Is your baby refusing to eat by mouth? It could be due to Oral Aversion!

Does your little one refuse to eat by mouth? Does he cry, look away, or clench his jaw when you bring a food or a bottle to his mouth? It's normal for babies to do this sometimes. However, if he continues to refuse to eat by mouth, it could be a condition called 'oral aversion'. Let's talk about this in more detail today, because it can affect your baby's nutrition and development.

What is this (Oral Aversion)? Simply put...

Simply put, Oral Aversion is when your baby wants to eat, but refuses to eat. Think of it like not being able to eat even when you are hungry. The main reason for this is a fear that arises from some unpleasant experiences related to the mouth in the early days of the baby's life. Just like if you were afraid of something when you were a child, that fear will come back when you see it again. If this condition is not treated quickly, the baby may develop further complications related to feeding.

If your baby is showing any of these symptoms, it is important to see your pediatrician immediately for advice, as these things can get worse if not managed properly.

What are the symptoms of a baby with Oral Aversion?

If your baby does these things, it could be a sign of oral aversion:

• When something (food, bottle, medicine) is brought to their mouth , they protest, cry, and look away.
• When you bring something to your mouth , you stick out your tongue and act like you're pushing it.
• As soon as something touches your lips, you close your mouth tightly.
• Refuses to latch on properly, whether breastfeeding or bottle-feeding.
• Sometimes he eats food with his fingers and eats it by himself, but if you try to feed him, he refuses.

It's normal for babies to be reluctant to eat and to look away from food sometimes. It's nothing to worry about. However, in a condition called Oral Aversion, these things happen very consistently and continuously. If you have any doubts about this, your baby's doctor can determine whether it's something serious or not.

Why do babies develop this condition called (oral aversion)?

Oral aversion occurs because babies expect something bad to happen when they put something in their mouth. This means they have learned this from repeated unpleasant experiences with their mouths. These unpleasant experiences include:

• Medical treatments that frequently involve the use of tubes, whether to feed the baby or to help him breathe (e.g., feeding through a nasal tube, inserting a breathing tube).
• Some medical conditions related to eating (e.g., vomiting milk, sore throat).
• Having problems with control of the mouth or swallowing.

Imagine, Niluka's baby was born a little prematurely. So, because the baby had difficulty breathing, he had to be intubated for a few days, that is, connected to a machine called ``Mechanical ventilation''. Then, because he had difficulty drinking milk, he had to be fed through a tube. Because of experiences like these, the baby may develop a fear and an unpleasant feeling about what his mouth says. Later, when he tries to feed him by mouth, the baby may remember those old unpleasant experiences and refuse to eat.

Who is at higher risk for developing oral aversion?

Babies with the following conditions are more likely to develop Oral Aversion:

• Babies who have had treatment for breathing problems. For example: intubation, mechanical ventilation, or tracheostomy (insertion of a tube into the windpipe through a hole in the neck).
• Medical conditions that cause problems with eating, such as gastroesophageal reflux disease (GERD).
• Having a sensitivity (allergy) to something in breast milk or formula.
• Throat-related conditions. For example, inflammation of the esophagus (esophagitis), pain when swallowing (odynophagia), or difficulty swallowing (dysphagia).
• Conditions that cause problems with muscle control or coordination, such as cerebral palsy.
• Genetic disorders. For example: `(Down syndrome)` or `(Moebius syndrome)`.
• Difficulty recognizing their own hunger due to prolonged tube feeding or severe illness early in life.
• Some neurodivergent conditions, such as autism spectrum disorder, can make babies hypersensitive to certain sensations, such as touch.

What are the possible complications of Oral Aversion?

Babies with oral aversion are more likely to develop complications such as:

• Malnutrition or stunted growth.
• The need for enteral nutrition.
• Aspiration pneumonia is caused by food or liquids entering the airway .

Research has shown that there is a "window period" for babies to learn to eat. If they don't learn it during that time, it can be a little harder to learn later.

Also, having oral aversion in infancy can increase the risk of developing other food or eating disorders later in life. Avoidant/restrictive food intake disorder is one such example.

Although these complications are serious, they can be treated. Also, early diagnosis and treatment can reduce the risk of these complications.

How to recognize the condition (Oral Aversion)?

A pediatrician or other qualified doctor can diagnose oral aversion by ruling out other causes. This may involve performing various tests and asking questions about your baby's health history, your home environment, and your baby's eating habits.

For this, tests like these may be done:

• Monitoring and evaluating the way food is served.
• Laboratory tests, e.g. blood tests, thyroid function tests.
• Imaging scans of the baby, such as fluoroscopy or MRI.
• Diagnostic procedures, such as `(Upper endoscopy)` (examination of the esophagus and stomach with a tube with a camera) or `(Esophageal manometry)` (testing the function of the esophagus).

How is Oral Aversion treated?

Treating oral aversion requires a team approach . Your child's pediatrician, along with other specialists such as a speech language pathologist or occupational therapist, will work with you to help your child overcome this fear. There is no one-size-fits-all treatment plan. Treatment plans are usually tailored to your child's needs and preferences.

Treatment may include one or more of the following:

• Providing positive oral experiences: This teaches the baby that not all oral medical things are bad. For example, gently massaging the baby's cheeks and lips, and gently touching the oral area while playing.
• Developing skills: Eating also requires coordination and skill. Helping your baby learn and practice these skills will make eating easier for him. If eating is easy for him, he is less likely to develop aversion to it.
• Exposing your baby to delicious foods: Once doctors have determined what flavors your baby likes, they can teach your baby to enjoy eating. Sometimes, they start by putting a small drop of flavoring on their tongue and then slowly eating it.
• Plan and follow new routines: Creating new routines helps your baby relearn what to expect. It's important to maintain consistency in things like feeding times and feeding locations.
• Teaching yourself and other caregivers: Showing your baby how to feed him/her best can help him/her overcome this reluctance. It can also deepen the bond between you and your baby.

Remember, it's normal to feel frustrated and anxious as your baby takes a while to recover from this condition. However, oral aversion treatment often requires time and the help of various specialists. This condition can be avoided by being patient and following the instructions given by the doctor.

What is the outlook for the condition (Oral Aversion)?

The outlook for oral aversion is generally good, especially if it is diagnosed and treated early. Most babies can make a full recovery from this condition.

Can Oral Aversion be prevented?

Oral aversion cannot be prevented 100%. However, healthcare providers can take steps to prevent it. If there are risk factors that put your baby at risk for needing special medical care early in life, preventive measures can be started early.

There are also things you can do to reduce the chance of this happening. Your baby's doctor can tell you more about this. For example, make oral activities (like washing your baby's face and brushing their teeth) as enjoyable as possible.

Is Oral Aversion the same as Food Aversion?

No, these are two different things. Oral Aversion is a very common thing. It means that the baby will try to resist and avoid anything that comes near their mouth, including eating.

However, food aversion can be very specific. That is, your baby may dislike specific foods, specific smells, or just the texture of the food. For example, some babies may like liquid foods like porridge, but may not like solid foods.

It's understandable that you might feel frustrated and sad when your baby refuses to eat. You might even be tempted to blame yourself. But remember, oral aversion is a very common condition. In fact, research has shown that about one in two babies experience it (although most of them are mild).

If you think your baby has a more serious case of aversion, definitely talk to your baby's doctor. He or she can explain what's going on and what your baby needs. He or she can also advise you on what you shouldn't do. Then you can give your baby exactly what he or she needs until you both get through this difficult time.

The most important points (Take-Home Message)

Okay, so, from what we've talked about, these are the most important things you need to remember:

• Oral aversion is a condition in which a baby refuses to eat by mouth and exhibits a fear of oral objects. This is different from a normal food aversion.
• The reason for this may be early unpleasant oral experiences .
• They may show signs such as crying, looking away, and clenching their jaw when something is brought to their mouth.
• Early diagnosis and treatment are very important, otherwise complications such as malnutrition can occur.
• Treatment may require the help of a team, such as a pediatrician, speech therapist, and occupational therapist .
• With patience and following the right methods, this condition can often be reversed.
• If you have any doubts about this, or are concerned about your baby's behavior, be sure to consult a doctor. You are not alone, and there are professionals who can help.

Remember, every baby is different. So, don't compare yourself to other babies. The most important thing is to treat your baby with love and patience, and follow the doctor's instructions.

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