Thursday, August 23, 2007

When a child won't eat

NYT reports on treatments for children with "feeding disorders".

There are only nine programs in the country designed to treat young children who will not eat. Dr. Manikam runs one of them, in a ward at St. Mary’s Hospital for Children in Bayside, Queens, that can house six inpatients. Inside a row of small rooms at the Center for Pediatric Feeding Disorders, therapists do the slow, careful work of breaking down children’s resistance to eating. They act as detectives, tracing the behavior backward to the experience that may have shaped it.

Underlying the work is the notion that eating is a learned behavior, not an instinctive one. Babies fed by tube after birth may never learn to associate the sensation of hunger with the act of eating; babies who do not move to solid food by the age of 8 months may not learn to breathe, chew and swallow without choking. When those learning opportunities are missed, children can develop a deep anxiety that defies logic, something that Dr. Manikam compares to a fear of flying.

He has spent a career trying to break down that fear, most often in children with disabilities who become accustomed to tube-feeding early in life.
“I am a firm believer that learning never ends,” he said. “If you are living, you can learn.”

What strikes me about this article is that the inability to eat came not from any inherent disorder, but instead from the conditioning that resulted as a secondary effect of the modern technologies that saved their lives as infants. We take certain activities for granted because they are so fundamental to our existence and culture, and the idea of someone who cannot eat because they did not learn the behavior of eating is baffling to most since (until recently) the only way to sustain oneself nutritionally has been to eat food. I can only imagine how lost and helpless the parents of these children must have felt before they discovered these therapists.

While this by no means invalidates the need to use such technologies to save and improve lives, it does emphasize that with continued rapid advances in technology must also come an increased level of empathy and understanding to help us recognize new areas of intervention that are required to allow those lives we saved to thrive.

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