The Timer, The Chart and New Therapist

The sticker reward chart is working, to an extent.  He's more motivated to eat.  But, it's still taking AAAGGGGEEEEESSSS.  Painful lengths of time.  Plus, I'm still hand feeding him a good portion of his meal.  He is willing to eat but he just won't do it.  He'll sit there forever and just not put a bite in his mouth.  If I do it for him, he'll eat without argument.  I really want to get away from this.  I need him to eat his meals on his own.  He needs it too, whether he knows it or not.  I think he'll feel more accomplished (and therefore more motivated) when he's eating meals with no help.

(*Simple chart...I do not claim to be Martha Stewart.  I know where the craft store is but I can't use 85% of the things they sell.)

So, in the interest of pushing him we've added a timer to meal times.  In the past, I've been opposed to limiting his time and just wanted to get as much food into him as I could.  Now, if I don't rock this boat...I'm going to be sitting in the same boat for a very long time.  I WANT A NEW BOAT!  Hence, the timer.  We're using it for lunch and dinner but not breakfast.  Morning is still too volatile a meal and we have less time on preschool mornings anyway.  He gets Pediasure for breakfast along with something he'll eat with less fuss...pancakes, toast, yogurt.  Maybe some fruit on a really good day.

(This timer is great for the younger kids.  Visual and audio cues for time running out.)

He gets 45 minutes to eat.  When the timer turns red, meal time is over.  That's it.  No more food.  No more time to earn stickers or dessert.  We've only been at this a few days so I'll let you know if it's working in another week or so.  I'm also being very strict about snack time.  It's 3pm on the nose.  If his snack isn't eaten by 3:30, I take it away.  I used to let it sit and he munched when he wanted.  Now he's old enough to understand that he needs to eat when it's offered or it's gone and he can't eat until meal time.  I feed him dinner at 6pm and he tends to get a little noshy around 5.  So I'm hoping he begins to recognize the "hungry feeling".

Not that this is really a huge help but I did try to "fun" things up a little and he and I went to Bed Bath and Beyond where he picked out a couple of fun plastic place mats (farm animals, forest animals, etc).  I figure as much as I can do to get him to want to sit down at the table, I will do.  So he gets cups, plates and cutlery that he really likes.

We also started therapy with the new occupation therapist last week.  I have to tell you, I'm optimistic.  We went through three occupation therapist during our time in Early Intervention and I didn't think any of them were very helpful.  (Lovely people but I didn't see any changes with Buster as a result of them.)  Our new therapist gave me more information in 45 minutes while working with Buster than I got in 2 years with the others.  She has a lot of experience with sensory kids.  Exactly what we need.  She told me what she thinks she knows so far about Buster's needs, how she needs to learn more, that we are going to teach him to modulate his responses to sensory input and THEN we'll get to specifically address his eating.  I am once again reminded that this is a marathon, not a sprint.  Anyway, my point is, I like her.  I fee like she gets me as his parent and she's dealt with a lot parents.   Most importantly, Buster warmed up to her instantly.  The kid didn't skip a beat.  He played with her right away.  He even spoke loudly enough to her that she could hear him and he told her what he did and didn't want to do.  That's pretty huge for him.  Especially with a new person.

I've updated the resources page with some new books.

I'll most some more detailed therapy info after another session and we get some "homework".  In the meantime, a few pages of information from this past week.

Buster Muffins

I'm on a muffin quest.  After a weekend jaunt through Costco where Buster taste tested a pumpkin muffin and loved it, I'm working on muffin recipes.

So, here's the first one that's been reasonably successful.  I am trying to do come up with healthy muffins as opposed to muffins with nothing in them that's helpful to his dietary needs.  I've combed through all the "toddler" muffin recipes out there and I'm changing and adapting as I go.  The first batch I made failed the Buster test but this recipe worked.  Next on the list will be a banana muffin recipe...because I have a bunch of bananas on my counter that are not going to be eaten before they get too ripe.  That's the problem with Costco...yes, I'm happy I got a load of bananas for $1.39 but seriously, who can eat a dozen bananas in a few days?  Not a house with a feeding averse child!!

BUSTER'S SQUASH & CARROT MUFFINS

(This would be good with any kind of squash...pumpkin, acorn, zucchini.  I just happened to have a butternut squash on hand so that's what I used.  Also, I did try to use 1/2 whole wheat flour the first time I tried this but the muffins were really dense.)

1 cup unbleached flour
2/3 cup brown sugar
1 tsp baking powder
1 tsp salt
1 tsp cinnamon
1/4 tsp allspice
1/4 tsp nutmeg
1/2 cup plain Greek yogurt
2 eggs (lightly beaten)
2 carrots
1/2 cup butternut squash

Preheat oven to 350 degrees (Fahrenheit).

Line small muffin cup tins with liners or use baking spray.  (I use small, not mini, muffin tins.)

Peel and chop carrots and squash into similar size pieces and boil, bake or microwave until fork tender. Puree until smooth.

Combine all dry ingredients in mixing bowl.  Then add yogurt, eggs and vegetable mixture.  Mix until combined.  Do not over mix.

Pour muffin tins 3/4 of the way full and bake for 15 to 18 minutes until tooth pick comes out clean.  Allow to cool COMPLETELY before covering to store in order to avoid the muffins becoming too sticky (therefore unappealing to kiddos who don't want to touch sticky things).

It Takes A Village...

...and I am not a village.  No parent equals a trained feeding professional.  (Unless of course, you are a trained feeding professional but you aren't the people I'm talking about.)

First, my apologies for a waaaay longer than intended hiatus from writing this blog.  I won't bore you with the details but the super abridged version of why I didn't get to write it this:  high risk pregnancy, bought new house in new town, birth of precious daughter (full term this time!!!), Buster started preschool and life just got away from me for a bit.  Now, I am back and I'm so grateful for all of the mommies who have been in touch with me through this blog...I am recommitting to continuing to share out story.

So, after so much progress with Buster's eating last year we made a few choices I now regret.  At the end of July (2013) he was doing well trying new foods.  He was not eating the volume of food we wanted but we were making slow and steady progress.  We bought a house in a new school district that we were more comfortable with because Buster was due to begin Early Childhood Special Education (the next step after Early Intervention in Illinois) Preschool in September.  At age 3, they move from EI to ECSE.  We made a GREAT choice...we could not be happier with his school.  But it did move us far enough away from our therapists that we weren't able to continue services with them.  ECSE preschool is for children who require special education or are at risk for learning/developmental impairments once they are in "real school".  Buster is receiving speech therapy and physical therapy at school.  He isn't getting occupational therapy because his fine motor skills are good and in the way that the school district looks at it, his ability to learn isn't impaired by any occupational needs.  (This is something I am going to address with them as we make his Individual Education Plan (IEP) for next year's preschool year).  He's also getting some help with his social skills...he's a painfully shy kid.  He really shuts down in groups of kids.  So, they are helping work on that.  Something that the school's therapy does NOT offer is help with his feeding.  It doesn't effect him academically so (understandably) it's something they don't deal with.

My husband and I decided we would see how it goes without therapy beyond what he was getting at school.  We had a newborn, Buster was doing reasonably well...we just thought it was time to try it alone.  But at some point in the chaos of moving, bringing our daughter into the world, Buster starting preschool, holidays, blah, blah, blah....feeding progress stopped.  He really does eat a pretty nice variety of fruits, vegetable and grains.  Proteins are not his strong suit.  Cottage cheese, yogurt, peanut butter, cheese...those are things he likes and his main sources of protein.  He will eat some deli turkey and ham.  He'll eat hot dogs (don't judge me...I get the preservative free kind).  And he will eat chicken nuggets.  But he won't eat any other meat in any form.  He will SOMETIMES eat scrambled eggs.  Sometimes.

Here's the problem, it's not that he won't eat things...he just won't eat ENOUGH of anything.  He'll happily take a few bites of lots of foods but to get an entire meal into him takes, at minimum, an hour and a lot of struggle.  He feeds himself a few bites but I still feed him the majority of his meals.  This HAS TO STOP, he will be four this summer.  We are much better about yelling than we were two years ago.  Occasionally, it still happens.  But, even without yelling, there is frustration, pleading and general discontent from all parties at the table.  Particularly our nearly 8 month old daughter who does not want to be in the kitchen for an hour and a half every night while her brother refuses bites of food.  One of us will usually take her in another room while the other works with Buster but if it's only one of us home at a meal time, she's stuck and it isn't fair to her.

Somewhere along the way we also stopped the rewards charts.  (SHAME ON US!)  He was putting a sticker on a chart for each bite.  The sticker itself was the reward because the kids loves stickers.  As of today, I have brought the rewards chart back but in a new way.  He's outgrown the old system.  He's going to get a sticker for each item he eats in its entirety on his plate...eat all of your peaches, get a sticker.  And after 10 stickers he will get a "prize".  I bought a basket full of inexpensive toys/stickers/crafty things to entice him.  I am also going to add cards for things like "go to the library", "go to the park", "ride your bike for 15 minutes", "play with the water table"...all things that we would probably do anyway but things he loves so he'll work for them (I hope) and as this brutal winter ends, the list of prizes can get longer because we can spend more time outside doing fun things.  On Halloween we discovered that he likes some candy...M&M's specifically.  So we always offer him 4 or 5 M&M's to get those last few bites in him at the end of a meal.  We'll keep doing that.  He'll have a longer term goal (10 stickers) and an immediate goal for that meal (M&M's).

TV...I think it's become a hindrance.  It used to be the only was we could distract him enough to get him to eat.  Now, he's more interested in TV than eating.  I've been playing a game of "take a bite or I'm pausing your show" but I'm getting REALLY tired of pausing Curious George 100 times a meal.  I think instead we are going to slowly take it away.  He'll get one episode per meal and then it gets shut off.  Last night I shut it off and told him it was because he needed to concentrate on eating.  He wasn't happy about it but after a few minutes of a fit, the rest of the meal MAY have went a little faster.  Maybe.

Anyway, I've made a long story long and here's the end result.  Yesterday, we went to a pediatric therapy facility in our new home town and had him assessed.  I've already talked in previous posts about Buster having Sensory Processing Disorder.  It is so, so different from child to child.  Buster's sensory problems are much less obvious than they used to be.  He will cover his ears from time to time with loud noises and he doesn't like the tv too loud.  But, he doesn't flip out if the vacuum is running anymore.  He is happy to have wet, sticky paint on his hands for art projects now...that didn't used to be the case.  I can pour bath paint all over him in the tub and he thinks it's great.  BUT, the SPD remains.  There are still things he doesn't want to eat because he doesn't like the feel of it...a muffin with a sticky top, peanut butter and jelly if it squeezes too much outside of the bread...things like that.  He still HATES to be upside down.  He doesn't like swings at the park, never has.  He has "low tone" which essentially means general muscle weakness.  He is easily frustrated with himself when he is trying to accomplish a task...he's too hard on himself.  He will often yell "it's not perfect!!!" when he doesn't trace a letter perfectly or paint something as well as he wants.  I'm trying to stop myself from saying things are "perfect".  He doesn't need to be perfect, he just needs to try hard!  That's really all that matters.  I'm trying to get him to understand that idea.

All of these (plus more) things still add up to SPD which is at the root of his feeding problem.  So, back to occupational therapy we go!  And I'm THRILLED.  I thought we could do it without help.  I thought we were to a point that it was manageable.  But, I'm here to tell ya...we can't.  We aren't there.  So woooohoooo for therapists!  BRING IT ON!  I need help.  I need support.  I need my kid to eat and I can't make it happen so I will do everything in my power to help my child.  I need more village, so I found it.

PS: The OT also said his shyness might be part SPD.  I think 50% of it is just his personality.  He is a shy kid.  His dad was a shy kid too.  I also think 50% may be sensory overload and he gets overwhelmed and shuts down around groups of people/kids.  So, I'm hopeful beginning therapy again will help him overcome social anxiety as well.  Fingers crossed.

Rewards System Working!

This week Buster's therapist decided to try a simple rewards system.  Up until now I wasn't sure he was old enough.  Turns out, he is.  This is so simple and we've used it only to get him to either try something new or get through those final brutal 15 minutes of eating a whole meal.

Tangent for a moment:  We actually hit our goal 1300 calories yesterday!  Thank you Duocal!  Not inexpensive but worth it!

Back to my original story....I've been trying pancakes and red kidney beans this week.  Not together, of course, but pancakes at lunch and the beans at dinner.  The pancakes have a decent calorie count, especially with butter melted into them.  Buster can't see the butter so he doesn't argue about it!  And the beans also have a decent calorie count and add protein and fiber.

He hasn't been thrilled about either one of them but takes 2 or 3 bites with some coaxing.  Well, his therapist suggested we give him something visual to get to a goal of say, 5 bites.  She drew 5 circles on a piece of paper and I pulled a sheet of little stickers out of the art bin.  Buster LOVES stickers.  He got a sticker for every bite of pancake (and later bean).  He took bites himself, with no argument.  Once he reached the goal of filling all 5 circles, he got a veggie straw.  He loves those potato chip-esque veggie straws.  He was happy, we were happy!

So, for the last two nights, I've used this system to get the last of his dinner into him.  It's taking about an hour to get him to eat everything he needs to eat.  By the last 15 or 20 minutes, he's sick of eating and we're sick of him doing everything he can do to avoid eating: play/be funny/park his "car" (fork) in the "garage" between his plate and cup/shake his head/play with his cup/play with his napkin....you get my point.  He's done and we're done but the food isn't in him.  Last night I drew one line of 5 circles, the number of bites of chicken nugget he had left on his plate.  And, 10 circles for the number of bites of grilled cheese "super man bread and cheese sandwich" I thought he needed to finish.  After every bite he popped into his mouth (with no argument, mind you) he got to pick a sticker and place it inside a circle.  Within about 5 minutes, he was "all done!" and it was "cookie time!".  He got his after dinner thin mint girl scout cookie.  He ate about 1/3 of it but I don't really care.  He ate his dinner, he got his calories, I got the rest of the cookie.

I'm so glad those sticker packets come with 1,000 stickers.  We're going to go through a lot of stickers.  Eventually the system and rewards themselves will change but this is a GREAT start!

Self-Feeding Control

I've mentioned Buster's tendency to choke and gag.  Though is happened a lot more when he was younger, it still happens now.  He will not remove food from his own mouth if he doesn't want it there.  He will just sit with it in his mouth for ages.  I'm still trying to teach him that it's okay to spit food out...into his hand, into my hand, anywhere really.  I don't know if it grosses him out or what but he won't do it.

Here's something I've noticed recently about the gagging.  He tends to do it less when he's feeding himself.  I don't know if it's because he's concentrating on it harder since it takes much more work for him to get it into his mouth or maybe he's just more prepared for it to get into his mouth.  But, for the first part of the meal, when he's feeding himself he gags less.  Eventually he gets bored of the process of eating and I have to feed him the rest of his meal just to be sure he's getting enough food.  This is when he tends to gag.  No actual choking recently, so little happy dance for that!

Bananas seem to be a trigger at the moment.  They are kind of thick and mushy and though he likes them, sometimes when it first gets in his mouth he'll gag.  We are constantly reminding him to "Chew!  Chew!  Chew and you won't gag, Buster!"  Last night it was bites of sliced turkey.  I think he just wasn't into eating it.  He had mac & cheese, strawberries, green beans and turkey on his plate.  Any sort of meat is always his least favorite thing.  He was a strawberry eating maniac but the few bites of turkey I gave to him on his fork immediately made him gag.  He would then chew and swallow but not without me telling him to chew.

So how to help him stop gagging?  I still do not know.  I suppose it's something he'll eventually grow out of and as long as he isn't chocking or throwing up, it's just something I should learn to live with.

This week I want to work on him eating grilled cheese again.  He's only eating a bite or two when I make one.  He will eat cheese and bread separately but once I put them together and toast them, he's less interested unless we are at a restaurant.  His therapist suggested getting some fun shaped cookie cutters and cutting a sandwich (be it grilled or not) into fun shapes.  I'm going cookie cutter hunting this week!

A Visit To The Dietitian

Because we had some serious concerns about Buster not getting enough/the right nutrition since he's started eating solid foods and no purees, we went for an appointment with a Registered Dietitian.  We found a great one with the help of Buster's GI doctor and she specializes in pediatric patients.  I fully expected to be read the riot act.  As it turns out, we're doing a decent job of getting food into the kid!  Let's hear it  for obsessive parenting!!!!  YEAH, I'M A HELICOPTER...I ADMIT IT.

We had to keep a food diary for three days prior to our appointment.  On paper, it REALLY felt like it wasn't enough food.  I've read a number of articles on the subject and knew that for his size, Buster should probably be eating around 1,100 calories a day.  I do try to keep track and we're usually in the ball park but never really exceeding expectations.

I was very curious to see his weight.  I do weigh him at home but I'm always suspicious of my bathroom scale.  Why I think it weighs me too heavy and him to light, I can't explain, I just do.  But I digress...he weighed in at a whopping 26.7 pounds.  He's been sitting in that neighborhood for awhile but I was happy to know he isn't losing.  He's between the 5th & 10th percentile for weight and around the 25th for height.  If he were calculated at his "adjusted age" he's a little higher on the charts.  Long story short, he's on the chart and he's not "failing to thrive".  WOOOHOOO!

So, my questions were basically this:

Am I a horrible parent and is my child lacking important nutrients?    Am I causing him harm?

Answer: No, no and no.  

WOOOOHOOOO AGAIN!

What do I need to do differently?

Answer: Nothing but I have some tips to help him gain weight.

REALLY?!

Am I a total neurotic freak?

Answer: Yes.

Okay, I didn't really ask this last one but let's be honest...I am.

She was very kind and full of good information.  It was ABSOLUTELY worth the trip and she had some wonderful information.  I wanted some sort of guideline for this sweet faced, curly blonde haired little boy.  What do I need to make sure he's eating?   How can I get him to gain some weight?

Buster is on a high calorie, high protein diet.  Which means, basically what we were already doing.  Full fat everything.  Butter and oils?  Bring 'em on!  Cream?  Throw it in there!  The first thing to pay attention to on any food label is calories.  Yes, without a doubt making sure he's getting enough essential vitamins and minerals out of his foods is IMPORTANT but if he's not getting enough calories into his body he's never going to gain weight.  So, if he wants a cookie, he gets a cookie.  (Oh how I wish this were my diet too.)  We're keeping his morning Pediasure bottle though someday when he's more willing to eat real food first thing the morning, a big stack of pancakes would be great for him.  He drinks whole milk after his nap.  We're now adding about 90 calories worth of cream or dry powdered milk into that cup of milk to bump up the calories.   He likes eating vegetables but they are low in calories and fat.  So, I'm putting butter on everything.

The goal is to get 1300 calories into him a day.  We weren't terribly far from that so we just need to add a few things to what he's already eating as opposed to adding more volume.  He's not ready for more volume. So, butter on the vegetables and anything else we can possibly get it in.  Cream cheese in the mac & cheese.   Duocal in anything we can dissolve it in...yogurt, applesauce, whatever.  This is a new product for us but I've been using the samples we were given and it's really easy to order either online or through your pharmacy.  No prescription.  I just called up our Walgreens and I should have a case of it in the next week.

Three meals a day plus two snacks.  We are not good at getting a snack in between breakfast and lunch.  He has NO interest.  So, we will work on it.  In the meantime, I just have to make sure we get the calories in the other meals/snack.

In order to continue our never ending pursuit of moving up the growth chart, he should be gaining about 1/2 a pound a month.  That's a little more than is recommended for a child his age of normal size.  

Below are some of the information sheets we were given.  I think they have some great information.

Why I Love Superman

My husband's favorite comic book/movie superhero is Superman.  Therefore, my son knows Superman.  He's never actually watched a movie or cartoon with him. But he has t-shirts, pajamas, capes, Mr Potato Heads, etc... that are all Superman themed.  He's knows Superman is cool.

One day we called bread "Superman Bread" and he ate it.  He'll eat most of a Hawaiian dinner roll if I tear it into small chunks and put it in front of him.  He shouts "Superman bread!!!!"  He also loves cheese.

So, the other day we were out at lunch and we thought we'd try something new.  We ordered him a grilled cheese and broccoli.  I asked the waiter to have them smash the sandwich down as flat as possible when they grilled it so it wouldn't be overwhelmingly thick.  The kid will eat at least some of any green vegetable I put in front of him.  He was totally excited to eat broccoli.  He's played with it plenty of times when he's helping me prepare meals.  So, I wasn't shocked when he ate it.  The sandwich, I really questioned.  To my surprise, after I cut it into tiny bites and told him it was "Superman bread with cheese"...he ate an entire 1/2 a sandwich.

WHAT?!  Who are you and what have you done with my child?  And, please stay.

Since then, we've tried it two more times at home.  We're trying to repeat exposure as much as possible until something is officially "accepted".  He doesn't eat it as well at home. Why?  I HAVE NO IDEA.  Maybe he is just more adventurous at restaurants?  Maybe I'm ruining it because I'm sneaking a slice of VERY THIN roasted turkey in there too.  I want him to eat more protein.  I'm not even sure if he's noticed.  He hasn't commented.  He just won't eat it without us telling him he has to take bites and even then, he makes it known he isn't happy about it.

Last night was the worst night we've had since this eating real meals thing began.  It normally takes us around 45 minutes to get dinner into him.  We've been rewarding him with a Girl Scout Thin Mint Cookie at the end.  We discovered he liked those last week.  They've been a great incentive to get him to finish what we want him to finish.  I'm so not above bribery.  Anyway, last night he had: 1/2 a Superman bread with cheese (grilled cheese w/ a slice of turkey sandwich), peas, broccoli and apple sticks.  He ate about half the veggies and the fruit before he got full enough and bored enough that he didn't want to eat any more.  He ate no bites of the sandwich on his own.  He let me put a few bites in his mouth after some pouting.  Then, things just deteriorated.  But he truly had not eaten enough so we had to press him.  He turned his head, threw little fits, played with his napkin and flatware...anything he could do.  This resulted in 2 time-outs and eventually I had to to get up from the table and walk away for a few minutes.  My husband bravely stepped back in a got him to finish his veggies and three more bites of sandwich.  All together this process took an hour and a half.  I know that's too long for him to be at the table but we did it.  And, punishing bad behavior surrounding a feeding aversion isn't encouraged.  But, when he's old enough (and he is now) to understand that his behavior isn't acceptable, something has to be done.  There was no yelling from us...just the time outs.  I think we did the right thing.  At some point he's going to able to understand that he as to eat all of A, B and C and a few bites of D before he can get up.  He's not really there yet so we're trying it one x or y at a time and reminding him every bite or two that he has to eat until it's "all gone".

This morning, I think I'm still exhausted from last night.  It's kind of soul crushing to have a really bad meal again.  But, it will happen.  We've just got to figure out how to motivate him better on those nights.