International Adoption Health Program

Feeding and International Adoption

Children who have been living in institutional and some foster care settings are at risk for having feeding difficulties. These difficulties may be due to medical conditions, oral motor skills, sensory processing difficulties, or social emotional challenges, and fine motor skills.

Undetected or untreated medical conditions can cause disinterest in eating. For example, discomfort from chronic reflux (not necessarily causing vomiting) can result in poor intake because the esophagus is inflamed. Parasites, and other gastrointestinal infections can cause abdominal bloating, intestinal cramping, and overall discomfort which can also lead to disinterest in eating. Food allergies can cause refusals. General poor health, can impair appetite, and energy for eating.

Oral motor skills are the coordination of muscles and jaw in your mouth. They help you bite and break through foods, allow one to shift food from side to side in the mouth, to chew, and to swallow effectively and efficiently. Early feeding experiences can limit children from developing age appropriate oral motor skills.
Infants living in institutions are often fed with propped bottles propped as food is introduced; the nipples are cut to allow for fast flow of formula, soups, and other food substances. Sometimes infants have a very hard time sucking fast enough to keep up with the flow. This mis-match in infant skill and bottle flow rate can cause decreased intake and growth issues. It can also limit a baby from developing good mouth skills for sucking, and swallowing, and ultimately also deter introduction of a spoon at a developmentally appropriate age. In some countries, children will not have experiences with solid foods until they are much (10-12 months or older.

Limited experiences in trying more solid textures may mean that your adopted child has never had mashed table foods, or yogurt/ pudding or cheerios/crackers. As a result of these limited experiences, children may not have the chewing and swallowing skills to jump right to age appropriate textures. When a child first arrives, a child should be fed textures that the child can consume safely and efficiently, with a goal of advancing to age appropriate with time or, if needed, therapy.

Children with sensory difficulties may also have a difficult time with meal times. A child who has difficulty with arousal or attention may have a difficult time staying alert or from being distracted during the meal. Children who are very sensitive to touching textures (such as mushy bananas or crumbly Cheetos) may have difficulty with textures in the mouth, which impairs advancing with the skill of chewing. Children may also have a hard time self feeding without utensils because they can not tolerate touching food with their hands.

Behavioral and emotional challenges can result from poor feeding experiences while living in their adoptive country. Young children who have not had the experience of being held and making eye contact in their early feeding experiences may have very limited eye contact or social exchange skills during meal time. Some children may have anxiety about not having enough food. They may hoard their food and try to eat excessively at each meal. They may pocket the food in their mouths, rather than swallow.

Children may lack fine motor skills to handle some aspects of self feeding. Young children transitioning to table foods may never have held their own cup, or finger fed. In some countries, children are spoon fed with a large unwieldy spoon but have not themselves ever held a spoon. Older children from Asian countries may have experience with chopsticks, but not with a fork or knife.

As a child enters its adoptive family, it is important to assess the child's feeding needs while trying to meet its nutritional needs, so that ultimately the child is receiving ideal nutrition in a developmentally appropriate way.

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