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, social-emotional challenges, or fine motor skills.

Medical conditions and feeding difficulties

Undetected or untreated medical conditions can cause disinterest in eating. For example, discomfort from chronic reflux (not necessarily causing vomiting) can result in poor food 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 and feeding difficulties

Oral motor skills are the coordination of muscles and jaw in your mouth. They help you bite and break through foods, allow you to shift food from side to side in your 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. 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 mismatch in infant skills 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 make it difficult for the child to use a spoon at the developmentally appropriate age. In some countries, children will not have experiences with solid foods until they are 10 to 12 months or older.

Limited experiences in trying solid foods may mean that your adopted child has never had mashed table foods, yogurt, pudding, cereals or 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 first adopted, a child should be fed textures that he can consume safely and efficiently, with a goal of advancing to age-appropriate foods with time or, if needed, therapy.

Sensory skills and feeding difficulties

Children with sensory difficulties may also have a difficulty at meal time. 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 cannot tolerate touching food with their hands.

Social-emotional challenges and poor feeding

Behavioral and emotional challenges in children can result from poor feeding while living in their adoptive country. Young children who have not had the experience of being held and making eye contact during feeding 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.

Motor skills and feeding difficulties

Children may lack fine motor skills to handle some aspects of self-feeding. Young children transitioning to table foods may have never held their own cup or fed themselves with their hands. 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 his adoptive family, it is important to assess the child's feeding needs while trying to meet his nutritional needs, so that ultimately the child is receiving ideal nutrition in a developmentally appropriate way.