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Can’t eat solid food

My son is turning 18 months this month, and ever since we started solid food at 6 months, he's been a little behind in terms of what he could tolerate with textures.  He had a severe gag reflex, and would often throw up if there was too much thickness to his food or if I gave him too much on a spoon.  As he's gotten older, he's definitely improved with textures (it's been an uphill battle) - it just seems to have taken him a little longer than other children we know.  He still likes the thick pureed baby fruit, however he'll also take lumpy/chunky baby food that I've prepared for him myself (with lumps of meat, veggies, etc).   We've also progressed to him taking pieces of toast with something spread on it, chunks of bananas, pancakes and dry cereal, and a few other select things.  Overall though, he's a picky eater when it comes to table food.

My question is, my husband and I were wondering if we should be concerned that he hasn't progressed to table food completely at 18 months?  He's capable of feeding himself with his fingers and sometimes uses a spoon, but often just prefers to be fed by me still.  As I mentioned, he'll take some table food (he prefers drier textures, and often will spit out wet textures before even tasting them).  However he gets quite a balanced diet by eating the prepared food I've made him that has been pureed slightly still.  Some of this seems behavioral to us (he's stubborn and has a very bad temper if we try to make him eat something).  Also, should I be concerned that although he can feed himself, he'd rather I do it?  We even tried recently not having me feed him (only for a day or so) to make him more hungry to attempt feeding himself more - he's stubborn and just refused to eat completely (except for the milk and juice we gave him in his sippy cup)!

Any advice you can provide would be extremely helpful.  Thanks so much,

You have described a mixture of oral motor and behavioral issues. It may be that his oral motor issue are leading to his behavioral issues or this may be all behavioral.

By 18 months he should be able to eat 95% of what you eat. Is he (or was he) excessively drooly? Has he speech progressed normally? Children with oral motor weakness often have delayed speech development and struggle to control their own saliva.

Is he well grown? His weight percentiles should be consistent on his growth curve. How much milk does he drink? Some children will drink their required calories and lose the drive to eat solids. Limit him to 12 ounces of whole milk a day.

His refusal to self feed, despite being able is clearly behavioral. Self feeding develops out of modeling others. Do you eat as a family? It is important to set a good example by eating healthy foods in front of him. He may benefit from seeing other toddlers eat at a park or playgroup. Are there any distractions at meal times? If the TV is on, turn it off.

If he is able to eat cookies, but is unable to eat steamed broccoli than most of this is behavioral in origin. At his age he should be able to eat pasta, fresh fruits, slices of cheese and steamed veggies. Most 18 month olds could not chew chunks of meat or eat uncooked veggies (carrots, broccoli or salad). As a side note, it is important to present him with healthy foods (like salad), so that he will eat them when he is able.

18 months olds to 3 year olds are classically poor eaters. If he is growing well and progressively eating thicker/more difficult foods than he is probably fine. However, it is best to address this with his primary doctor - specifically looking at his growth, development, and eating habits. He may need oral motor therapy.

Follow up

He is enjoying solids much better now.  :o)  Thank you so much for asking.  He's still not too keen of the green vegetables but he's eating baby food (out of a jar), puffs, Cheerios, and toasted bagels.  I also fed him cheese a few times, which he likes - in general, though, he has a strong gag reflex, so I've been going slow.  My 3-year old daughter loved solids right away, so I guess it's true that every child is different!

 

Written June 2011 by
Dr. Gordon, Orlando Pediatrician

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