Where the inside of my mind leaks onto the screen.

Saturday, August 16, 2014

Clown-faced Apple Eater

When I shipped the kids off to spend a week with Grandma Tess and Grandpa Randy, I sent Dylan with a whole bag of food.  The contents of that bag included:

- Enriched white bread
- String cheese with the highest amount of protein per serving
- 100% fruit juice boxes
- Cheese slices
- Bacon
- Yogurt (key lime, orange creme, lemon pie, and vanilla)

This, plus an assortment of breakfast foods, is what Dylan eats every day.  A typical meal consists of a cheese sandwich with ketchup on it plus a helping of either bacon, string cheese, or yogurt depending on his mood.  A recent well-child check up indicated that Dylan is in perfect health, and that I actually don't need to worry about his incredibly limited diet because he is actually managing to get the nutrition he needs.  At my insistence, however, our pediatrician agreed to consult with the Primary Children's Rehabilitation therapists across the hall to find out if there are any therapies available to help me send my child into adulthood eating more items that I can fit in one grocery bag.

I've been looking forward to the evaluation all summer.  I figured it would result in either a pat on the back and assurances that I needn't worry or in an action plan to help Dylan try new foods without gagging.  It's not like I haven't tried everything to get him to eat.  I mean, I really have tried.  Coercion, consequences, bribing, pleading, forcing, starving... you name it, I've tried it.  It wasn't until I read a study linking kids who talk late with kids who have sensory sensitivities to food that I realized this was maybe out of Dylan's control.

And then I backed off.  It was actually during this back-off period that Dylan added string cheese and bacon to his list of approved foods.  He also recently helped eat an order of cheese fries, and opted to try a banana - without even being asked.  Backing off seems to be working pretty well, but I still looked forward to the evaluation to see if there was anything at all that I could be doing to help him on his quest to find foods he considers "yummy for him."

I got up early Thursday morning to prepare for the evaluation.  I was asked to bring a selection of foods I know he will eat and foods I would like him to eat.  Adam was pretty jealous this morning as I prepared eggs, chicken, mashed potatoes, and bacon... and then told Adam to have a bowl of cereal.  I added yogurt and string cheese to the Teenage Mutant Ninja Turtles lunchbox and headed off to D's first session of therapy.

I had to stifle laughter as I participated along with Dylan as his therapist, Helene, guided him through getting closer to eating the new foods on his plate.  She asked him to move the food from its container to his plate using his bare fingers.  It was interesting to see how difficult it was for him to even touch eggs with his fingers.  Helene added an apple from her own lunch to the array, and he didn't mind adding that one to his plate.

She started with the bacon, an item she knew he would eat.  She asked him to touch the bacon to his nose, cheeks, and chin before eventually giving the bacon a kiss.  I had to mirror these actions with my own piece of bacon; I have to say it's the first time I've ever kissed my food before eating it.  He had no problem kissing the bacon, but when asked to repeat the process with the egg, he adamantly refused.  Only after Helene had picked up the egg and touched it to his nose, cheeks, and chin and then after I had repeated the procedure was he able to pick up the egg and touch it to his various facial features.  He repeated the process with the chicken, with much less resistance.  Helene asked him to bite off a piece of the chicken and spit it out.  He was able to do so, but immediately wiped the inside of his mouth on the outside of his arm once the offending chicken had been spit out.  She didn't push chicken any further.

Next came the apple.  After completing the touching and kissing ritual, Helene showed him how to make a clown face using the apple.  I thought it was a pretty sneaky way to get him to bite into the flesh of the apple!  After he posed for a picture, she asked him to bite the apple and spit it out.  He didn't wipe his mouth clean, so she directed him to take another bite, chew it, and spit it out.  Only after he had accomplished that did she ask him to take a bite, chew it, and swallow it.  She showed him how to move the portion he'd eat to the side of his mouth for chewing and explained that he wouldn't feel so much like gagging if he chewed it over there.  He successfully chewed and swallowed the apple!  She asked him to take another, bigger bite, but his compliance resulted in an involuntary gag reflex.  She explained to him that it will take practice, but if he keeps practicing, his mouth won't think apples are yucky anymore.

Helene explained to me that a child his age should be able to eat 10 foods in the protein, starch, and fruits & veggies categories.  After filling out his 10-10-10 chart, I could see that he only eats 6 proteins (4 of which come from dairy and one of which is specific to a certain Thai restaurant in Sandy), 8 starches (none of which are whole grains), and 0 fruits and veggies.  Adding apples as his very first fruit/veggie was a huge milestone.

I've been tasked with the homework of getting him to chew and swallow 2 new foods per week, and he's been tasked with eating more apples.  But our plan consists of more than that.  After watching Dylan eat and considering which foods he already eats, Helene informed me that she believes Dylan has reflux.  The foods he has chosen are precisely the sorts of foods that limit stomach acid production and help relieve the pain of reflux.  In addition, he frequently complains of stomach pain, which I had dismissed as a sign of continual hunger.  Dylan gets to join me in taking daily medication to limit the production of stomach acid, and we will monitor him over several months to see if his symptoms decrease.  Hopefully the combination of treating the underlying medical condition as well as working daily to help him accept a wider variety of food textures will result in a kid who eats a healthy variety of foods.

To be honest, I'm overwhelmed.  He needs to meet with Helene twice monthly, and I need to work daily food practice into our routine.  But I am encouraged that there is a plan, that Helene is confident we will see results, and that with any luck, our days of ordering a cheeseburger with no burger are in the past!


Sarah said...

Such interesting interventions! I'm glad you pushed for further help. Good luck working through it all.