Have you ever experienced a change in your appetite when you weren’t feeling well?  Experienced reflux?  Been constipated?  What happened?  Chances are that you were able to assess how your body was feeling and identify ways to make it feel better. Or you had the language to be able to tell your doctor what was going on so they could help.  But what about for infants and children?

When your child is not eating, it can be incredibly stressful for the entire family.  There can be many reasons why your child isn’t eating.  Sometimes not eating is a hint that there is something else happening in the GI tract (gastrointestional), that your child may not yet be able to identify or tell you about.  The longer that feeding issues occur, the harder it can be to detect underlying medical concerns. The information below may be helpful in starting a conversation with your child’s pediatrician on possible underlying medical issues impacting feeding. 

Children can indicate that they are having difficulties in their GI tract by:

  • Grazing/volume limiting 
  • Gagging/vomiting/retching
  • Poor appetite/inconsistent intake 
  • Crying/irritability with meals
  • Skips meals 
  • Avoids food groups/ extreme picky eating 

Children with feeding issues are often very sensitive to their GI tracts. Two common concerns in the GI tract are constipation and reflux. 

 

Constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer. It is one of the leading causes of abdominal pain, and it can greatly impact feeding. For children, the goal is to be able to pass 1-2 large stools per day without straining or pain. 

Constipation can impact eating by: 

  • Creating a feeling of fullness
  • Causing nausea, poor weight gain
  • Abdominal pain, cramps, gas, distention 
  • Slowing motility of the GI tract, including gastric emptying 
  • Leading to an inability to attend to other activities  

Questions to consider:

  • How often does your child have a bowel movement 
  • What does it look like?
  • What is the consistency? Hard, soft, mixed
  • Does your child exhibit any signs of pain or straining?
  • Does your child skip having a bowel movement on certain days?
  • Do they eat better after a bowel movement?
  • What is your child’s fluid intake?
  • What is your child’s fiber intake?
  • Does your child have low muscle tone that may impact their ability to use the bathroom regularly?

Natural Remedies for Constipation Include:

    • Increase water or fiber intake
    • If your child prefers juice try giving them prune, pear, or purple grape juice.
    • For infants and young children, try changing the formula or reducing dairy. Check in with your pediatrician before changing formulas 
    • Use a probiotic
    • Try using a tummy massage or a warm bath to relax abdominal muscles 

 

*If these remedies do not help and your child continues to appear constipated, please contact your pediatrician. 

 

Another common gastrointestinal concern that may go undetected is reflux or gastroesophageal reflux disease (GERD). Some common signs of reflux in children include:

  • Regurgitation
  • Heartburn for older children and adults
  • Failure to thrive and poor weight gain 
  • In infants reflux can present as crying and irritability around mealtimes 
    • Arching their back during feeding or around mealtimes
    • Refusing feedings
    • Gagging or choking 

Since the GI tract is connected from our mouths to our bottoms, signs of reflux or GI concerns can occur along any area of the GI tract. Here are some signs to look out for based on specific areas of the body: 

  • Mouth or Oral Cavity 
    • Bad breath
    • Gagging, oral defensiveness, oral hypersensitivity 
    • Runny nose, chronic sinus issues
    • Dental problems, tooth enamel erosion 
    • Ear infections
    • Lip smacking, chewing, swallowing outside of meals 
    • Increased drooling/salivation– more secretions means the child is neutralizing the acid 
    • Snoring or mouth breathing
  • Throat 
    • Choking
    • Lump in the throat
    • Gulping/hard swallow– If you can hear your child swallow, then they are swallowing against resistance 
    • Throat clearing, hoarse voice, laryngitis 
    • Grunting 
  • Lungs
    • Pulmonary issues: pneumonia, asthma, congestions, bronchitis 
    • Chronic cough
    • Wheezing 
  • Esophagus
    • Bleeding, inflammation
    • Heartburn, pain
    • Hypersensitivity 
  • Stomach
    • Recurrent vomiting during/after meals 
    • Regurgitation, spitting 
    • Spitting of clear mucus 

As a result of reflux, children can have delays in developmental milestones or difficulties with learning. When a child is feeling uncomfortable, his or her body can shift into a high arousal state. This makes it incredibly challenging for new learning or development to occur. Some examples of difficulties associated with reflux may include:

    • Torticollis, or an abnormal posturing of the head toward one side of the body. Children with reflux may spend more time on their backs, and they may be more likely to favor one side to help manage symptoms of reflux. 
    • Difficulties tolerating tummy time and thus delays in rolling and sitting 
    • Sleep disturbances. When children lay flat at night, it is easier for the acidic stomach contents to travel further up the GI tract. This can lead to coughing or irritability in the night. Children with reflux may also eat less at breakfast or refuse meals in the morning, as their bodies may be more sensitive. 
    • Feeding Concerns: Children with reflux can have a variety of feeding concerns including:
      • Sleep feeding in infants. Feeding may be so stressful or painful from the reflux that babies prefer to eat when they are sleeping 
      • Difficulty transitioning to solid foods 
      • Texture and volume limitations 
      • A strong preference for water or drinking liquids, especially cold water 
      • A preference for certain food groups that may be less likely to cause reflux such as carbohydrates 

Symptoms of reflux tend to wax and wane, and they may increase more with illness, stress, or poor nutrition. 

 

If you are concerned that your child may have constipation or reflux, please contact your pediatrician to determine the best course of treatment. 

 

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