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WHAT IS ORAL DEFENSIVENESS?
Oral Defensiveness is a descriptive phrase that defines a serious, often temporary, feeding disorder that a minority of cleft-born children may experience. An orally defensive child will not allow food and/or objects to approach or enter the mouth. Some orally defensive children will accept liquids but no solids. Some will mouth their fingers, toys or other objects, but will not accept food. Some will not allow anything to approach the mouth at all.
Oral defensiveness is often an iotrogenic problem. That means it is a problem that is caused by a treatment for another problem. Orally defensive children often have a history of long-term gavage feeding or intubation, or some other very noxious experience involving the oral cavity. There are, however, some children who are orally defensive, but seem to have no reason for this defensiveness.
Because an orally defensive child refuses to eat, it is a serious problem that must be addressed right away. There are only few treatment interventions that are offered for orally defensive children at present and none that have met with universal success. However, there are two interventions designed to deliver nutrition to the child who refuses to eat.
Those two interventions are 1) gavage feeding (feeding the child through a tube inserted through the mouth, down the throat and into the stomach); and 2) Gastrointestinal tube (a tube surgically inserted through the abdomen and into the stomach, through which nutritional liquids can be passed.
Those two interventions do nothing to encourage the child to eat more normally and may, in fact, contribute further to the ongoing problem of defensiveness.
The parent is encouraged to continue to offer foods to the child in a more normative way. It is important to keep a record of calories that are consumed by an orally defensive child so that the more intrusive methods of feeding, such as gavage or GI tube, can be avoided. The following are some suggestions that might help an orally defensive child learn to eat:
1) Feed the child in an environment that is as stress-free as possible. You may want to turn lights lower than usual, minimize loud or distracting noises, maybe use a background sound of soft music. You may find that if you spend a few minutes before the feeding in infant massage, your child will be more relaxed at feeding time.
2) Offer foods at room temperature. Some children do not like foods that are either hot or cold. Often a parent is advised by well-meaning others to give the child ice cream, but parents of orally defensive children will attest that any frozen treat holds no attraction for these kids.
3) Offer the child bland-tasting foods. Unwanted taste can be an assault on the senses of an orally defensive child. While some orally defensive children may develop a preference for foods that are slightly sweet, or foods with a particular flavor, they will most likely not want a wide variety of different tastes and they will not want foods with more powerful flavors.
4) When offering solids, offer soft foods or foods that require a minimum of chewing. Orally defensive children often reject foods that offer any resistance. As they begin to accept more and more different types of foods, they will also begin to accept more and more different textures.
5) Supplement your child's nutrition with high-calorie formulas or supplements. Ask your pediatrician to recommend a good supplement for your child. Your child should also take daily vitamins. Because the child's poor nutrition may also lead to weaker tooth enamel, you will also want to be sure your child receives fluoride.
6) As long as the child is taking in plenty of nutrition to support his or her body weight, DO NOT FORCE ANYTHING. The child's defensiveness may be based on an exaggerated fear and forcing food on the child may only increase that fear. More foods may be offered, but they should be removed if rejected. The child will indicate when he or she is ready to something new.
7) Be sure you spend time cuddling, touching and interacting with the child during non-feeding times. Most parent-child relationships rely heavily on feeding times to help in the development of parent/child attachments. However, this time, and therefore sometimes this attachment is compromised when feeding time is as distressing as it often is for orally defensive children. It is, in fact, the close interaction, and not the delivery of nutrition that cements that attachment. Therefore, it is doubly important that an orally defensive child get that interaction when not feeding.
Oral Defensiveness is a very serious condition. Do not attempt to treat the problem in a vacuum. Utilize the expertise of your pediatrician. You will also want to consult with your Cleft team. They may be able to provide you with feeding equipment that might help to feed your child. They may also be able to make a referral to a feeding program in your area. A nutritionist may also be available to help you make the most of every calorie your child does take in.
Expect an orally defensive child to have some extra speech and language delays. The muscles and structures used to eat are the same muscles and structures used for speech. A delay in the area of eating may result in a further delay in speech development. This is particularly true if the oral defensiveness lasts beyond the child's first birthday.
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