How can I help 6-year old be less afraid of choking when she eats?

Q: My 6-year old granddaughter will not swallow food without chewing it into watery mush, she says it feels like she is choking. She has been to the doctor and there is no blockage. Any ideas on how to help her would be greatly appreciated.

A: My youngest son did the same thing, and it was very hard for both of us. When he was a preschooler, he had a bad habit of taking bites that were entirely too big for him to chew and swallow comfortably. I told him over and over to take smaller bites, and I warned him that if he didn’t, he might choke on his food. But since he had never experienced choking, he didn’t know what all the fuss was about. I tried everything I could think of to get him to slow down, take smaller bites, and chew his food more thoroughly, but nothing seemed to stick for more than a day or two. I was always worried that he would choke, so I never left him alone for a minute while he was eating.

When my son was about 8 years old, he was eating chicken at our kitchen table, and I noticed that he got very still. His eyes began to water, and he started making gagging sounds. My heart stopped, because I knew he was choking! I pulled him out of his chair and performed the Heimlich maneuver on him. Fortunately, the oversized bite of chicken came right out and he was fine, but the experience of choking and not being able to breathe scared him to death. After that, he was terrified of choking again. Just like your granddaughter, he started chewing each bite of his food until it became a watery mush and ran out the corners of his mouth. He seemed to have developed a fear of swallowing his food.

At first, I tried to reassure him that there was a happy middle ground—he needed to eat smaller bites and chew his food properly, but he didn’t need to chew each bite for five minutes. That didn’t help much. He was still a bit traumatized by the experience of choking. His grandmother noticed that he was chewing his food excessively, and when she asked him about it, he got really embarrassed. At that point, I decided the best course of action was to just ignore his excessive chewing and see if a little tincture of time would help.

It took about two months for my son to relax and resume a normal way of chewing and swallowing. During that time, I made a point of not saying a word about his odd eating behavior, and I made sure that everyone else in the family avoided discussing it as well. I felt certain that if we focused on it and made a big deal of it, we would only keep the problem alive and make it worse.

It’s possible that your granddaughter might have had a similar experience of choking on her food, and it’s made her a bit fearful of swallowing. Now that you have the doctor’s reassurance that your granddaughter doesn’t have any blockage that might be responsible for her excessive chewing, you might try ignoring the behavior for a few weeks. By not mentioning or focusing on her behavior, she might be able to relax more while she’s eating, and resume a more normal pattern of chewing and swallowing. Just knowing that people are watching her and worrying about her might be reinforcing the behavior. If you’ve already tried that to no avail, or if the problem has lasted several months, your next step is to ask your family doctor to refer your granddaughter to a gastroenterologist and a speech-language pathologist and/or an occupational therapist for further evaluation and treatment. The gastroenterologist can perform diagnostic studies to make sure your granddaughter doesn’t have any medical problems that might contribute to her excessive chewing. The occupational therapist or speech language pathologist, who specializes in feeding and swallowing disorders, can help identify any additional problems she might have and can work one-on-one with your granddaughter to develop a more relaxed and normal pattern of chewing and swallowing.

Answered by Dr. Rallie McAllister