What causes oral aversion?
Oral aversion can result from a variety of medical issues or early childhood experiences. Sometimes we are not sure why a child develops an oral aversion, but it can usually be traced back to one or many of these issues.
Medical trauma: When a child is in the hospital they may experience a wide range of unpleasant interventions around their face and mouth. These can include more mildly unpleasant experiences like bad-tasting medications or breathing treatments or can include more invasive experiences like intubation, feeding tube placement (oral, nasal, or gastric), or need for oxygen or ventilation support.
Lack or absence of early feeding experiences: For many reasons a child may not be able to eat early in life. Lack of these early and formative feeding experiences may lead to aversive behaviors simply because a child does not know or understand what is expected of them and they may not have the oral-motor skills necessary to eat age-appropriate foods.
Discomfort: Children with gastrointestinal disorders (reflux, constipation, food allergies) or respiratory issues (asthma, chronic environmental allergies, oxygen dependence, sleep apnea) may develop oral aversions because eating is associated with discomfort. Children with GI discomfort, even if it is mild, can make associations between food and feeling bad. Children with respiratory issues can often find that eating is difficult because we stop breathing briefly during every swallow, which can make eating for these children very tiring.
Sensory integration/regulation disorders: Children with sensory processing, integration, or regulation disorders perceive sensation differently than typical children. This can include low awareness of sensory input (unaware of a messy face, stuffs mouth in order to “feel” food better) or high awareness of sensory input (intolerant of lumps or texture in food, dislikes strong colors or smells). Children with altered sensory input can become aversive to foods with the characteristics they find overwhelming or unappealing.
Choking episodes: This is a very special subset of children with oral aversion. Children who have experienced a choking episode may have a true “food phobia” rather than an oral aversion. Children who have become aversive to eating or drinking after a choking episode should include a psychologist or child therapist in their feeding team to help the child and family deal with the trauma of that event.
This is not a complete list of reasons a child may become orally aversive. However, in my experience, these are the most common. Often an oral aversion will develop from several of these scenarios together. If you are selecting a feeding team to treat your child’s aversion, see our suggestions for choosing the right therapist.