to "wake up" his mouth before meals
and get him ready for eating. You can use vibrating teethers or even
dip nubby toys into pureed foods and let him experiment with oral
play that way.
Use a Nuk tooth brush or a vibrating tooth brush for oral
stimulation.
Skip Stage 3 baby foods, as these often lead to texture issues in
many children and move directly to easy to chew, small chopped
pieces of table foods. Cut toast in strips so he can hold one end
and bite on the other and try to present foods on the sides of his
mouth, toward his molars, not in the center to encourage chewing and
tongue lateralization.
Since weight gain is an issue, enhance foods that he will
currently eat with added butter or sugar or powdered milks. Make
milk shakes he can drink from a cup, but boost calories with full
fat ice cream & add instant breakfast powder and pureed fruit.
This article talks about calorie boosting in foods.
Definitely check in with your pediatrician on health/weight gain
issues and ask for suggestions and perhaps a consultation with a
nutritionist for your son. Some children are prescribed additives
for extra calories or given Pediasure to boost calories.
My final advice is to definitely make a call to your local early
intervention provider for a developmental assessment for your son.
Many early intervention programs will offer the services of an
occupational therapist and/or speech therapist to work on children's
feeding/self-help skills.
This is a link to services in Idaho.
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Questions & Answers - Behavior Concerns
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