Swallowing and Feeding Issues with Internationally Adopted Children

Vegetables in Whole Foods Market


Photo by Masahiro Ihara

My children were “picky eaters.” One would only eat peanut butter and jelly, frozen pizza, chicken nuggets or macaroni and cheese. The other one would only eat frozen pizza and hot dogs. Neither of them would eat any vegetables. If it was green, it was considered inedible! Needless to say, cooking for them was a challenge. Somehow they survived and are both healthy adults who eat more variety than I ever thought they would.

Many of our food preferences are based on our food experiences. Children residing in orphanages have feeding experiences that are affected by the number of staff available to feed large groups of infants and toddlers. Parents have reported observing children left in their cribs with bottles propped up to allow self-feeding, given plates of food too hot to eat without utensils to feed themselves, and children fed pureed instead of solid foods. These experiences may not only affect physical growth and nutrition but also adversely affect eating and swallowing development. Some researchers have reported a wide range of eating and swallowing problems from clinical samples including (a) chewing problems, (b) preoccupation with food availability, (c) gorging and (d) sometimes becoming omnivorous (Johnson & Dole, 1999). Others found that 15% (21 of 144 children adopted from Romania) continued to have chewing and swallowing problems at 6 years old, 2 to 5 years following adoption (Beckett, et al., 2002). Beckett and colleagues also found that if solid food was not introduced before the age of 1 year, more of these children had continued eating and swallowing problems. Many of the children seen at the Saint Louis University International Adoption Clinic present with eating and swallowing difficulty or unusual oral motor problems such as facial tics or intermittent velopharyngeal closure during speech and swallow.

Children adopted from abroad are at risk of having eating and swallowing problems. Practitioners are advised to explore the presence of oral motor sensitivity, eating and swallowing problems with the client or client’s family. If problems were observed or continue to occur, a thorough assessment of oral motor structures and function and possibly an assessment of eating and swallowing behaviors may be needed. If children demonstrate eating disorders related to mental health issues such as bulimia or anorexia, it is important to refer them to clinical psychologists or counseling and family therapists.

References

Beckett, C. M., Bredenkamp, D., Castle, J., Groothues, C., O’Connor T. G., Rutter, M., & the
English and Romanian Adoptees (ERA) Study Team. (2002). Behavior patterns associated with institutional deprivation: A study of children adopted from Romania. Journal of Developmental and Behavioral Pediatrics, 23(5), 297-303. http://journals.lww.com/jrnldbp/pages/default.aspx

Johnson, D. E., & Dole, K. (1999). International adoptions: Implications for early
intervention. Infants and Young Children, 11, 34-45. Retrieved from:
http://www.peds.umn.edu/iac/prod/groups/med/@pub/@med/documents/asset/me
d_49295.pdf

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University professor and Director of the International Adoption Clinic with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and disrupted development.