What Are Causes Of Oral Aversion In Babies & How To Treat It?

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Oral aversion in babies is a more frequent problem, especially in infants who were fed through feeding tubes in the NICU. It is a sensory-based feeding difficulty in which the baby avoids anything brought near their face or mouth (1). As a result, babies with oral aversion refuse to nurse, eat, or drink (2). Feeding aversion is a fear or dislike of eating or drinking sensations in and around the mouth. A full-term, healthy infant can also acquire aversion for several reasons. Therefore, it is critical to understand the reasons and overcome oral aversion in babies to avoid their growth and development concerns in the future.

The following post discusses the possible causes, symptoms, and risks of oral aversion in babies and ways to manage and treat it.

Signs And Symptoms Of Oral Aversion

Persistent refusal to feed even when hungry/thirsty is one of the most prominent signs of oral aversion (2). However, it isn’t the only sign to make any diagnosis. In most cases, a baby with oral aversion displays additional signs and symptoms, such as:

  • They become fussy and distressed when put into a breastfeeding position or offered a bottle.
  • They arch their back and try moving away from the breast or bottle
  • They feed when they are either drowsy or asleep
  • They show poor growth than expected for the age

Babies who have transitioned to a weaning diet could:

• Consume less food for their age, i.e., take fewer sips of milk or bites of food
• Gag, choke, or vomit the food or drink they have ingested
• Begin eating food but quickly pull away due to fear/anxiety associated with feeding

Some babies and toddlers with oral aversion may even display discomfort and distress while brushing teeth or washing the face. If your baby or toddler persistently refuses to feed and displays any of the above signs/symptoms, consult your doctor promptly to diagnose the cause and seek a resolution.

Causes Of Oral Aversion In Babies

Babies can develop oral aversion due to several reasons. The following are some of the common reasons.

1. Frequent intubation and tube feeding

According to the National Association of Neonatal Nurses (NAAN), approximately 80% of premature infants could develop difficulties with oral feeding (3). Preterm babies require medical feeding support in the form of:

Preterm babies require medical feeding support in the form of:

  • Intubation and suction tubes for maintaining proper breathing (oxygenation)
  • Nasogastric (NG) tube that goes from the nose to the back of the throat to pass the feed
  • Orogastric (OG) tube that goes from the mouth to the stomach to pass the feed

These tubes often cause painful or uncomfortable stimuli that make premature babies, especially those who have spent a long time in the NICU, susceptible to develop oral aversion. As a result, they turn away from everything that comes near their mouth or face.

2. Motor and sensory issues

Oral motor issues due to weak face and neck muscles or cleft palate make moving food in the mouth and swallowing difficult (4). Similarly, oral sensory disorders make an individual sensitive to the taste, smell, and feel of the food or feed around the mouth. It could cause them to eat specific foods and refuse to eat other foods. Both of these conditions cause babies or toddlers to develop an oral aversion to foods.

3. Gastroesophageal reflux disorder (GERD)

Babies, especially those born preterm, often struggle with acid reflux, which happens due to an underdeveloped esophageal valve. Reflux causes the gastric juices and stomach acid to flow from the stomach to the food pipe, causing a painful burning sensation. It’s this sensation that makes babies fear feeding and develop oral aversion (5). Congenital malformations, such as congenital diaphragmatic hernia, could also cause GERD in babies (6).

4. Negative feeding experience

Babies can readily associate feeding with fear, pain, and anxiety after a negative feeding episode, such as choking or force-feeding (7). It’s this association that causes the development of oral aversion in several babies. Hence, you must stay vigilant while feeding your baby to minimize the risk of gagging and choking that could make a baby fear feed or mealtimes.

Risks Associated With Oral Aversion

Oral aversion can be frustrating and tiresome for parents, caregivers, and babies, giving way to long-term issues, such as:

  • Poor nutritional status hampering proper growth and development of the baby
  • Constant stress for the parents and the baby
  • Lower parent-infant bonding
  • Behavioral issues, such as crankiness and irritability
  • Poor socio-emotional growth
  • Lack of confidence in parents regarding their ability to feed and care for their baby

Treatment For Oral Aversion In Babies

Treating a baby with oral aversion usually involves a multidisciplinary approach where a team of several experts, such as a pediatric gastroenterologist, pediatric nutritionist, occupational therapist, psychologist, and speech therapist, work together to locate and treat the cause of oral aversion. For instance, to treat oral-sensory issues in babies, the expert may recommend desensitization therapy.

In this therapy, a child is fed the problematic food repeatedly until the child adjusts to its taste, smell, and texture. Alternatively, the expert may advise changing the way the food is fed to babies by changing the utensils you use until the baby improves.

This approach will be different if the baby has oral aversion due to oral motor issues. In such cases, the expert will work on the cheek, lips, and tongue exercises to improve their ability to chew and swallow food. Likewise, some approaches may use pain-relieving techniques and medications to alleviate feeding-related pain that may be causing oral aversion in babies.

Overall, the treatment for oral aversion depends on its underlying cause. Based on the cause, specialists will work on the baby to help them overcome their oral feeding difficulties.

Can You Prevent Oral Aversion In Babies?

Preventing oral aversion in babies isn’t always possible, especially when caused by congenital malformations or oral sensory issues. However, you can avoid oral aversion caused by prolonged NICU stay by putting the following simple tips in practice under medical guidance (8).

  1. Swabbing: Infants on orogastric or nasogastric tube feed are most susceptible to losing stimulation around their mouth. In such cases, regularly swabbing their mouth and lips with a warm, wet, soft washcloth can help stimulate their mouth area and offer oral stimulation even when they aren’t sucking.
  1. Non-nutritive sucking: Give your baby your clean little finger or a pacifier to suck on. It will help maintain their oral stimulation and also refine sucking. As the baby grows, you can give them pacifiers dipped in baby food or puree to suck on. Alternatively, you can provide them with baby foods in a baby-friendly bowl or plate to dip their fingers and suck on them.
  1. Cue-based feeding: You may give the baby more control by waiting for their cues while feeding. For instance, if your baby’s medical condition allows, place them in an elevated, side-lying feeding position or sitting position with horizontal milk flow. This position is favorable to ensure the baby regulates milk flow and establishes suck-swallow-breath coordination (9). This is also called paced bottle-feeding. In addition, it helps prevent gagging that happens when the baby lies in the supine position.
  1. Self-pacing (ISP) bottle: Self-pacing (ISP) bottles are different from standard bottles. In these bottles, the milk doesn’t drip from the nipple if the baby stops sucking (10). Also, no vacuum buildup happens when a bottle is about to become empty, meaning the baby doesn’t have to suck hard for milk to come out.

These attributes are vital for a preterm baby with feeding difficulty as they allow the baby to self-regulate milk flow and establish suck-swallow-breath coordination, necessary for comfortable feeding.

Besides these, maintaining a preterm baby’s oxygenation during feeding is vital to avert oral aversion. A preterm baby who isn’t able to breathe while feeding is likely to choke or gag while feeding, giving in the way to negative feeding experiences.

Frequently Asked Questions

1. Do babies grow out of oral aversion?

Most babies outgrow their oral aversions by the time they reach their toddler years. However, to overcome learned oral aversion in babies, you can use several therapeutic approaches, such as behavioral therapy and changing the texture and presentation of food (11).

2. How long does feeding aversion last in babies?

There is no set time frame for resolving food aversion in babies. It is dependent on the effectiveness of feeding therapy, the pediatrician’s guidance, and the underlying cause (12).

Oral aversion in babies could lead to a tiresome feeding experience for the parents or caregivers and vital nutrient deficiency in the babies. However, this problem can be dealt with efficiently with the help of proper treatment, medicines, and patience on the parents’ part. Although complete prevention of oral aversion is not possible if the child has been staying in the NICU for prolonged times, encouraging your baby to non-nutritive sucking or using self-pacing bottles might help manage the situation.

Key Pointers

  • Oral aversion in babies is characterized by a persistent refusal to nurse or eat.
  • It could be caused by several reasons, including a negative feeding experience and motor or sensory issues.
  • The treatment of oral aversion usually requires a team of experts to first locate the cause of the aversion.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. Oral Aversions.
    https://thecdhfoundation.org/oralaversionfeedingtube
  2. Feeding Aversion Module.
    https://www.spoonfoundation.org/wp-content/uploads/2019/01/Module-10_Feeding-Aversion-_Lesson-Plan.pdf
  3. The Neuroprotection of Oral Enjoyment by Giving Milk Drops.
    http://nann.org/publications/e-news/january2020/feature
  4. What are oral-motor and oral-sensory problems?
    https://childrenswi.org/medical-care/gastroenterology-liver-and-nutrition-program/conditions/oral-motor-and-oral-sensory-problems
  5. AAP Issues Recommendations on Managing Gastroesophageal Reflux in Preterm Infants.
    https://www.healthychildren.org/English/news/Pages/AAP-Issues-Recommendations-on-Managing-Gastroesophageal-Reflux-in-Preterm-Infants.aspx
  6. Gastroesophageal reflux and congenital gastrointestinal malformations.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515833/
  7. Feeding Disorders.
    https://www.urmc.rochester.edu/childrens-hospital/developmental-disabilities/conditions/feeding-disorders.aspx
  8. Oral Stimulation.
    https://www.gillettechildrens.org/your-visit/patient-education/oral-stimulation
  9. Pediatric Newborn Medicine Clinical Practice Guidelines.
    https://www.brighamandwomens.org/assets/BWH/pediatric-newborn-medicine/pdfs/feeding-cpg—final-06-06-2016.pdf
  10. To Individualize the Management Care of High-Risk Infants With Oral Feeding Challenges: What Do We Know? What Can We Do?.
    https://internal-journal.frontiersin.org/articles/10.3389/fped.2020.00296/full
  11. Colin D. Rudolph et al.; Feeding Disorders in Infants and Children; Pediatric Gastroenterology and Nutrition (2002)
    https://www.libs.uga.edu/reserves/docs/scans/feeding%20disorders%20in%20infants%20and%20children.pdf
  12. When Your Baby’s Not Eating Well Feeding Therapy Can Help; Intermountain Healthcare
    https://intermountainhealthcare.org/blogs/topics/pediatrics/2018/07/when-your-babys-not-eating-well/
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Swati Patwal

Swati Patwal is a clinical nutritionist, a Certified Diabetes Educator (CDE) and a toddler mom with over eight years of experience in diverse fields of nutrition. She started her career as a CSR project coordinator for a healthy eating and active lifestyle project catering to school children. Then she worked as a nutrition faculty and clinical nutrition coach in different... more

Maria Carmela Villania-Mamauag

(MD, DPPS)
Maria Carmela Villania-Mamauag is a board certified diplomate of the Philippine Pediatric Society with a degree of Doctor of Medicine from Our Lady of Fatima University, Valenzuela City and a Bachelor in Science in Psychology from Saint Louis University, Baguio City which was augmented by a year of Bachelor in Science in Family Life and Child development at the University... more

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