Case Challenges

Picky Eating and Food Aversion, From Typical to Extreme

Katja J. Rowell, MD; Jenny H. McGlothlin, MS, CCC/SLP


April 04, 2016

Failure to Thrive?

Jaden, a 16-month-old boy, has been your patient since birth. His mother brings him in because although he has been in feeding therapy for 6 months, he is still not gaining weight appropriately, and intake is declining. He gags on lumps in food and won't eat offered finger foods, although he seems interested. His mother is tearful and anxious.

Jaden was born at term, weighing 8 lb 4 oz. He had difficulty breastfeeding, and a consult showed a tongue-tie, which was clipped by the on-call pediatric ear-nose-throat (ENT) specialist. Jaden was able to breastfeed subsequently, although he always took a long time and his mother experienced significant nipple pain. He was started on solids at 6 months, and transitioned fairly well to smooth purees by spoon.

At a 10-month well-child visit you noted that Jaden had fallen off his curve for weight, which had been stable at the 50th percentile. He was not losing weight but was gaining more slowly, while his height remained stable. You referred him to a feeding clinic where he began an intensive behavioral program. Initially, Jaden's mother reported some improvement in intake. She describes how the protocol used cartoons for 4-6 hours a day to distract him and get more bites in. Mom feeds pureed foods to Jaden, providing positive reinforcement if he eats and ignoring his behaviors if he doesn't.

In the past month or so, Jaden is eating less and is more upset at meals. He still breastfeeds, but the psychologist providing feeding therapy has asked her to stop, fearing that it sabotages his appetite. Jaden's mother feels she is "failing as a mother."

On examination, Jaden's weight, although increasing initially with therapy, has begun to fall off again. He appears happy and well-attached to his mother. There are no indications of abuse or neglect. An oral exam shows scarring and possible restriction of the lower lingual frenulum. His physical exam is otherwise unremarkable, with no indication of dehydration.


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