Poor Nourishment in International Adoptees


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Adoption Nutrition: Hope and Healing through Proper Nutrition

Transitional Feeding Difficulties in Adoption

Bonding & Attachment Food/Eating Post-Adoption

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  Written by Dr. Julian Davies, MD, Center for Adoption Medicine, University of Washington on 12 Mar 2015

While many international adoptees have no trouble eating & drinking & growing & gaining, some children from orphanage or neglectful backgrounds have initial trouble with age-appropriate foods. Feeding difficulties are some of the hardest to cope with emotionally, since feeding your likely malnourished child gets at the core of parenting.

The trouble you may have likely has little to do with you or your feeding skills. If you just received the child, they may be scared, stressed, grieving, and just not that hungry. Also, their past experiences with feeding have a large influence on your early mealtime issues. Prior feeding practices may have including bottle-propping with wide-open nipples (chug-chug-chug passive feeding with little active sucking involved), uncomfortably hot or cold foods, sweeter formulas thickened with cereal, and limited or no introduction of solid foods. These practices can lead to markedly immature oral-motor-feeding skills, aversions to feeding, fear of novel food experiences, and taste/temperature sensitivities. Some kids have the feeding ability, but just want things the familiar way, so if you get the opportunity, do ask their caregivers what that way is.

The immediate focus in children with marked feeding difficulties or refusal should be on keeping up hydration; that said, it is VERY unusual for a child to refuse himself into severe dehydration. Solid foods can wait until you get home. Formula is still the drink of choice, as your child will need the calories. If your child is refusing the bottle, you might try some of the following tweaks:

* try the familiar local stuff, in a local bottle (straight bottle, big open nipple)

* experiment with various formula brands (for more on this visit

* add in 1 tsp of sugar per 6-8oz bottle if the local stuff is sweeter (but wean this over the next 1-2 weeks)

* try a slightly more dilute formula (not for more than a day or so)

* mix in some rice cereal to the formula (I don't love this practice but they're often used to it)

* play with temperature (from cooler to warmer than you'd think, but test it on your wrist first)

* and definitely try different nipple styles or open up the nipple you do have

The massive transition you're going through together may also contribute to your child's energy level and interactivity. Keeping as much routine as possible around meals/snacks/sleep, nesting in your hotel room, and avoiding crowded and overwhelming spaces can help.

The solid foods can happen at their pace ... oral defensiveness is certainly something that we see. What these children need is a gradual, persistent, and consistent approach to introducing textures (simple to more complex) and tastes (bland to more stimulating). The same approach should be used for children with difficulty making transitions from one feeding stage to the next (pureed to junior textures, bottle to cup). If they don't progress in the next few weeks then visiting a feeding/speech/oral-motor therapist on return would be a good idea.

Things that also may contribute - any painful-looking mouth sores or teeth (emerging or decayed)? Any painful reflux behaviors (sour face, arching back)? Any cough/sputter with eating? Vomiting/diarrhea, or bad constipation? Other concerning signs of illness? If so, let us or your doctor know.

Dr Julian Davies, MD, is a pediatrician specializing in adoption medicine at the Center for Adoption Medicine at the University of Washington. To see the most up to date version of this article and find other wonderful resources, visit 



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