Q&A: Child Only Eats Pureed Foods

CME WebsitesChild Routines, Mealtime

blockquote_bgMy husband and I adopted a little boy from China. He had cleft lip and cleft palate; both have been repaired. He just turned. It was a real struggle getting him to eat from a spoon, but we finally achieved that goal. He still will only accept slightly chunky pureed food.
If we give him anything with more form or texture, he gags on it and will spit it out, and he doesn’t seem to know how to chew. We know he has sensory disorders and some developmental delays due to orphanage living. He only says about four words. Any advice you can give on how to transition him away from pureed food would be so appreciated.

Your question, though brief, provided many possible factors that are contributing to your child’s resistance to transitioning from pureed foods. When evaluating a child for feeding treatment, I will look at several elements that impact “normal eating.” These are environmental, sensory, motor skills, and developmental. Based on your summary, your child has many factors weighing into feeding problems.

It sounds as though transition from bottle to spoon occurred late due to cleft palate and lip, orphanage feeding practices, and surgeries, not to mention cultural and environmental changes. Some thoughts to keep in mind: if quality is good over time, quantity will follow; if quantity is pushed too early, children will shut down and become averse to eating.

Since your son is over 3 years old, offer pureed foods your entire family is eating to increase flavor and nutrition. Use ice cube trays to freeze leftovers and pop into freezer bags for other meals. Typically, each cube equals 2 oz. This is great if you are monitoring calorie intake and volume. Heat makes foods more flavorful. If he is refusing/spitting foods out, you may want to present foods at room temperature or cold.

Steps leading to chewing begin: thin creamy, no chewing; then thicker creamy; then on to thicker with small, discreet lumps. Chewing starts with dry, meltable, crunchy foods placed on molars for munching. Use foods such as shortbread cookies, graham crackers, cheese curls, hull-less popcorn, and vanilla wafers during snack time. Offer foods he likes/prefers, then begin to offer similar foods. For example, if he will eat applesauce, puree canned pears and peaches. This practice is called “food chaining. If he will eat smooth strawberry yogurt, offer a variety of flavors (peach, blueberry, raspberry, etc.) but continue with smooth texture. There is a great book on the subject, titled Food Chaining, by Cheri Fraker. It can be found at most bookstores in the child development section.

Finally, seek out an outpatient feeding program in your area that offers occupational, speech, and nutrition services where oral motor skills, sensory processing disorder, and growth/nutritional needs can be addressed due to the complexity of his feeding.