Monday, June 14, 2010

3 days to go!

Team work using the "fire hose" to fill the pool yesterday.

Today is the third to last day of feeding clinic. Tomorrow and Wednesday my husband and mother will be spending the day observing and being trained on how to feed the boys using the proper protocols to deal with their eating behaviors. Because their issues with eating are truly behavioral stemming from being conditioned by so much vomit and pain. They can both eat purees and bite and chew and swallow with no problems, it's a matter of convincing them to do it and to get over the gag reflex. It's not enough for me to show them how to feed the boys, they really need the therapists to show them and give them instruction and guidance on dealing with the boys refusals and quirks.

As of right now their protocol to feed both oral averse, spoon defensive children at the same time is this:

Therapists are assigned to provide assistance and keep track of the feeding data (refusals, acceptances, gags and emissions). They also are there to help block the boys from the television with a folder instead of my having to pause the television. (It is to the point that if they refuse and then see me reaching to pause the tv they will suddenly lean forward and open wide to get their food in order to prevent me from taking their television away.)

They eat the best when sitting in the traditional highchairs, but can be fed in a simple booster seat with a lap belt and tray to keep them seated too. I will feed them several sips of milk (maybe 10 to 20 sips in a five minute period) and may occasionally have to pause the television because they are either so mesmerized by what they're watching or they are ignoring/refusing the drink. Then I will take turns feeding 5 to 10 bites of a smooth puree, either a stage 1 or 2 and some stage 3's though those are quite a gag challenge and they will consume less volume of stage 3's. Then after those 5 or 10 bites I will offer the child their Take & Toss sippy cup to sip from while I turn to his brother and follow the same steps.

When the spoon is offered if the child refuses or ignores the spoon or swats it away, then the tv is paused or turned off until the child willingly takes the bite of food or sip of drink. Because they are only 2 they aren't crafty enough to know that they could continue to refuse forever and ever, and since we know they like some foods they willingly do accept some. Eventually the process of opening the mouth becomes rewired into their brains as an automatic response and they barely even know that they are doing it. Hallelujah! THIS very thing is the reason why you want to get your non-eating child into a positive reinforcement program like Mt. Washington's Feeding Day Program as soon as possible. Because while they've lost two years of eating and oral development skills, they are still young enough to basically rewire the habits that we take for granted as adults without oral aversions. And this is why we never would have gotten to this point on our own at home. Because in order to make sure that we could thwart the boys defensiveness and fear of eating was to have a program that was perfectly consistent and positive and had the physical manpower needed to do the "hands down" procedure to take away that automatic defensive response to swat the spoon coming at them. Initially this is something one person could not do, but now with the proper conditioning of the boys by the program and training for me, I can do this by myself with one hand on the child and one on the spoon. It is exhausting, and will change and morph and be modified as the grow and learn and try to test their boundaries and limits, but it works and very well.

This by necessity means that to feed both boys at the same time meals take longer than any one meal should take for a 2 year old. But if there is no one trained to help then this back and forth, taking turns eating/feeding is the only option.

You might be thinking, "Well you have help at home so why not have one adult feed a kid while you feed the other, Laura?" But this makes it difficult too unless the boys are facing in different directions and watching two different screens and can't see each others tv's. And how productive and functional would that really be? If there are two of us feeding the boys but only one tv it' is crucial that the two adults know exactly how to feed the boys using the proper protocol AND both adults must observe each bite of food by each child so that they are aware of whether or not they need to hold back on offering a spoon of food so that the other person can pause the tv without negatively impacting the child who is eating well. So in practice it's MUCH easier for me to feed the boys alone without help, but it takes longer and they may not consume as much food quickly as if they are fed individually. But that's the lot that happens when you have two kids with the same feeding issues.

We have been able to use the Response-Cost Contingent Reinforcement with Video protocol (that just means they can't have the tv back on until they take a bite) with crunchy foods too, though Evan is still too afraid to try to bite down. I know he can do it, but just getting him to do it is our next huge goal. Cameron will now take small bites of crunchy foods and now eats Goldfish crackers, Ritz Crackers, Gerber Lil'Crunchies puffs, cheese curls, and veggie stix.

It's still a very long and very slow work in progress.


Jennifer said...

You do anything you can do to get your kids to eat. Now that mine are finally eating more (sans veggies), they are throwing more, too. When the food starts flying, the TV comes on. No more throwing. The TV keeps us all from going insane. Never feel bad about it!!