ABSTRACT
A young child with VACTERL association who refused oral intake and had relied on gastric tube feeding for almost all of her nutritional intake since birth was initially managed with nutritional guidance based on the assumption that refusal was due to oral hypersensitivity. However, no improvement was observed in the refusal of oral intake, and her inherent developmental delay and bilateral hearing loss prevented the continuation of nutritional guidance. A speech-language-hearing therapist was then consulted to assess the patient’s swallowing function, and the diagnosis was that the lack of experience of oral intake itself and the dependence on tube feeding were more likely causes of the refusal than oral hypersensitivity. We therefore decided to use the approach proposed by Tazumi et al. for stepwise management of eating disorders requiring tube feeding in young children. This allowed us to create a step-bystep management plan toward achieving oral intake, resulting in gradual but significant changes in the patient's eating behavior. Although oral intake has not been achieved as of the time of writing, we are continuing to manage the patient with this trial-and-error approach.