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.

Empowering Him With Choices

The Fit:  "NO!  No chair!  No sit!"

He didn't want to get in his chair and eat.  Dad wasn't home for dinner yet.  He wanted to watch a cartoon.   He just wasn't in the mood.  TOO BAD KIDDO!  It's dinner time and we're stickin' to our schedule!!!  

The Fix: A choice.  I gave him some control over what was about to happen.  

"Buster, look at me.  Stop flailing and look at mama for a minute. Do you want milk or water with dinner?"

"Milk."

"Okay, get in your chair and I'll get you a cup of milk.  Do you want a blue cup or a green cup?"

"Bwue."

"Okay.  Thank you.  I'll get your blue cup of milk."

He had a choice.  He had some control.  He settled down, got in his chair and two minutes later he was eating green beans, mac & cheese, carrots (first night of success with carrots!!) and not eating, but did touch, some hot dog.

Toddlers can control very few things the happen in their lives.  What they put in their mouth, they can control that.  Sometimes, it's not yet about the food...just about getting them to the table.  It's hard for them to give up that control.  So, offering choices will very often give them the control they need to feel they have.  Peas or carrots?  Cheese or apples?  Simple, healthy choices and he's FAAAR more likely to eat something if he feels like it's there because he decided it's there.

As Janet Jackson said "Control....to get what I want."  (I just showed my age a little there, didn't I?)