EVAN HAS CHEEKS AGAIN! WHOHOO!
We have been hard at work in feeding therapy for three months and it has paid off! Nissa, our feeding therapist is an absolute gem! I’ve joked that if we were to have a third child and the baby was a girl, I’d name our third daughter after her. Nissa’s name means “miracle” and she is living up to her name! Evan has gone from being stuck in the 19-20 pound range for almost a year to now being 21 pounds quickly heading towards 22 pounds! Not only that, but meals have become enjoyable, not only for him, but for us too. I never thought my son would ask to eat but he does. And he actually ENJOYS himself and Ryan and I enjoy feeding him. And we’ve been able to expand what he eats beyond YOGURT. In just a few short months, Nissa has him eating a decent list of foods. Granted they’re all currently pureed (who knew you could puree pot pie!!!), but still, they’re a variety of food!
So, what has feeding therapy looked like? Nissa comes into our home and does a variety of things: She coaches us as parents in how to set up the feeding sessions with Evan including making sure that everyone involved is consistent in how they interact with Evan including being very specific with the language that is used, teaches us how to make Evan’s meals, makes the new foods the first time, feeds Evan initially to show us the techniques we need to use, observes us when we feed Evan and gives us feedback, creates individualized meal plans (which include caloric information and instructions on how to make the meals), and provides phone and email support as needed. Nissa was excellent with feedback and support over the months as we worked with Evan to get him eating. There were moments where we were so frustrated and exhausted and she would encourage us not to give up. She’d remind us that Evan had had months and months of not having to eat when he didn’t want to and now he was learning that he HAD to eat. This was going to be a difficult lesson for him to learn, one he was going to challenge again and again. We were going to have to be stronger willed than he was for this to work! We were going to have to wait him out some nights…sitting in the kitchen for hours if that was what it was going to take!
What has the overall structure looked like?
Here’s what mealtime looks like with Evan (I’m sure feeding therapy interventions look different for different types of issues but some aspects of the structure remain the same):
*We have needed to use cartoons as a distraction during mealtime with Evan. It is turned on five minutes prior to mealtime to avoid a possible power struggle of getting Evan into his chair. The cartoon is playing before he even comes to the kitchen.
*Once the mealtime is officially started, the cartoon is briefly paused. Evan is given clear expectations of what is expected of him. He is told that all the food will need to be gone before he can leave his seat (there have been times he has sat for an hour or more because this hasn’t happened—happily, this is not happening anymore).
*He is then fed food (we have an exact amount he has to eat, once it’s eaten he can get down). We start with the food he likes least for that meal. If he rejects a bite, the cartoon show is paused until he accepts food again. If he accepts food, it is immediately started again (very behavioral). If he spits food out or lets it slide down his chin, he’s told “finish your bite.” All of his refusals or other acting out behaviors are ignored (spitting, screaming, biting himself, throwing up–if its behavioral, etc).
*When he does eat, he is praised. The interactions are meant to be very positive and as much as possible, power struggles are to be avoided (which is hard at times—Evan was so good at engaging in them with his bib—he’d cover his face, etc., he’d also bite on his spoon trying to keep it in his mouth—so you’d have to get creative at how to set it up so its easier to not not engage in them as the adult—some nights if he’d seem in the mood to play games, I’d just leave the bib off—I’d have to do more laundry but it was an easier meal).
*When he has finished all of the food, we highlight that the bowl is EMPTY and that he can now get down and play or do whatever special activity he wanted to do. Evan now delights in having everyone (even people not at our house currently) clap and celebrate when his bowl is empty!!!! It’s so fun to see him get excited, especially about EATING!
To highlight our progress here. Here’s where we were a few months ago:
Food he was eating before: Yogurt, one or two baby foods, cheese (he would eat it some days, refuse it others), goldfish crackers(he would eat them some days, refuse them others), drink pediasure (until he started to refused it) and water
Foods he’s eating now: Yogurt, Baked Potato Soup, Chicken Pot Pie, Applesauce, Peaches, Pears, Broccoli Cheese Soup, Sweet Potatoes, Stuffing, Carnation Instant Breakfast, juice and water
What’s Next: In the next month or two, we will take the next step of addressing Evan’s aversion to textures and get him into eating solids. This will be a difficult issue to address as Evan has a very sensitive gag reflex due to some of his other past issues. Right now he’ll put solid food into his mouth, chew on it a bit, and then hand it back to us or spit it out into a napkin or onto a table or something else if we can’t catch him fast enough. I am dreading tackling this issue, but I have faith that if we can get this little boy to gain weight and eat a variety of food, we can get him to eat solids too!