ASK THE EXPERT: DAVID COLEMANanswers your parenting questions
Q My 29-month-old son had chronic reflux until he was about 20 months old and, as a result, has oral aversion. He is quite literally afraid of food. I have found that there is little or no understanding of this concept in Ireland and am very anxious to seek out professional support to assist him with overcoming this issue.
All of his food must look the same (ie a lumpy mess); he would not dream of eating a carrot stick, a pea, or indeed anything identifiable as food. Nor does he eat chocolate, ice cream, lollipops, chips, etc. His reflux (together with the endless medical procedures he was subjected to) has not only left him with a terrible relationship with food, but also chronically underweight. He weighs 19 pounds, versus his 11-month-old sister’s 21 pounds. I would be grateful for any advice that might let me help him.
A True oral aversion, as you describe, is different from “fussy” or “picky” eating. A child builds up negative associations with food because of pain, discomfort or continuous gagging or regurgitation while eating. This means that they just don’t eat, or are so resistant to eating that they don’t get enough nutrition.
Your son’s low weight is a serious cause for concern and I can see why you are so worried about him. It must be terrifying to see him so underweight and yet frustrating to see him refusing certain foodstuffs.
Change must involve him overcoming his fears and usually occurs in response to positive behavioural reinforcement of his efforts to eat.
Treatment, for a child with oral aversion, tends to be a slow process and it is important to hang in there because things can and do change for the better. In my experience, occupational therapists and sometimes speech and language therapists are best placed to help a child with oral aversion. It would be well worth your while contacting your public health nurse or local HSE health centre and seeking either referral to the HSE services or recommendations for local private practitioners.
Q My sister has three children; a girl aged nine, a boy of four and a baby of 18 months. The middle boy is in playschool five mornings a week. Each morning she has to drag him into school and run out while one of the assistants holds him. He then stands by the door for up to two hours daily before he makes any effort to play or integrate with the other kids. In fairness to the teachers there, they are most attentive and warm but despite their efforts they have failed to settle him.
The only reason he might be feeling upset relates back to when the youngest baby was born when the parents spent two weeks in hospital with him as he was very ill. We don’t know if that explains his insecurity. They try to encourage any progress in school through reward, etc but nothing seems to work. He will not visit other children’s homes except in the company of a parent and he generally is “stuck” to them when he does so.
What can my sister do, especially with him heading for big school next year?
A I think it is important thing for your sister is to recognise that her middle child is feeling highly anxious about being separated from her and/or her husband. Even though you (the uncle) seem to acknowledge this, it is crucial that you support her to come to the same realisation. For, unless she and her husband take on board the issue, they will not necessarily be motivated to change it.
Usually, when a child demonstrates some separation anxiety by crying or getting distressed at the separation, they do so in order to persuade their parent not to leave them. Once a parent does go away, the child normally settles relatively quickly. In time the child learns that their parents go, but always return, and the routine of their new environment allows them to become accustomed and settled.
This does not seem to be happening for your sister’s son. It sounds like he is experiencing chronic separation issues and has been since his baby brother was born 18 months ago. That is a long time for him to continue to give the message that he is not happy and is highly anxious about being away from his parents.
What is clear too is that the preschool is not meeting his emotional needs. This is not a criticism, or bad reflection, of the preschool staff. It sounds like they are well aware of his needs and are doing the best they can but it isn’t helping him.
Given the consistency and unchanging nature of your nephew’s distress, I think he might do better out of the preschool. I think it would be a strong and supportive message for your nephew, if he were moved, that his parents are hearing his distress and responding to it.
This is not about “pandering” to your nephew, it is about recognising that what happens now is patently not working for him and so it may be time to do something different. Obviously what I suggest can only work if your sister or her husband will be at home to care for him instead.
Spending some time at home should help your nephew to rebuild his confidence and sense of connection and security with his parents. They can focus on activities to build his self-esteem, which in turn will have a positive effect on his confidence. They can continue to arrange play-dates for him, on a one-to-one basis with friends from the preschool, and/or other children who are likely to be in his class next September when he starts in National School.
It may simply be a maturity thing for your nephew such that, after spending some months at home again, he will be more ready to step out into the world next September.
David Coleman is a clinical pyschologist, author and broadcaster. Readers’ queries are welcome and will be answered through the column, but David regrets that he cannot enter into individual correspondence. Questions should be e-mailed to healthsupplement@irishtimes.com
