Oral disorders are defined as an age-inappropriate impairment of food intake associated with medical, nutritional, feeding skills and/or psychosocial dysfunction, lasting more than 2 weeks. These disorders affect about 20-25% of infants and young children.
How can they be identified? What support is available for these children? How can a paediatric dietician help children and their parents in this situation?
Orality is the set of functions assigned to the mouth: breathing, exploration, pleasure, eating, oral expression and sensory perceptions. Disorders of orality can occur from birth but also later. They are not limited to the oral area but are often associated with irritability all over the body (foot, hand, face, head, etc.). The possible causes are sensory, neurological, organic, psychogenic or post-traumatic.
What are the warning signs?
Several signs may point you in the direction of oral disorders: presence ofhypersensitivity (tactile for example), difficulty or refusal to suckle, absence or low level of oral exploration, presence of gagging(gag reflex), refusal of the spoon or pieces beyond the age of 16 months, implementation of strategies at mealtimes (avoidance movement), low weight gain, absence of food pleasure, hyperselectivity (food repertoire restricted to less than 20 foods).
Who to consult?
These signs may lead you to consult a health professional specialised in these disorders : speech therapist, occupational therapist, paediatrician, gastro-paediatrician, ENT specialist, dietician, psychomotrician, physiotherapist, psychologist, IBCLC lactation consultant, etc.
What is the role of a paediatric dietitian specialising in oral disorders?
During the first consultation, the dietician takes stock of the child's lifestyle, weight and height development and dietary history since birth. A precise nutritional assessment (collection of food intakes) will be compared with the child's nutritional needs in order to identify potential nutritional deficiencies. This appointment also allows us to identify health problems arising from orality disorders: constipation, food allergies or intolerances, low weight gain, reflux, etc. A daily breakdown, advice and appropriate and personalised recipes will be given to the family to meet the child's nutritional needs.
Subsequently, workshops are held with the child to gradually expand his or her food repertoire and textures at his or her own pace. Growth and weight gain are monitored regularly. Advice on enrichment can also be given if necessary (in the event of slight weight regain).
Some tips to get you started
Avoid forcing food at all costs, let your child touch and taste the food with his hands (he will thus obtain a lot of information about the food such as its consistency or temperature for example
, which may reassure him once he has put it in his mouth), give him massages (to babies and older children), cook as a family (even with the youngest ones) ... These ideas will certainly help you but you should know that accompanying a child with oral disorders can be long at times, however it is important to know how to appreciate each small victory!
Dietician - Nutritionist specialising in paediatrics
