not eating real solids

[kati_kati]

My DS is 25 mo and still eating purees. He has global delays, about a year behind in most things. He did eat meltable solids (like veggie sticks from Trader Joes and pretzels and crackers) occasionally about 3-4 months ago, then stopped. We didn't think it was a big deal, so we stopped offering them for a while because the crackers etc are just like toys to play with for him. We've been trying again for the last 2 months but he refuses to eat them and won't put them in his mouth (or let me feed them to him - he will feed them to me, though!).

Our regular occupational therapist has not been much help. Another OT told us to just focus on providing a structured, distraction-free mealtime, no toys etc and the rest will come. Will that really help? We eat 4x a day and sometimes he is fine without much distraction, but other times he needs a book or some kitchen utensil or something to keep his hands busy and then I feed him and he eats great. We try to eat at the same time as we feed him, but he doesn't seem to care what we are eating. Sometimes he will put his hand in my food if I put it in front of him, but he has never picked anything off my plate and put it into his mouth. He will sometimes self spoon feed his purees if he's motivated enough.

I've tried making the purees thicker. He can handle lumpiness as long as the base puree is nice and smooth, not too chunky (like I can put pieces of boiled apple inside apple sauce). He swallows some chunks well then, but doesn't chew them. We even tried chocolate cake (!) but he spits out anything that's not goopy enough. I'm even thinking of putting pure sugar on some crackers or something, or maybe jam? I don't know if that will do it. It definitely seems behavioral, because he had the skills in the past I think, but he is also definitely limited in motor chewing skills. Maybe he's scared he can't chew well enough. He has no words and only one "d" consonant sound so far.

I need ideas!! Please send me your thoughts! Thanks so much.

[frontierpsych]

My DS is 19 months, has no real delays, but is still very picky when it comes to solid foods. It's still 90% breastmilk, but he will sometimes eat 1/2 to 1 jar of baby food in a day, or sometimes some cheerios or crackers (most of which end up on the floor). I am not sure how to get him to eat more, but I am glad that I am able to breastfeed him and know that he at least has that!

PS - I am a Kati too!

[KimPM]

I'm not sure it sounds behavioral. It sounds like he's still doing the suck-swallow thing and he hasn't really learned to chew. Perhaps an SLP (speech-language pathologist) who specializes in feeding therapy can help. This would be instead of, or in addition to, an OT who does feeding therapy. They have totally different approaches, as the SLP has very detailed knowledge of how the mouth works.

My DS was doing something similar, and he has SPD with HUGE mouth and hands texture issues. First, just a look at the food texture was threatening to him. Then, he didn't know how to chew, and I think he knew that. Whenever he got something he had to chew in his mouth, if the texture didn't gag him, it scared him that he wasn't able to coordinate the chewing motion, so the food always came back out. Add to that his general anxiety issues, and you have one kid totally afraid of food.

The SLP identified his oral coordination issues and worked with him first on learning to chew on non-food therapy items. She also worked on texture desensitization both inside and outside his mouth. Then she worked toward chewable food items. After that, she worked with him on play-based feeding therapy to help him get over the fear and texture issues. All of that was very helpful. However, we had to get and pay for this privately, though our insurance covered a portion of it. I had to call around and ask a lot of questions to find the right therapist. EI (early intervention) where we are located and other feeding therapy places just weren't equipped to handle it, as we wasted about a year without results from those places.

[kati_kati]

I guess I feel like it's partly behavioral because he was learning to chew a few months ago, and then he just stopped. He was eating big fat pretzel sticks, and I was giving him bits of almond butter on "Ritz-type" crackers. I don't know what happened exactly.

Over the last few weeks we've been trying to get him to self-feed again. I give him a full spoonful and he puts it in his mouth by himself. I wonder if self-feeding is related to the crunchy stuff, somehow, because I finally got him to "self-feed" a whole meal yesterday and he was chewing on the plastic spoon in between bites and then later he even put a 'veggie stick' (meltable) in his mouth and crunched a few times! First time in months! So maybe there is hope.

I guess I'm just really frustrated at our OT for not being helpful. It's been a total waste of time (like KimPM said!). I will have to think about the SLP idea, or switching OT's or something. I guess I'm curious if there are other theories out there for teaching kids to chew... Is there a good resource to read about this somewhere? I want it to make sense to me...

frontierpsych - we were close to 90% breastmilk at that age too! DS still nurses but my supply is way down, nothing like before. he eats a lot more pureed "solids" of course now. is your little one still growing/gaining weight ok? all our doctors were worried about our DS because he stopped gaining any weight for 6 months (was only on breatmilk) and then finally started eating purees.

My DS by the way loves touching things with his hands - he rubs the wall, scrapes his nails on anything that has texture. I guess like Kim said he's probably scared because he doesn't know what to do with the new food textures.

[KimPM]

Hmmm, he likes chewing on crunchy things and touching things with his hands. He sounds very sensory seeking, but in particular ways. Children with SPD can be both sensory seeking and sensory avoiding. It's weird. My DS chewed on anything hard that was NOT food. But he still couldn't figure out how to chew food...until the SLP worked inside his mouth. The texture thing also varies over time. One day my DS may be fine with eating something and the next, he's complaining about the texture of it. So that may be part of it too.

BTW, the first foods my DS would even touch with his hands were very hard foods like a pretzel stick or a cracker. They were also the first kind of things he tried to eat too.

Perhaps you could get an evaluation (at least) by an SLP. See if they can tell what is going on. Maybe he had some mis-coordination while trying to chew and it scared him. Who knows. A good SLP can spot an oral problem at the first visit.