Older children may refuse to eat some foods, become picky eaters or even go on binges where they will only want to eat a certain food. An important way that children learn to be independent is through establishing independence about feeding.

Even though your child may not be eating as well rounded a diet as you would like, as long as your child is growing normally and has a normal energy level, there is probably little to worry about. Remember that early childhood is a period in his development where he is not growing very fast and doesn't need a lot of calories.

Food refusal in younger children and infants, especially refusing to begin to take solids, is usually a different matter.

It is recommended that infants be started on solids foods when they are about four to six months old. Cereal is the first solid you should give your baby and you can mix it with breast milk, formula or water and feed it to your baby with a spoon (not in a bottle). Start by feeding one tablespoon of an iron-fortified Rice cereal at one feeding and then slowly increase the amount to 3-4 tablespoons one or two times each day.

If your infant refuses to take the cereal with a spoon when you first introduce it, then just wait a week or two and try again. Not all children are ready to begin solids at the same time.

By seven or eight months however, if your child still refuses to take solids, then you should have an evaluation with your Pediatrician. If he is otherwise growing and developing normally, then his refusing to take solids may very well be normal, but it is important to rule out other disorders, so that treatment, if necessary, can be started.

An evaluation is especially important if your child is not gaining weight (failure to thrive) and developing normally, or if he coughs, chokes, gags, or vomits during feedings, which may indicate that he is aspirating during feedings and can lead to recurrent respiratory problems.

Common reasons for infants to refuse to take solids and have difficulty swallowing (dysphagia) include, but are not limited to:

• gastroesophageal reflux: children with this condition will usually spit up a lot, which can lead to esophagitis and pain when swallowing, causing irritability.
• oral motor dysfunction: can lead to aspiration and recurrent pneumonia, especially in children that cough or gag when eating.
• food aversion disorders: this usually occurs in children with a chronic medical problem, who may have been hospitilized at a young age, requiring help breathing with a ventilator, intravenous nutrition or tube feedings.
• neuromuscular disorders: such as cerebral palsy can cause trouble swallowing.
• obstruction: delayed gastric emptying or other gastrointestinal obstruction
• achalasia: an uncommon condition, especially in younger children, in which the muscles of the esophagus do not work properly, so that foods do not move through the esophagus to the stomach normally.
• many other anatomical and neuromuscular disorders can also cause dysphagia.

A thorough evaluation by your Pediatrician, with special attention to your child's growth and development, is usually required for children with dysphagia. If your child is growing and developing normally and has good weight gain, then it is not unreasonable to wait a month or two and continue to try and feed small amounts of solids.

Additional testing may be required if your child has dysphagia and he is not growing and developing normally, or if he is not improving after a period of watchful waiting.

Further evaluation is usually with a speech pathologist or occupational therapist, who can observe how your child swallows, or attempts to swallow, foods of different consistencies. These specialists are usually part of the early childhood intervention programs that are available in most areas.

The most common test performed for children with swallowing difficulties is a video swallow or videofluoroscopy, which is a type of barium swallow. In this test, barium with different consistencies is given to the child to drink. X-rays are then taken to see if the barium is swallowed or aspirated. This test is usually done with the assistance of a speech pathologist who can observe and look for swallowing abnormalities.

Treatments for dysphagia depend on the underlying cause. Reflux is usually treated with an antacid. Food aversion and oral motor dysfunction is usually treated by a speech pathologist and/or an occupational therapist.

Treatments include changing the position the child is in when he feeds, and offering foods with different consistencies. The speech pathologist will also attempt to desensitize your child to having solid foods in his mouth, especially if he seems hypersensitive to having things in his mouth. Special adaptive feeding devices may also be used.

Internet Resources:

• Swallowing Disorders in Children: Signs and causes of swallowing disorders in children and a description of the stages in the swallowing process.

Important disclaimer: The information on keepkidshealthy.com is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.