SELECTED ARTICLE
Author
Alla Gordina, MD, FAAP 
Article Title
Feeding problems in a newly adopted child - a case of a picky eater 
Posted Date
1/3/2006 
 
I am always concerned, when I am hearing about a newly adopted child, who is a picky eater. Any child can have problems eating if he/she is exposed to new
    - Types of foods (meats, fresh vegetables, etc)
    - Textures (dry foods like cheerios or teething biscuits, or if foods are not pureed enough)
    - Smell (kids are used to the smell of the orphanage food and would not tolerate new and unusual sensations)
    - Temperatures (children are usually not used to cold or very hot foods)
    - Feeding techniques (kids can be bottle-fed through a nipple with a huge hole, and unable to eat from a spoon)
    - Feeding position (frequently kids don’t see the person who is feeding them)
    - Feeding environment (café or buffet rather then familiar room with the small tables and familiar caregivers)
Some of the other reasons for feeding difficulties can be
    - Oral aversions and other sensory deficits will have difficulties with accepting foods, chewing and swallowing.
    - Low muscle tone (generalized or of facial muscles only) will lead to early fatigue and poor feeding - Painful lesions in the mouth (past or present)
    - Abusive feeding techniques in the orphanage
    - Behavioral and emotional problems
It is extremely important to
    - Anticipate this condition and to request orphanage to show you how exactly this particular child was fed in the orphanage and with what.
    - Be flexible with the feeding routines and techniques – feeding a bottle, spoon-feeding, giving local formulas, feeding with the baby’s face away from you and so on
    - Reduce over-stimulation as much as possible before and during feeding
    - Make sure that your child gets enough rest and sleep
    - Not to stare on your child, while he/she is eating
    - Offer your child warm formula/milk/yogurt, sweetened enough for this child to take it willingly. You will be able to slowly reduce the sweetness later on.
    - Warm all foods, even milk.
    - Offer Russian-style foods, black bread and so on
    - Create as much routine as possible even while on the road – when the child is eating, with what, how, where and in what order
    - Not to be concern with the lack of food variety in your child’s diet in the first days and even weeks after adoption. Slowly introduce new foods/ textures/ temperatures if your child will tolerate them.
    - Not to give such child a sippy cup; use a bottle with the hole as large as your child needs, slowly decreasing the opening; straw cup or a regular cup can be used too.
    - Spoon-feed your child if necessary even with the fluids like milk and formula.
When you arrive home
    - Don’t expect for this particular child to get better on her own
    - Have the full medical evaluation,
    - Evaluation by a specialized pediatric feeding team (usually present in speech departments of large hospitals) as soon as possible
    - Early intervention program evaluation has to be scheduled as soon as possible
    - Have formal occupational therapy evaluation
The information appearing here is intended for educational purposes only. It should not be used as a substitute for professional medical advice tailored to your child's individual needs. If you have questions or concerns regarding your child's physical or mental health, please seek assistance from a qualified healthcare provider.
 
References
GLOBAL PEDIATRICS is an international adoption medical support service that has specialized in assisting families adopting from the Former Soviet Union through every step of the adoption process for the past ten years. Dr. Gordina's unique professional background and attention to detail ensure the highest possible level of service. She is recognized by her patients and peers as a leader and pioneer in the field and has presented her adoption-related research at sessions of the AAP, JCICS, NACAS and other meetings. Dr. Gordina has both participated in and organized several humanitarian missions to pediatric clinics and orphanages in the Former Soviet Union. For all questions regarding our services please check www.globalpediatrics.net 
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