How to stop mealtime gagging

Posted by Barbara F. Meltz  December 21, 2011 06:00 AM

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Hi Barbara,
My 2 year old daughter has recently started a disturbing behavior and I am at a loss for what to do. She has started shoveling food in her mouth and not chewing and then gagging. I am constantly reminding her to take small bites and to "chew, chew, chew." She just laughs and does it again. Of course she gets a huge reaction from me because she gags and it is scary. How can I ignore her behavior if she really is choking? I have put less and less food on her plate, I have cut everything up in small bites, but she still finds a way to do it. Last night we had medium sized pasta shells and sauce for dinner. She would put two in her mouth and NOT CHEW, just swallow and then gag and then laugh. I finally just told her if she didn't chew she wasn't getting anymore and removed her from the table. My husband got upset saying that I can't let her starve so he brought her back to the table and fed her while I was in the other room and she didn't do it for him, she was fine. Can you please give me some tips on how to stop this behavior? Thank You!

From: Rachel, Marshfield, MA


Dear Rachel,

Although I've never heard of this behavior before, feeding specialist and developmental pediatrician Mario Petersen says it's not unusual. He should know, he's a specialist at the Feeding Clinic at Oregon Health Science University.

Petersen describes this as nothing more than an annoying attention-getting device. How does he know? "If it was a medical issue or a behavioral disorder, it would happen with the dad, too," he said in a phone interview. He urges you to try to relax: Gagging, he notes, is not the same as choking. "The worst that can happen is that she'll throw up."

He approves of your strategy of giving her small portions and of removing her from the table as soon as she doesn't chew. His recommendation is to matter-of-factly remove her from the food: "I can see you don't want to chew. You can be excused from the table."

She will probably protest loudly. Offer to let her try again to chew. Put her back in her high chair. Most likely, the gag/laugh sequence will be even more intense. "She does this for mom's attention." Petersen said. "When she doesn't get the attention she expects, she will try harder."

Remove her again. Quickly. Tell her, "You can try again next time." Meaning, next meal. The idea is to reward chewing with lots of praise and ignore the behavior you don't want.
Petersen predicts, "If you do this consistently at every meal, she will stop after three days."

Now, about dad. As you suspect, he needs to be on board. You could do this strategy yourself for meals when he isn't home, and then leave the room for him to feed her when he is home, but better to do this together. "I can reassure the father, kids do not starve themselves," Petersen said. "I don't think there's reason to panic or even worry about this. This is not going to produce any harm to the baby. It is not comfortable to watch [the gagging or sending her from the table], but it is not harmful."

Since it's possible this will get worse before it gets better, my suggestion is to institute "Mom Time," where you announce that this is time just for the two of you: "No interruptions. I'm not going to look at my email, or answer the phone, or anything. This is just for you and me." Give her a choice of activities. When she sees that she can have your undivided attention in a positive way, she'll have less need to seek it in other ways.

This blog is not written or edited by Boston.com or the Boston Globe.
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3 comments so far...
  1. I hate your portrayal that Mom is handling this correctly here and Dad needs to get on board. Except for the part where he undermined Mom's authority by bringing her back to the table, it seems to me that Dad has been doing it right by not giving this behavior the "constant" attention that Mom does, and Mom is the one who needs to get on board.

    Posted by geocool December 21, 11 11:02 AM
  1. Yes, beware the extinction burst. Things will likely escalate before they get better (just like when we press a dead remote control HARDER to try and get it to work before we give up and check the batteries). It's not a sign that your strategy isn't working, but that it *is*. Hang in there.

    Posted by Susan December 21, 11 03:45 PM
  1. Since this sounds like new behavior, I'm not sure if my situation fits, but I mention to promote awareness...my son, 25 months, was recently diagnosed with something called verbal apraxia, which is an oral-motor disorder. One of the symptoms is "stuffing", or filling their mouths with food but without swallowing so that they end up gagging. I was convinced my son was doing this on purpose, too. And he didn't seem to do it for his father, either, but I was generally the one who fed him. We didn't associate the two until he went to early intervention for speech issues (not talking) and eventually was diagnosed. One of the symptoms is "stuffing", since these kids seem to have both a lack of sensation in their mouths (which would tell their brain to swallow) and they also have trouble with motor processing (when their brain tells the muscles to swallow, the muscles don't always get the message).

    Posted by northshore123 December 26, 11 08:55 PM
 
3 comments so far...
  1. I hate your portrayal that Mom is handling this correctly here and Dad needs to get on board. Except for the part where he undermined Mom's authority by bringing her back to the table, it seems to me that Dad has been doing it right by not giving this behavior the "constant" attention that Mom does, and Mom is the one who needs to get on board.

    Posted by geocool December 21, 11 11:02 AM
  1. Yes, beware the extinction burst. Things will likely escalate before they get better (just like when we press a dead remote control HARDER to try and get it to work before we give up and check the batteries). It's not a sign that your strategy isn't working, but that it *is*. Hang in there.

    Posted by Susan December 21, 11 03:45 PM
  1. Since this sounds like new behavior, I'm not sure if my situation fits, but I mention to promote awareness...my son, 25 months, was recently diagnosed with something called verbal apraxia, which is an oral-motor disorder. One of the symptoms is "stuffing", or filling their mouths with food but without swallowing so that they end up gagging. I was convinced my son was doing this on purpose, too. And he didn't seem to do it for his father, either, but I was generally the one who fed him. We didn't associate the two until he went to early intervention for speech issues (not talking) and eventually was diagnosed. One of the symptoms is "stuffing", since these kids seem to have both a lack of sensation in their mouths (which would tell their brain to swallow) and they also have trouble with motor processing (when their brain tells the muscles to swallow, the muscles don't always get the message).

    Posted by northshore123 December 26, 11 08:55 PM
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About the author

Barbara F. Meltz is a freelance writer, parenting consultant, and author of "Put Yourself in Their Shoes: Understanding How Your Children See the World." She won several awards for her weekly "Child Caring" column in the Globe, including the 2008 American Psychological Association Print Excellence award. Barbara is available as a speaker for parent groups.

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