Hyperactive gag reflex (9 months)

My daughter is 9 months old. She has been totally breastfed since birth. I started offering solids (cereal and fruit) at 5 months. She refused everything I offered her. I continued offering her solids every few days and also started offering her teething biscuits and putting cereal and baby food on her high chair tray for her to play with during our mealtime. I also gave her cups and spoons to play with.

It is now 4 months later and she still refuses everything offered to her. She will not let a spoon, bottle, or cup near her face. I have put cereal or fruit on my finger and put it in her mouth (even that was a challenge) and she gagged. In fact, she gags when anything but my breast is in her mouth.

She does not mouth toys as other children do. She puts nothing in her mouth. Strong smells make her gag also. I have tried "starving her out" and refusing to nurse her and offering her formula, juice or water in a bottle but she refused the bottle. I finally broke down after 10 hours and nursed her. I think she would have gone 10 more hours. She never did get fussy or cry.

In addition to the strong gag reflex, she still exhibits a tongue thrust. All developmental milestones have been reached on time or early. Her pediatrician does not seem concerned and said she would be perfectly fine on nothing but breast milk until 18 months of age if necessary. I am concerned about her not eating or drinking anything for 9 hours Monday through Friday while I am at work. She will be staying at home with her father (not in daycare).

How should he encourage her to eat or drink something? Will she be OK if she does not? And could such a strong gag reflex and tongue thrust at 9 months indicate an underlying problem? thank you for prompt attention to our problem. We have searched everywhere for help and continue to come up empty-handed. With only 10 days left at home with her I am getting desperate.



Sue Gilbert

Sue Gilbert works as a consulting nutritionist. For many years she worked with Earth's Best Organic Baby Food, integrating nutrition and... Read more

Dear Lillian,

The fact that your daughter has never participated in any sort of oral play is an indication that she may have a hyperactive gag response. Children with this problem gag at the slightest provocation, different tastes, textures, and even smells. Because of the hyperactive gag response, babies may severely restrict the variety of food textures in their mouth, which further perpetuates the sensory deprivation and the oral sensitivity.

Treatment to decrease this hypersensitive response is needed to change feeding behavior and to improve nutritional intake. I suggest that you seek the help of an occupational, speech, or physical therapist as well as a pediatric clinical dietitian. They should be able to help develop a treatment program. Ask your pediatrician for a recommendation, or your local hospital's pediatric department.

Meanwhile, I suggest you leave some expressed breast milk with your husband to offer to your daughter when you are away. Because unfamiliar smells and flavors can elicit the gag response, the familiarity of your milk, instead of trying formula, would be best. Have you husband wet the nipple of the bottle with some of the milk to encourage her to take it when she is hungry.

Perhaps you pediatrician feels that your daughter may outgrow the hypersensitive gag reflex by 18 months? If this is the case, and you decide to wait it out, you may want to look into vitamin supplements for your daughter, particularly iron and vitamin D as both are low in breast milk.

Waiting until 18 months may be unacceptable or impossible for you because of work demands. In this case, getting you daughter some help in overcoming her problem now is the best bet. Generally, the longer a child goes without oral stimulation, the tougher the problem is to overcome later on. Even if you choose to wait, it may be helpful to at least consult with a therapist and dietitian.

Thank you for writing.

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