A young mother from another state called to see if I could help her adopted daughter. She was only three days old when they received custody. She spent most of her infant life in and out of a famous research hospital. Her real mother was on crack during pregnancy and the child was born addicted. There were many medical problems but once she was stabilized, every issue was resolved.
At age two and a half she was introduced to food. Every time she tried to eat something of substance she would throw up. Mom was a wreck. The child had gone through all kinds of medical testing to determine possible digestive problems. When everything checked out normal she went through all kinds of behavioral testing. Mom, Dad and child returned to the world renowned hospital and saw several behaviorist. They tried several things in their offices but the final conclusion was to bring the child to the clinic once a month for intravenous feedings. Otherwise she would never have the nutrients to grow properly.
Mom was beside herself with worry. She heard about me and begged me to help. I told her I didn’t know if I could but I would love to come to supper. She laughed and said, “Supper?”
“Of course. How else am I supposed to see what’s going on if I don’t watch the actual situation? I need to come at least 30 minutes ahead of time so I can see your family in action. I don’t want to talk about the problem but rather want to be treated like a friend who came to supper.” She agreed.
I arrived early and watched as the family prepared for supper. The child happily drank milk from a bottle. Mom introduced the sippy cup and insisted that she try it. She glanced at me and whispered, "I know I need to get her off the bottle but I worry about it. That's the only nutrition that she actually receives. How can I take that away?" When the child fussed, mom gave in and returned the bottle. Tears ran down her cheeks as she glanced at me and rushed around the kitchen preparing supper.
The child sat at the table and took a few bites of pudding. She mushed it around in her mouth like any child would do. She played with small bites of regular food pushing them around the plate with her spoon. Mom and Dad continued to urge her to eat. Finally she put the small bite of food in her mouth. Within seconds she gagged and threw up the milk, pudding and bites. Mom hysterically grabbed her and ran for the bathroom. She cleaned her and prepared her for bed. She was given a clean bottle and lots of attention. Dad cleaned up the table and looked exhausted and tired.
Mom hugged me and cried on my shoulder. "Please, can you help us? I don't know what to do?"
"I don't know if I can. I need some time." I thanked them for supper, collected her medical papers to study and told them I wanted a week to pray and think about it.
A week later I called mom and told her I would take the case. I asked if I could come for supper again. I also asked if I could bring my poodle. I arrived an hour early so the child and I could play with my dog Bandit.
I brought a large chart to be hung on the wall. I explained that their hysteria about the situation only made it worse. Their child was taking her clues from them and the more nervous they were the worse they made the situation. If she threw up at supper, they were to sit still and let me show them how to handle the situation.
I also brought a box of small baggies. Everything the child ate from now on must be measured. If we decided to introduce some new food, it would have to be cut into small bites, counted out and put in a baggie. The child would be given the baggie and what she ate would be recorded.
The chart had spaces for each day and a listing of what she ate during that day. Everything that went into her mouth was to be counted and listed - no matter how small or insignificant. If she ate three small pieces of cereal today and yesterday only had two small pieces – then we were making progress. The chart was more for mom and Dad to see the progress that was being made and therefore would keep them calm and not so worried. It would also be something they could show to the doctor and hopefully avoid those dreaded IV’s.
My research revealed that the child was in and out of the hospital so much that “chunks” of food wasn’t introduced until she was almost two and a half. Babies have a window of curiosity about food. If that curiosity window is missed, it is possible that the child will “learn” to prefer liquids to solids. Chewing is a learned response that happens very early and usually accompanies teething. Add to that the possibility that she had an extremely sensitive gag reflex that could be triggered by un-chewed food and voila – vomiting would occur. On the previous visit when I watched the child attempt chunks of food – I didn’t see chewing. Instead the child pushed chunks of food around in her mouth as if it were pudding. My goal then was to teach the child how to chew.
Have you ever seen a dog chew? He uses his back teeth and curls his lip so it’s easy to see the chewing process. That was perfect for showing a child what to do. Besides, dogs are fun for three year olds.
First I held Bandit until the child was comfortable with her. Then I sat on the floor and showed the child how Bandit loved to eat. I brought Captain Crunch peanut butter cereal. It was small enough for the child to eat, would crumble fairly easily and Bandit loved it.
I let Bandit have a piece and I laughed hard. "Look! Look at how Bandit chews. Isn't that funny." The child giggled and pointed to Bandit. I used every trick I had to appear fun, animated and excited. My eyes were wide, I was smiling ear to ear and I clapped and laughed for every chew. The child wanted to feed Bandit as well. I let her give Bandit one piece and we all clapped and laughed.
I immediately changed the rules. "Oh wow! Let's play a game. Bandit loves games. No one can feed her unless we eat one first and chew like Bandit. Daddy, come sit by me and let's see if you can chew like Bandit." Dad sat on the floor and I gave him a piece of cereal. He curled his lips and chewed loudly. We all clapped and laughed. Then he gave a piece to Bandit and we all clapped and laughed again.
Mom leaned over the counter and said, "Can I try?" I gave her a piece and we repeated the same scenario. The child was wildly excited and wanted to try. I gave her a piece and she immediately wanted to feed the dog. I stopped her by gently placing my hand over hers. "No darling, that's not the game. Watch Debbie. I took her piece and ate it (clapping and laughing) and then gave another piece to Bandit. "You have to eat a piece like Bandit so she will know what to do. Can you chew like Bandit?"
The child smiled and shook her head yes. "You will have to show your teeth like Daddy did. Daddy, show me your teeth." Daddy chomped his teeth together and I laughed and clapped. "Look at my teeth." I chomped and clapped. I opened my hand with a piece of cereal. "You can't feed Bandit anymore unless you can chomp your teeth like Daddy." The child grabbed the piece of cereal and chomped like Daddy. I went wild. I clapped and laughed. Mom and Dad clapped and laughed. I quickly handed the child another piece. "Quick, feed Bandit before she forgets how to chew!" The child fed Bandit and clapped and giggled while she chewed.
For 15 minutes we played the game. It even included Dad being so excited that I asked him to stand on his head. We had a laughing rip roaring good time. And...I counted 18 pieces of cereal that she ate.
Supper was ready and we sat down to eat. Mom had trouble smiling without tearing up. Both Mom and Dad wanted to talk about what had happened but I steered the conversation to a more generic topic. I didn't want the child to hear us talking about her situation. Instead I continued the game. When Mom sat the plate in front of her child, I intervened and asked her to keep it beside her instead. "Let's play the Bandit game while we eat." Three adults sat through an entire dinner eating loudly and chomping like dogs.
The child wanted to play. I had mom give her one bite at a time. We all watched, clapped and laughed as she happily chomped away. She had five bites of dinner, two bites of pudding and then hopped down to play with the dog. This was the biggest solid meal of her life - and no throwing up.
While planning this possible solution I had to be concerned not only about teaching the child to chew, but also all the things that might go wrong. For example, what if the gag reflex was the biggest problem? She might try to chew and swallow but as the pieces of food scraped along the throat, the new sensation might cause her to gag. That would be disastrous to my plan. The loud clapping, cheering and laughing - along with the excitement of watching Bandit should have been enough to distract her from new sensations in the throat. A three year old's attention span is about 45 seconds long. I needed more time than that to introduce a new habit. Bandit knew several tricks and if the child lost interest in chewing, I could introduce a new trick to catch her attention. Asking the parents to be involved not only kept them from being nervous, it provided a plan for them later - along with lifting the spirits of everyone in the room. We took a normally "downer difficult" situation and transformed it into a party like atmosphere.
I promised to come back in a week and told the parents to call me if they had problems. They were to continue the "party" atmosphere as long as it took to make sure the child didn't gag and learned to chew. I also gave them instructions on how to introduce new foods and at what texture level to introduce them.
The mother called me 6 days later with a problem. "I don't know what to do. She is eating great! She hasn't thrown up at all and I'm already amazed at how much she is eating."
"I'm confused then....what's the problem?"
"She loves pizza and that's all she wants. She eats the other stuff I present but she whines and cries for pizza. What should I do?"
I laughed out loud and congratulated her. "Welcome to the world of normal parenting!"
Being a Mommy Detective means that you look for clues to your child's behavior. Most of the time it's not obvious and it's not what we think the problem is. Children often get all mixed up in their evaluation of the new world around them. It's our job as parents to find out the "real cause" for their problem and introduce a creative way to solve those issues.
Seeking His Wisdom,
Debbie
