Oral Aversion in Infants and Preemies

Babies need proper nutrition to grow and thrive, and difficulties with feeding in infancy can be a worrisome and dangerous condition. There are many different reasons a baby may struggle with feeding and all merit evaluation and treatment by your babies physician.

Babies who exhibit oral aversion (the reluctance, avoidance, or fear of eating, drinking, or accepting sensation in or around the mouth) refuse to eat or experience significant distress during feeding, causing them to receive inadequate nutrition. Signs of oral aversion include:

• Appearing hungry but refusing to eat
• Fussing or crying when preparations are made for feeding time such as when placed in a feeding position or when presenting a bottle
• Clamping his or her mouth shut and turning his or her head away from the breast or bottle
• Taking a small amount of breast or bottle milk and then pulling away
• Feeding only while drowsy or asleep
• Consuming less milk or food than expected for age
• Displaying poor growth

A sensory-based feeding disorder, oral aversion is more common in premature babies, and especially those who have experienced a longer stay in the neonatal intensive care unit (NICU) because of unpleasant stimuli to their mouths or faces they have experienced during treatments. Many common NICU procedures are painful and can cause babies to try to push or turn away from anything that comes near their faces, even a pacifier, bottle, or mom's breast. NICU procedures that may increase the risk for oral aversions include:

• Intubation and mechanical ventilation
• Frequent suctioning
• Long-term use of NG or OG tubes
• Inappropriate oral feedings in the NICU

Oral aversion can be very frustrating for parents, caregivers, and the babies themselves. There are many psychosocial and medical complications of feeding difficulties, including:

• Infant and parental distress
• Parental lack of confidence
• Social isolation
• Impaired parent/infant bonding
• Poor growth
• Compromised development

Treating infants with oral aversion may involve collaboration from a multidisciplinary group of specialists, including neonatologists, speech pathologists, occupational therapists, and other professionals who specialize in the care of infants. Some of the behavioral therapy techniques used to treat infants with oral aversion may include initiating pleasant stimuli to the face, use of pain control medications and techniques, and starting feedings gently.

If behavioral therapies fail to help an infant overcome oral aversion, a feeding tube may be considered. Feeding tubes, although frightening at first, can help ease some of the anxiety for both parents and babies, and allow adequate nutritional intake for growth and development. Feeding tubes are generally very safe and effective, carrying only minimal risks such as irritation of the nose, mouth or stomach.