Oral Aversion

Oral aversion is when your baby won’t eat and resists attempts to feed them by mouth, even though they need to eat. Babies can do this out of fear after having negative mouth-related experiences very early in life. Without treatment, babies are likely to develop further nutrition-related complications.

If your baby shows signs of oral aversion, their pediatrician can help you. It’s important to get help early because oral aversions can get worse without the right interventions.

What are the symptoms of oral aversion?

Symptoms of oral aversion can include your baby doing things like:

• Protesting or turning away when something gets near their mouth
• Sticking out their tongue (as if to push something away)
• Tightly closing their mouth when something touches their lips
• Refusing to latch on to and feed from a nipple (either breast or bottle)
• Feeding themselves finger foods, but refusing to let anyone feed them

Babies often hesitate to feed or might push away from attempts to feed them. That’s normal, and it’s nothing to worry about. But oral aversions are much more consistent. If you’re unsure which is the case for your baby, their pediatrician can determine if there’s a cause for concern.

What causes oral aversion?

Oral aversion happens because your baby expects something bad when something’s near their mouth. They learn to expect that after repeated negative mouth-related experiences. Negative experiences may include:

• Repeated advanced medical procedures to feed your baby through a tube or help them breathe
• Conditions or issues related to feeding
• Trouble with mouth or swallowing control

What are the risk factors for oral aversion?

Babies are more likely to develop oral aversions if they have or experienced the following:

• Treatments for breathing issues, like intubation, mechanical ventilation or tracheostomy
• Conditions that affect feeding, like reflux or gastroesophageal reflux disease (GERD)
• A sensitivity to something in breast milk or formula
• Throat conditions like esophagus inflammation (esophagitis), painful swallowing (odynophagia) or difficulty swallowing (dysphagia)
• Conditions that affect muscle control or coordination, like cerebral palsy
• Genetic disorders like Down syndrome or Moebius syndrome
• Trouble understanding their own hunger cues because they’ve been on tube feeding for a long time, or because they were very sick early in life
• Neurodivergent conditions like autism spectrum disorder, making them more sensitive to certain sensations (like touch)

What are the complications of oral aversion?

Babies with oral aversion are more likely to develop:

• Malnutrition or growth faltering
• Need for tube feeding (enteral nutrition)
• Aspiration pneumonia

Research also shows babies have a “window” where it’s easier for them to learn how to feed. If they don’t learn how during that time, it’s harder for them to learn later.

Having an oral aversion as an infant may also increase your baby’s risk of having another food- or eating-related disorder later in life. Avoidant/restrictive food intake disorder is one example.

While these complications are serious, they’re also treatable. And early diagnosis and treatment reduce the risk of them happening.

How is oral aversion diagnosed?

A pediatrician or other provider can diagnose oral aversion after ruling out other causes. That can involve tests, asking questions about your baby’s health history, your home life and environment, how your baby feeds and more.

That can involve tests like:

• Feeding assessments and observing feedings
• Lab tests, like blood tests and thyroid tests
• Imaging scans on your baby, like fluoroscopy or MRI
• Diagnostic procedures like upper endoscopy or esophageal manometry

How is oral aversion treated?

Treating oral aversion takes a team approach. Your baby’s pediatrician will team up with other specialists, like a speech language pathologist or occupational therapist, who can help your baby unlearn their aversion. There’s no one-size-fits-all approach. Treatment plans tailored to meet your and your baby’s specific needs and preferences are common.

Treatment can involve one or more of the following:

• Positive oral stimulation experiences. These teach your baby that not all mouth-related medical care feels bad.
• Skill building. Feeding takes coordination and skill. Helping your baby learn and practice those skills can make it easier for them to feed. If they’re comfortable feeding, they’re less likely to have an aversion to it.
• Exposure to things that taste good. Once providers find tastes your baby likes, they help your baby learn to enjoy feeding.
• Planning and following new routines. Setting up new routines can help your baby relearn what to expect.
• Teaching you and other caregivers. Showing you how to best feed your baby can make it easier for them to unlearn their aversion. It can also deepen the bond between you and your baby.

It’s understandable to feel disappointed or worried if your baby’s aversion takes longer to treat. But oral aversion treatments often take time and help from multiple specialists.

Can oral aversions be prevented?

Oral aversions aren’t 100% preventable. But healthcare providers can take steps to avoid them. That can start early if your baby has risk factors like needing advanced medical care early in life.

There may also be things you can do to reduce the odds of them happening. Your baby’s pediatrician can tell you more about what you can do to help your baby.

What’s the outlook for oral aversions?

The outlook for oral aversions is generally good, especially with early diagnosis and treatment.

Are oral aversions the same as food aversions?

No, oral aversions usually are very general. That means your baby will want to avoid or resist anything that involves something near their mouth, including eating. Food aversions can also be very specific. Your baby may only be averse to specific textures or tastes.