Oral aversion

After the series of jokey political diversions over the last weeks—reverting the direction of traffic through St James and Ariapita Avenue; Section 34, surely destined to become a famous mas band next J’Ouvert; the temporary, temporary, temporary VAT order; ordering doubles “slight planass please,” and the infamous “PNM murder,” about as low as you can reach on the political spectrum—I have developed an even worse case of politician aversion and have decided instead to move on to something called oral aversion in children, which has nothing to do with foot-in-mouth disease endemic among politicians.

Oral aversion describes the avoidance or fear of eating, drinking or accepting sensation around the mouth (toothbrushing or face-washing).  Like eating or drinking, oral aversion is learned behaviour. We tend to think that eating or drinking is instinctive. It is not. It is learned.  Even breastfed babies need to be taught how to feed. Some learn easily and within hours of birth. For others, it may be more difficult.

Some mothers may think their babies are feeding well only for someone to notice that the child is not gaining weight. These babies may be going to the breast and making sucking movements but, like our governments, it’s all sham. They aren’t doing anything.

Most babies learn from the moment they are born that eating and drinking are fun and positive experiences. Occasionally, a baby or small child learns that eating or drinking is uncomfortable, unpleasant or causes anxiety. Just like listening to politicians makes you sick, anything that makes a child build up that association between eating, drinking and feeling bad causes oral aversion.

One of the most common causes of this is medical trauma. Sick babies are easily traumatised orally and when that happens they don’t go through the normal, pleasant feeding process and may give problems to eat or drink.

One of the more common ways to traumatise a baby is by passing a feeding tube through its mouth or nose into its stomach.  If this is ever necessary for medical reasons, the tube should be removed as soon as possible and in the meantime efforts should be made to keep the baby’s suck reflex strong by placing a dummy soaked in sugar or, even better, in breastmilk, in the mouth.

Politicians do the same sort of thing when they give out jerseys. It keeps people’s mouths sweet. Similar things happen if a breathing tube has to be placed down the baby’s windpipe or even if something as simple as an oxygen mask is needed for the first few days of life. Later on even a bad-tasting medicine (and the trauma surrounding the giving) or a breathing treatment for asthma or cold can have the same effect.

A corollary of this is the window of opportunity for introducing new foods that appears to exist between the sixth and twelfth month of life. Many children who do not get the opportunity to savour new food flavours, textures, colours, shapes etc during these months, refuse to do so later on in life.

They haven’t learnt to eat properly. In the 70s, I was amazed to find malnourished two-year-olds at the Port-of-Spain General Hospital who had never eaten peas or eddoes or callalloo in their lives and adamantly refused to do so. Illness or discomfort is another cause of babies or children developing oral aversion.

Gastrointestinal disorders in children, milk allergy, constipation and reflux are all associated with the development of oral aversion. Respiratory problems, asthma, sleep apnoea and chronic rhinitis can also cause problems.  Because we stop breathing very briefly during every swallow, eating becomes difficult and tiring for these children.

Then there are children with low IQs or some form of brain damage—cerebral palsy and the like—who either have difficulty learning to eat or to control the muscles that we use to eat. There are children who while otherwise normal and have a very high awareness of oral sensations. They simply cannot tolerate lumps in food or different textures or strong flavours or smells.

Others have the opposite problem: low awareness and the need to stuff food into their mouths in order to “feel” food better. These children can become aversive to foods with the characteristics they find overwhelming. There is a special subset of children with oral aversion. These are children who have experienced a choking episode. They are like adults who have been fooled once too often by politicians and develop a political phobia.

These children too really have a true food phobia (a phobia is an extreme or irrational fear of or aversion to anything). Children or adults who have developed phobias after choking on food or the nonsense going on in the country need special therapy to help them deal with the characteristics they find overwhelming or unappealing.

But unlike adults, who sometimes have to get rid of the politicians they associate with unpleasantness, children can benefit from psychological therapy. I am afraid there is simply no therapy available for us.