Last week, the father of a 6.5-year-old daughter approached me for advice (names removed for privacy reasons):

Hello Tatiana! The girl choked on food 10 days ago. While eating, I watched a cartoon on the tablet. We began to warn her that while eating, you should not be distracted by TV and gadgets, as you can choke and die. Apparently, they went too far.
Gradually, over the course of the week, she increasingly refused solid food. The last three days he has been eating only very liquid semolina and mashed potatoes ground in a blender, and that is very bad. Actively drinks water or milk.

We don't pressure her. We try not to focus on food intake. But every day it only gets worse. The child is very mobile, sociable, but shy and cautious. Kindly, give recommendations on how we should proceed, we will be very grateful.

Such cases are very common for me. I see how many parents are completely lost and do not know how to behave. Panic and acute fear for the child settle in the family. And they can be understood.

Therefore, I decided to briefly describe what is happening at this moment with the child, what psychological mechanisms are activated in his mind and how you can go from an acute period to a mild one, so that later you can return to the previous track. During the period when the child calmly ate everything.

Until the critical moment (that is, before the girl choked on food) - there was a normal and stable eating behavior.
According to her father, she ate almost automatically, calmly chewing and swallowing chewed food. This automatism was developed against the background of previous positive experiences with chewing and swallowing food.

What happened to her at that critical moment? An explosion of fear. Panic. The old automatism has disintegrated. The strongest survival mechanism was activated in the brain. And if a girl, by temperament type, has features of a melancholic type, these feelings are intensified.
It is for this reason that her brain is now blocking solid food and instructing her body to eat only safe food.
The child does not realize this - he acts as he feels intuitively, it is impossible to interfere with this. Those. choosing liquid and "light" food - the child's body at this transitional moment, as it were, is trying to make sure that the food is safe and you can move on with solid food.

If the girl previously had a successful conditioned reflex “I eat calmly”, now a new conditioned reflex of rejection of solid food against the background of fear of choking has formed.

Now a question. How to unlock this reflex so that it does not become stable and fade away?

Remember how habits are acquired and then lost. There are 2 ways:

1. We need some sufficiently powerful signal or situation that will block the previous one and form a new conditioned reflex.

2. Or you need to stop reinforcing the unwanted behavior and it stops.
At the same time, the previous habit (fear and the choice of liquid food) does not fade away instantly, but gradually. It can appear once, then another - then less and less. And finally, until it is replaced by a sustainable new one (eat regular food).

In other words, the girl needs to create such a successful situation in which she can eat something freely and at will. Now it does not matter what exactly: liquid or solid. It is important to have a calm attitude towards food.
And the family should stop worrying and remind about food (because the family’s excitement only reinforces the child’s fear and does not solve the problem), provide understanding and maximum support.

As soon as the girl relaxes and becomes free to eat according to her choice, she will also gradually move on to her usual food. That's the only way this fear will go away.

Few parents realize that this problem lies at the intersection of biology and psychology. I had a case when a mother was angry with a child that he did not want to eat as much as she put on his plate. Everything seemed to her not enough. And the child's attempt to refuse some dish infuriated her.

There were so many tears and suffering both from the side of the child and from the side of the mother! When she found out what it was, she radically changed her approach to nutrition.

I spoke in more detail about the mechanisms of formation of conditioned food reflexes and the chain of normal eating behavior in the course "" (click on the link and you will see Full description, the course itself is in the format PDF, 131 pages and in the format audio MP3, duration 4 hours).

The course is suitable both for those mothers who are just starting to feed their children and who have everything ahead, and for those who are trying to establish a child’s nutrition that has gone astray for various reasons. And the mechanisms described in the course are universal for any age, because. they are very ancient, based on biological laws, plus the features of our human psyche are added here.

In any child, the swallowing reflex is well developed from infancy. So when he has difficulty eating, the parents start to panic. After all, if you do not get rid of this disease in time, in the future it can lead to quite serious violations. What should be done if the child is afraid to swallow food? To answer this question, you should understand the root causes of the onset of the disease.

Causes of phagophobia

Fear of choking (phagophobia) is incredibly destructive to a child's body. The cause of this unpleasant disease largely depends on the age of the baby. If a we are talking about the baby, such a fear may arise due to an excessive amount of milk in the mother's breast. The baby does not have time to eat and chokes, he completely loses the desire to swallow.

In older children, the fear of choking appears for completely different reasons. For example, after a sore throat, a child is afraid to swallow solid food, because during the illness this process caused severe pain. Perhaps he accidentally swallowed some kind of foreign body, as a result of which he now treats solid food with horror.

The reason may also be that the baby cannot concentrate on one process or is too lazy to chew food. The main reason for the occurrence of this disease is that the child is afraid to eat after choking.

In a mild form, phagophobia manifests itself in relation to certain types of food. It can be fish with small bones, dry flour products, nuts, tablets, etc. In more severe cases, any food causes fear.

This phobia can lead to exhaustion and pose a serious threat to the body of your son or daughter. Therefore, when a child has become afraid to swallow food, all possible measures must be taken to rid him of fear as soon as possible.

How to fight?

Treatment of phagophobia is possible without causing psychological trauma to the baby. Do no harm modern methods getting rid of this disease and the digestive system of the peanut. So, there is a special facial massage that can develop a swallowing reflex in him.

So, before you arose difficult situation Your child is afraid to swallow food. What to do to treat such a disease, psychologists suggest:

If the child is choking and afraid to eat, then a gradual swallowing technique can be used, starting with small objects and ending with larger objects. Talk to him seriously and explain that all people periodically choke, but are alive and well.

Where to go for treatment?

If the baby's fear of swallowing does not go away, despite all the efforts and persuasion of the parents, it's time to turn to professionals. Specialists of the psychological center "Insight" will select the most effective method treatment of phagophobia, taking into account individual features little patient.

If the child choked and is now afraid to swallow, entrust the solution of this problem to our employees! To sign up for a consultation with certified psychologists of the company, call the managers or fill out an application on the website. We provide both individual and group lessons.

Once a mother of two wonderful children (at her request I will omit the names) contacted me with an alarming message that her youngest daughter, at 3 years old, refuses to eat solid food(afraid to swallow).

Since this problem is quite interesting, because it is more related to the psychology of the child's perception of a particular situation (provided that bodily health leaves no doubt), I agreed to our meeting.

A Skype consultation was held, during which all questions were worked out, including the girl’s medical history, her psychological and physical development, as well as the system of relationships in her family.

Hello, readers of the blog "Your Child Psychologist"!

I would like to express my deep gratitude to Tatyana for her invaluable help in my situation.

I am an ordinary mother of two children - a son (6 years old) and a daughter (3 years old). I will say right away that I was prepared for tantrums, but I was not at all ready for the fact that my child would not eat and fell into a stupor. My daughter refused to eat coarse food - she only drank (and only fruit kefir, drinking yoghurts, tea and juices). The reason, according to the striker 🙂 " Crumbs interfere and I'm afraid to swallow».

The pediatrician, who looked at my daughter 2 times, said that the child is completely healthy, just wait. But, like any mother who thinks that my child is not eating enough, who has read all sorts of horror stories on the Internet, she could not leave this situation. “Why didn’t you feed her mashed potatoes ?!”, you ask. Yes, because the daughter has not opened her mouth on mashed potatoes since she was 10 months old, when she learned to chew adult food, because if mashed potatoes were shoved into her, she spat them out. God forbid, some lump or crumb (even a clot of yogurt) comes across - the daughter immediately began to scrape everything out of her mouth, spit, even to the gag reflex.

How - my child is hungry, my child does not eat enough, my child will lose weight, my brains screamed! Therefore, I cooked oatmeal porridge, broccoli, carrots, rubbed through a sieve (God, I didn’t rub so much in infancy), bought ready-made mashed potatoes (because sweet) and green beans (at least some variety) and mixed it into fruit kefir, orange juice (it turns out that orange juice interrupts many flavors J), mixed with chocolate milk once a week. If only the daughter received at least some nutrients. And God forbid, if a grain comes across - the daughter spat, if you overdo the mashed potatoes - the daughter immediately felt that the taste was changing ...

Since the child is healthy in body (according to the pediatrician), then it is necessary to show the soul, or rather, the brains to a specialist, and not only my daughters, but also mine 🙂.

I turned to Tatyana after more than two weeks of starvation of the child. And so, having sent a detailed letter about the situation, photographs of the child, her drawings, works, I had a consultation with Tatyana Egorova.

Having omitted all the details of the conversation, I will say one thing that Tatyana skillfully dotted all the “I”, directed me in the right direction, pointed out my mistakes and indicated my further tactics. The hardest part of the striker's tactic was to turn off my brains, my MOTHER's brains. God, I did it!

Educational psychologist, neuropsychologist, family counselor and parent-child relationship coach. She has publications in the magazines "9 Months" and "Nanny" as a medical psychologist, led the column "Question to a Psychologist" in the magazine "9 Months". Published in "Rossiyskaya Gazeta". Author of seminars, courses and trainings for parents on practical child psychology.

Dysphagia is a pathological process characterized by impaired swallowing. In the literature, this process is described as difficulty in swallowing hard and soft foods. It should be understood that this is not an independent disease, but only a consequence. Violations can occur both in adults and in children, and in the latter, dysphagia has its own characteristics of the course, consequences and complications. What are the main causes of dysphagia, can it indicate serious diseases? How to diagnose dysphagia and what treatment does modern medicine offer?

The mechanism of the act of swallowing

The act of swallowing is a complex process, although it seems to us as a matter of course. At first, the child chews food, crushes it, for easier swallowing. During this process, salivation and the production of gastric juice are stimulated. Saliva wets each piece of food, contributes to the formation of a food bolus. With the help of the coordinated work of the tongue and cheeks, food is pushed to the root of the tongue.

On its surface is a reflex zone. When it is touched, a reflex is triggered - the food lump is swallowed and moves into the throat. At the same time, the soft palate begins to move, separating the nasal cavity from the pharynx, and the muscles that raise the larynx also contract - this is necessary so that the food bolus gets into that “throat” and does not go to the larynx, bronchi and lungs.

As soon as the necessary pressure has been created in the pharynx, the esophagus opens, food begins its movement to the stomach. The circular muscles of the esophagus and their alternate contraction ensure the promotion of the food bolus and the creation of an area of ​​low pressure.

note

Despite the complexity of the process, only chewing food and pushing it to the root of the tongue consciously takes place. Otherwise, the process is unconscious and controllable. nervous system and pharyngeal-esophageal structures.

If we talk about dysphagia, then it is characterized by a violation of precisely the stages that are not amenable to conscious control, which can manifest itself in the following:

• return throwing of the food bolus from the pharynx into the oral cavity;
• the appearance of pain in the center of the sternum, one can say in the course of the food bolus;
• a “lump” is formed in the throat, children feel like a food lump is stuck in them.

Types of dysphagia

In clinical practice, several types of dysphagia are distinguished, which can be conditionally qualified according to its localization:

In addition to the types of dysphagia, there are also degrees of severity, of which 4:

• the inability to swallow only certain types of solid food;
• swallowing solid food is difficult, with soft, semi-liquid - there are no problems;
• it remains possible to swallow only the liquid form of food;
• there is no way to swallow anything at all.

Causes of dysphagia in children

Swallowing disorders in children's practice have some features, which is justified by the characteristics of the child's body. So what diseases and conditions can cause impaired swallowing?

cerebral palsy

Other specialists are also involved in the process of diagnosis and further treatment: a neuropathologist, an ENT specialist, an endocrinologist, a gastroenterologist, etc.

How is dysphagia treated?

Only after the diagnosis is confirmed, a treatment plan is developed on an individual basis, which is carried out in a hospital under the supervision of doctors. Due to the fact that the causes of dysphagia can be more than diverse, therefore, the treatment will be directed precisely at its elimination.

For example : a diagnosed tumor will require appropriate treatment: surgery, chemotherapy, radiation therapy. If dysphagia is provoked by inflammatory diseases of the oropharynx, drug therapy is prescribed: anti-inflammatory and antibiotics. In the diagnosis of functional dysphagia, a psychotherapist is required to participate.

In addition to the treatment of dysphagia, which is aimed at eliminating the cause, a diet is mandatory for a small patient. Although children can swallow liquid foods without problems, there is a list of foods that can aggravate dysphagia. These include:

• fast carbohydrates;
• strong tea or even coffee;
• lemonades, carbonated drinks;
• some types of citrus;
• fried and smoked.

note

Such foods can cause an increase in intragastric pressure and stimulate the acid-forming function of the stomach, which causes impaired swallowing.

Dysphagia is dangerous for its acute symptoms: while eating, pieces of food can be sent into the respiratory tract and the child may choke and begin to choke. Parents should be able to properly provide first aid. To avoid accidents, treatment should be carried out in a hospital where doctors can provide first aid in a timely and correct manner.

In advanced cases, the baby can be fed with a special tube.

Why is dysphagia dangerous for children?

Dysphagia in children dangerous state, especially if timely treatment was not started and the dysphagia itself started, and the reason that provoked its appearance.

If you start difficulty swallowing, it can cause serious complications. There is a high risk of inflammation of the esophagus, which can become chronic. This form of inflammation is a risk factor for the formation of tumor processes, not only in the esophagus, but also in other organs.

If the child does not have the opportunity to swallow food normally, then he can completely refuse to use it, which threatens the development of anorexia. And, as you know, this condition is already threatening health and even life. Refusal to eat is stressful for the child's body.

Doctors remind that dysphagia and its cause must be diagnosed in a timely manner and an effective treatment plan drawn up.

Alena Paretskaya, pediatrician, medical commentator

Parents of babies are well aware that all stages of the development of a baby by modern pediatrics are placed in certain age limits, which it will be more convenient for moms and dads to navigate in the process of growing a child. So, the timing of the introduction of complementary foods, the approximate timing of the appearance of the first teeth are called. There are also time limits for skills such as independent use of a spoon while eating, as well as the ability to chew and swallow solid food.

According to medical standards, a child at 7-8 months old may well eat from a spoon with the help of his mother, and by the year he can keep it on his own. Confidently own a spoon, according to official textbooks on pediatrics, the baby should be one and a half years old. The baby should bite and chew solid food already closer to a year, if the number of teeth allows.

In theory, everything looks even and smooth. In practice, parents often face problems. The child does not want to eat hard, even if he has teeth, the baby refuses to take a spoon in his hands, quickly loses interest in eating with a spoon, stops eating or chokes on pieces. An authoritative children's doctor Evgeny Komarovsky tells parents what to do in this situation.

All the rules of feeding will tell Dr. Komarovsky in the next video.

Komarovsky about the problem

Doesn't chew

There are no children in the world who would not have learned to chew and swallow by the age of 5-6, says Yevgeny Komarovsky. The chewing reflex (and this is not a skill, but a reflex!) Is present in all people, it is only activated in different time. Some earlier, others later. When asked what prevents the reflex from developing early, the doctor answers one thing - parents!

Overly caring parents who are in no hurry to give their child solid food are all afraid that the baby will choke. As a result, a baby at 2 years old, when he is already physiologically able to eat in pieces on his own, continues to receive food mashed into gruel from mom and dad.

Doesn't eat from a spoon

District pediatricians, especially the older generation, very often remind mothers that by 8-9 months a child should eat normally from a spoon, and a year later keep it on its own and at the same time get it into the mouth. Allegedly, this skill can be used to judge the neuropsychic development of the child.

The spoon is more of a psychotherapeutic technique for mom and dad, and not extremely necessary thing for the child himself.

In other words, if the baby eats from a spoon, and even on his own, parents begin to respect themselves immensely, be proud of their upbringing of the baby and in every possible way feel “like everyone else” and even better. But if he doesn’t take a spoon or, worse, denies it altogether, then this is a distress signal for many mothers, saying that somewhere she, mother, made a mistake - she was too lazy to teach, didn’t insist, didn’t demand, wasn’t interested .

In fact, the need to eat on their own with a spoon in a child will sooner or later form independently. And then the baby pretty quickly (because there is motivation-interest!) Will learn to hold a spoon and bring it to her mouth. Therefore, if a baby prefers to eat liquid porridge from a bottle at 9-11 months, you should not force him to do it with a spoon. Everything has its time.

Does not want to eat food in pieces

Yevgeny Komarovsky warns that this problem is quite common among children who have been breastfed for a long time, and their parents were in no hurry to accustom them to complementary foods. But if such questions arose, then it is too late to look for reasons, you need to think about what to do.

Komarovsky encourages parents to reasonably and objectively assess their child's ability to chew. To do this, you need to calculate how many teeth he has, and how they are located. Giving a crumb to gnaw an apple or a bagel if he has only two teeth is a real parental crime, especially considering that the overwhelming majority of parents do not know how to provide first aid at all. Two teeth are enough to bite off a piece, but not enough for reflex chewing.

Therefore, it is better to follow the same approach to the consistency of food in the diet, which is followed by manufacturers of ready-made baby food, and they change it gradually - first mashed potatoes, then mashed potatoes with small pieces, then thick homogeneous food and, finally, thick food with solid fragments. But here it is difficult to indicate the age limits, says Evgeny Olegovich, since all children are individual, and one year with a whole mouth of teeth chews an apple, and the other one and a half with three or four or a little more teeth continues to eat mashed potatoes.

Doesn't want to eat until the cartoons turn on

This is another common problem. A child looks at his parents, copies them, and 90% of the population is used to eating while looking at TV. In addition, some especially “sharp-witted” mothers specifically turn on cartoons that the child is distracted from the violent resistance to eating while she, a caring mother, will stuff a couple of extra spoons of porridge or mashed potatoes into him.

Yes, the baby, looking at the TV, will eat more. But this is precisely the main danger. When a child looks at a plate while eating, he produces gastric juice, which is so necessary for normal digestion. And if he looks at the cartoon characters, then the juice is not produced, and such food will not bring benefits, and threatens with stomach diseases. Even for this good reason, you can’t eat while watching cartoons.

• If the child does not chew, but tries to lick or suck an apple or cookie, he does not need to rush to rub this very apple on a grater or soak the cookie in milk. Give solid food more often, if the number of teeth allows, let him train. It happens to everyone without exception. No child has yet gone to school without being able to chew food.
• It is best to give complementary foods with a special baby spoon, and not with an ordinary teaspoon. Such a cutlery is made of plastic, which the baby will not get hurt, it has a smaller volume, which will not make it difficult to swallow. If the child does not accept even such a spoon, you should not feed him so forcefully. Let him eat from the bottle.
• If the child refuses to chew, swallow and take a spoon in his hands, Komarovsky advises to reconsider the diet. It is likely that the baby simply does not have time to get really hungry. This happens in families where the crumbs are given to eat "when it's time", and not when he asks for food. Overfeeding is not only the reason for the unwillingness of the baby to take part in the process itself, it can trigger the mechanisms of the most various diseases. Therefore, overfeeding is more harmful than underfeeding.
• It is not difficult to teach a child to eat on his own, says Komarovsky, the main thing is to “seize the moment” and help the child, unobtrusively support him in an effort to take a spoon, a cup in his hands. But to teach by force, especially if the child is not yet ready for independent actions at the table, and even more so to “pressure” on the crumbs, is not the best parental decision.
• If a child is selective in food (he only eats something specific), then this is definitely not a hungry child, says Dr. Komarovsky. Real hunger completely eliminates selectivity. And therefore, you should not indulge such selectivity, the child should eat what his mother put in front of him. If he doesn't eat, it means he doesn't want to eat. It is better to wait until he is really hungry.
• Do not do for the child what he is already capable of doing for himself. If we are talking about the fact that a baby at the age of one and a little older does not take a spoon, this is one thing. But everything changes if a child at 3-4 years old does not want to eat on his own and demands from his mother that she feed him. After two years, Komarovsky advises putting down a plate, giving a spoon and leaving the kitchen for a while, increasing the time of absence every day.

Returning, mom should not be interested in how much the baby ate with a spoon, you need to pretend that nothing surprising happened. Usually, after a few days, the child begins to eat at least half of the prescribed portion on his own. Do not forget to show maximum patience and tact.