My 4 year old daughter refuses to eat!

Question

My 4yr old daughter had a little choking scare with a piece of popcorn 9 days ago. since then she has refused to eat anything except freezies, 9 days without solid food! We have been to the doctor twice as well as the childrens hospital everyone says to wait it out? She has had 1 bowel movement in those 9 days

Answer 1

Sounds like you're doing the right thing to keep the doctor appraised of her condition and progress. A four year old isn't going to starve in a week or two. She's had a trauma, let her get over it at her own pace, as long as her doctor doesn't see any problem with it.

That said, if you want some advice for helping her while she's getting over it:

• Freezes are a good answer, and along the same lines shakes. You can make very nutritious shakes - there's a lot of recipes around for nutritious shakes with thinks like spinach/kale in them for green veggies, some blueberries or strawberries or whatnot for sweetness, and some yogurt for protein. Good for you and very good tasting. Banana+mango+spinach is popular with my kids for breakfast.
• Drink nutritious drinks, like milk and juices.
• Soups - bean based soups that are pureed, or butternut squash/pumpkin soup also pureed. Cream in them makes them rich and calorie-filled, but no choking hazard at all.

When she's ready for a little solids, start with something really fun and easy, like macaroni and cheese - something she really enjoyed before, and is soft and mushy.

Answer 2

It is very common for adults who have experienced choking to avoid/dread food, and they understand how it happened. How much worse it must be for a child who doesn't really know the mechanics.

You say you are frustrated because your doctors tell you to "wait it out". This is extremely sound advice. Any other method of dealing with this would traumatize her further, e.g. hooking her up to IV alimentation, or tube-feeding her, etc. She doesn't need counseling yet.

Choking is the fourth leading cause of unintentional death in children under the age of 5. She was frightened on a very deep and real level (to her, this was not a small choking scare). She needs reassurance: reassurance that her fear will be respected, reassurance that you will protect her from this recurring, reassurance that she will get over it. Your role is to provide her with these reassurances in a way she can understand and be comfortable with. Patience is key here.

Feed her liquid food without anxiety that she's not eating enough. Your anxiety adds to hers. This might take weeks. She will be fine.

Introduce foods to her that are non-threatening. Chunks of canned peaches, cut grapes, and other soft, slippery foods cut too small to obstruct her trachea (for a 4 yr old, that would be smaller than about 8 mm) would be great. Vegetables like carrots, celery, and green beans should be shredded or cooked and cut up. Avoid dry foods, or hard to chew foods. Scrambled eggs, applesauce,Soups with small chunks are good. Use gravy and other "lubricants" with food until she feels comfortable again.

Teach her, and model, safe eating habits. This will help her to avoid re-experiencing the trauma. Let her know that these things can help her to avoid choking.

• eat sitting up (no eating while walking, laying back, etc.)
• no talking with food in mouth
• no eating while overly distracted or excited (no exciting movies, running kids, etc.)
• chew foods well
• offer her sips of liquids between bites

Always attend her while she is eating and reassure her that you will keep her safe (learn what to do if your child is choking so this will be truthful.) At the same time, it's important to avoid appearing overzealous, anxious, or overly vigilant, so she learns progress herself, not only reling on you.

If this persists for more than a few weeks, talk to her doctor about a special therapist who can work with her swallowing and her fear. Far and away, most people recover without difficulties, although she may prefer to avoid popcorn for a few years.

_{Choking Prevention for Children
Paper on treatment of a 4 yer old child's severe food phobia after an earlier episode of choking.}