Monthly Archives: March 2012

Evan’s First Day of Preschool (3/12/12)

After visiting his school the previous Friday and seeing all the fun activities, Evan was excited to go to school. He’s gone two days so far and although he starts out a bit clingy upon arrival, by the time I’m back to pick him up, he doesn’t want to leave! :) Evan’s class is small so far: only three other little boys. I think a little girl starts next week. We hope Evan grows and learns a lot and that friendships are forged.

Points to Ponder

“We can easily manage if we will only take, each day, the burden appointed to it. But the load will be too heavy for us if we carry yesterday’s burden over again today, and then add the burden of the morrow before we are required to bear it.”
― John Newton

“Do not spoil what you have by desiring what you have not; but remember that what you now have was once among the things you only hoped for.”
–Facebook quote, no source given

Having Fun in March

Evan loves to “read”. We find him all over the house doing it in various ways. Sometimes he’ll plunk down on the floor–who cares if its hard wood–to enjoy a book with his blanket. Other times we’ll come into his dark bedroom and find him sitting by his night light reading books.

Today I came into his room during his post-nap quiet time in his crib and he was “reading” to his elephant! So cute!

Evan is also currently obsessed with his little shovel. He feels like such a big boy when helping me shovel the driveway and when hanging out in the backyard with Ryan when we have snow.

We enjoyed the mild March weather this weekend by taking a long, albeit muddy, walk on a local trail. It culminated in time at a park. Makenna got to swing for the first time. She was her typical laid-back self about the new experience!

Behavioral vomiting, say what?

So the other day on Facebook, one of my college friends posted that her almost two year old son had thrown up for the first time! I was impressed as Evan has it down to a science…or a hobby….

Before watching a Jon and Kate Plus Eight episode where one of their daughters could throw up to get her way, I never knew that throwing up could be a toddler behavioral issue versus a medical one! For Evan, this is a multi-faceted issue. He has a sensitive gag-reflex, gets full really easily, but also uses throwing up as a maladaptive coping skill (nice mental health language) when he is really upset or as a strategy to get his way. Many an outfit, crib sheet, and blanket have been washed repetitively due to this hobby of his. Evan is a really smart boy too. He knows it’s not something that we enjoy dealing with so he will also threaten to throw up if things aren’t going the way he wants them too! He will milk this power or control for all he can!

Prior to Evan’s surgery, we had seen the behavior completely go away and we were so thankful! But since the surgery, it has returned in full force….i.e. it was a daily occurrence. I guess it makes sense that he’d revert back to something he found comfort or power in after going through something traumatic. Some of the vomit episodes revolve around eating, but most of them are because Evan works himself up so much that he’ll throw up or because he wasn’t getting what he wanted in the moment.

So how have we handled this behavior?
1.) We have teased out what could be connected to his gag reflex and stomach emptying issues (with the help of professionals and trial and error). This means that we have worked to continue to head towards eating solids in a way that we try to minimize triggering the gag reflex. And we have done TONS of exercises with the speech therapist and feeding therapist to desensitize Evan’s mouth and gag reflex. We have also spread out his meals as much as we can so his stomach does not feel full going into the next meal.

2.) When he behaviorally throws up, he does not get out of his current situation because of it. For example, if he throws up in his crib, we change him and the crib sheet without him getting out of his crib (this is pretty comical to watch if you’re an outsider—and are plugging your nose). If he throws up in his eating chair, we change him next to it and clean up the chair, but then he goes right back in. We want to do all we can to make sure Evan doesn’t get something he wants from this behavior (i.e. more attention, a bath, getting out of a crib or chair, avoiding eating, etc.). If he throws up during a meal, he has to eat again (at times we adjust the amount or what he ate, but he still has to do over what was just thrown up).

3.) When he mentions that he might throw up or when he does throw up, we connect a negative consequence to the behavior. Lately that has been that he has to spend some time in his bed because throwing up means he’s “sick so he needs to have extra rest”. We’ve also had an incident when he threw up while friends were over—they had to leave.

4.) We also try to attach positive incentives to him not throwing up. He has gotten a bath for not throwing up but we’ve had to clean him up with washcloths and wipes when he’s thrown up. I know it sounds gross and odd to not give him a bath after vomiting, but it was one of the things that Evan loves and back when he would get an extra bath after throwing up, he tended to do it intentionally to get another one if there was a night he wasn’t scheduled for one.

This issue has been a difficult one, especially as is directly affects his weight gain and loss. Now that I’m home with the kids, it’s just one more reason why I am so thankful for Evan’s former daycare provider, Erin, who took care of Evan for almost two years. She repeatedly cleaned up after this hobby of his and didn’t complain! She was also very adept at discerning when it was a behavioral issue and when it meant he was sick and needed to go home. There were times I was surprised we weren’t told he needed to find a new daycare! It’s one thing to clean up vomit from your own child, it’s a whole other ball game to clean up after someone else’s little one.

Like any other issue, the moments when I get frustrated, I really need to remember to focus on the progress and baby steps made rather than the fact that we’re still dealing with the same behavior! And maybe Evan will become a child behavioral psychologist, pediatrician, or pediatric surgeon in the future, with unusual insight into the behavioral quirks of little ones!

Evan the Eater

With all the surgery and other medical stuff going on, I haven’t said much about Evan’s feeding progress. Evan’s now 23 pounds which is AWESOME considering we’ve had a major surgery and other issues to address in the past few months that effect weight gain.

We’re up to five meals a day with Evan. Besides the early morning meal, Evan eats six ounces of purees and two ounces of Carnation Instant Breakfast at each meal. That’s a HUGE increase from where we were before starting feeding therapy. Before I was scared because I could see his ribs, now I love seeing how big his tummy gets at the end of a meal! He’s also growing like a weed height-wise!

Recently, Evan has taken the next step towards eating solid foods. He’s taking multiple bites each day of soft solid foods (strawberries, bananas, hard boiled eggs, grapes, etc.). “Bites” meaning chewing AND swallowing, which is a big step forward for Evan. Some days he enjoys doing so (as evidenced by him chewing and swallowing them quickly, asking for more, and even trying to sneak more bites) and other days he struggles (as evidenced by him holding the food in his mouth and not chewing, chewing it but then squirreling it and not swallowing, and on rare occasion—spitting chewed food out). We’ll continue to work on this skill while also consuming the purees so his weight will continue to increase. After he’s proficient at eating soft solids, we’ll move on to more firm or crunchy ones.

Some days I manage Evan’s fluctuating motivation regarding eating solids better than others. Ryan likes to say “you can lead a horse to water but you can’t make him drink” about Evan’s eating situation. At times, I feel like we’ve figured out how to help the horse decide to drink and even enjoy drinking and at other times, I feel like “will this ‘horse’ ever realize it’s beneficial for him to drink? And will it always be a struggle with this ‘horse’ and this issue?”

This coming Tuesday we’ll have a five hour “intensive” feeding therapy session with Nissa. It might be one of our last sessions with her for a while. I hope to not only learn more tricks and techniques at addressing the current issues at hand, but also hope to walk away with HOPE. Nissa has always good at reassuring me that Evan’s behavioral feeding issues are manageable and reminding me that I work well with this “horse”. : ) She also speaks about the future in concrete, vivid terms. Nissa paints a picture where Evan will have a sandwich with soup or pudding—that he’ll be eating solids and purees together. I’m thankful for the encouragement and the reminder to not focus solely on the current frustrations, but to hope and believe in the future…a future where Evan eats a whole grilled cheese sandwich with chicken noodle soup without any problem…