My husband and I just adopted a 17 month boy from Russia. He is at the 25 percentile for both height and weight. However, since arriving home he has begun refusing to drink or eat. He acts hungry, but then only takes a few sips or a few bites then turns his head, arches away from me, seals his lips shut and cries. I’m tracking his intake and he is only getting 500-600 calories a day. I will be weighing him tomorrow at the doctor, but last week he had lost half a pound since adoption ( 4 weeks ago). He also only has accepted pureed baby foods and a bottle from me. He will take sips from an open cup.
Children who were raised in orphanages, even if they are still very young, can come with a unique set of challenges when it comes to feeding. Unlike typical children raised in loving and nurturing environments, your son may not have been accustomed to having an adult pay attention to him and actually feed him during meals. Babies learn early on that food brings comfort and relief from hunger. Unfortunately, babies who spent their first months or years of life in institutional care often did not learn this and may have only received their formula by propped bottles or by a caregiver feeding many children at a time. Also many children learned to eat to a set time and schedule and not their own hunger pangs. Children adopted from institutions or other places where they were served extremely bland food may display pickiness with regard to their food selections. These children may need to become accustomed to the many new tastes you serve; pressuring them, engaging in a power struggle, or taking it personally will only create future problems in your mealtime experience.
It is great that he will take sips from an open cup, and I would suggest moving toward using the open cup and/or a straw cup (which is better for oral motor skills than a sipper cup with a spout) for meals if he can manage it. Here are some suggestions:
Keep mealtimes positive and pleasant. Always have a family mealtime, so your son can observe everyone else happily eating.
Do not force him to eat or drink or express displeasure or anger when he does not eat or drink.
Praise him for simply touching a food or bringing it to touch his lips, even if he did not taste, chew or swallow it.
Make sure you are partaking of some of the same foods on your son’s plate.
Allow him to self-feed using his fingers if needed, so he can explore the texture and taste of foods on his own, which he may not have had experience with.
Use meltable foods, such as cheese curls or Gerber puffs that dissolve easily when he puts them in his mouth, so he can finger feed.
Gradually thicken his purees using crushed up crackers or other additives to build up the texture and thickness of his food, since he may not have been served any solids or table foods in the orphanage and may be unaccustomed to handling textures in food and have no experience with chewing.
To help him practice chewing, you can buy a mesh food bag and place flavorful fruit or other foods inside to let him practice these skills.
He may not have had access to teething toys and may benefit from some oral motor play with toys to “wake up” his mouth before meals and get him ready for eating. You can use vibrating teethers or even dip nubby toys into pureed foods and let him experiment with oral play that way.
Use a Nuk tooth brush or a vibrating tooth brush for oral stimulation.
Skip Stage 3 baby foods, as these often lead to texture issues in many children and move directly to easy to chew, small chopped pieces of table foods. Cut toast in strips so he can hold one end and bite on the other and try to present foods on the sides of his mouth, toward his molars, not in the center to encourage chewing and tongue lateralization.
Since weight gain is an issue, enhance foods that he will currently eat with added butter or sugar or powdered milks. Make milk shakes he can drink from a cup, but boost calories with full fat ice cream & add instant breakfast powder and pureed fruit. This article talks about calorie boosting in foods.
Definitely check in with your pediatrician on health/weight gain issues and ask for suggestions and perhaps a consultation with a nutritionist for your son. Some children are prescribed additives for extra calories or given Pediasure to boost calories.