[Dysphagia] help with pediatric oral aversion

[sem at new-vis.com (Suzanne Morris)]

I think it is risky to make the assumption that just because some  
children gag and throw up when they see food that they are "making  
themselves throw up".  Because of current or prior associations with  
reflux and other gastrointestinal difficulties, many of these kids  
develop strong associations between the sight and smell of food and  
nausea, gagging and vomiting.  These kids don't have problems, as you  
point out with other non-food things in the mouth because that's not  
where the problem lies.   This is one of the reasons I don't like  
calling this combination of problems an "oral-aversion".  It is  
really a eating-systems aversion or discomfort that is not  
specifically related to an oral discomfort.   This is very different  
from the child whose sensory system is malfunctioning and creating a  
heightened or noxious response to the sensory input that comes into  
the mouth through taste/smell, texture, temperature etc.   If we look  
at all problems of discomfort/rejecting food orally as an "oral  
aversion" we fall into the trap of believing we have to do something  
with the mouth to reduce the problem.  This has lead to lots of mouth- 
focused therapy to desensitize the mouth etc.   Again, our diagnosis  
or hypothesis about the nature of the problem should lead us to a  
treatment approach that is effective, or at least not harmful to the  
child.

I had an interesting situation this Fall that pointed this out to me  
in personal experience.   For several months I dealt with a problem  
with ulcerative colitis in which I experienced a constant mild  
cramping pain and nausea related to ulceration of my colon.   My  
interest in eating was almost at a zero level.   On some days the  
sight or smell of food actually caused more nausea, almost to the  
point of gagging and retching.   On other days the same sensory food  
input caused no problems at all.  On still other days (when I felt  
better), I was really interested in eating the very food that had  
caused nausea, gagging and a strong system rejection on a previous  
day.  This seemed to have nothing to do with my learned associations  
that food was causing me more discomfort.   It seemed to be a very  
physiological response that related to the totality of whatever was  
going on in my body at the time.

It is for these reasons that I suggest that we not jump to  
conclusions that kids who gag and vomit have an "oral aversion"; and  
certainly we need to be very cautions before we suggest that they are  
making themselves throw up.   Of course, there are kids who have  
learned to throw up to get people to take the food away; but not  
every kid who does this is triggering and using their gagging and  
vomiting to generate a specific response in others.  It is clearly a  
physiological response in others and a combination of a physiological  
response and heightened stress reaction in still others.

__________________________________
Suzanne Evans Morris, Ph.D.
Speech-Language Pathologist
New Visions
1124 Roberts Mountain Rd.
Faber, VA 22938
(434) 361-2285 ext. 5
www.new-vis.com

On Jan 16, 2007, at 9:23 PM, Otpitt98 at aol.com wrote:

i have several toddlers who all have oral aversions and who all have g
tubes,,,,some of the kiddo's gag and make themselves throw up at just  
the sight of
the food they will however, put everything else in their mouth.

Michelle J. Storm, OTR/L
Occupational Therapist, Registered and Licensed NM #1899
Kids Unlimited