AnonymousWe had our long awaited feeding evaluation for Noah today. We met with an OT, SLP, Ped, psychiatrist and nutritionist. After taking Noah’s history once again, they started out with their assumption as to why Noah is aversive to eating. Every test he’s had done has come back normal, except for his swallow study. He showed a delayed swallow and pooling way in the back of his throat. They think this is his entire reason for not wanting the bottle. They feel that as an infant he may have been uncomfortable with thin liquids because he couldnt control the flow into his throat. He may have felt as though it was difficult to breath since the liquid would pool at the junction of his wind pipe and esophogus before he swallowed. Even though he doesnt aspirate, he still could have had difficulty coordinating the swallow-breath reflex. So this being their basis for his feeding issues, they began the evaluation by thickening the formula to a honey consistancy and then giving it to him in an open cup. They watched through a double mirror while I tried to feed him. He opened his mouth for it (he does this anyway) and swallowed what he got into his mouth. We did this out of a couple different cups. Then we moved on to bananas from a spoon. He did this pretty well since this is the only solid that he eats well. He ate about 1.5 oz. We then went back to the thickened liquid and he flat out refused it. He was arching his back and trying to get out of the chair. They were wondering if he was acting that way because he wanted out or because of reflux. It had been 4.5 hours since his morning bottle, and he still only took 2 oz total between the bananas and thickend formula. He had had enough at that point.
After he was done eating, they all got together to discuss and came up with recommendations for us. Here is what they said:
1. do not do any sleep feedings. All feeding are to be done awake.
2. He is not to use a bottle at all. All milk comes from a cup.
3. We are to thicken his formula to honey consistancy and then after a few weeks go to a nectar consistancy.
4. He is to have 3 meals a day and 2 snacks. Consisting of 2 – 4 oz of solids and 3 oz of formula per meal. He is to have a total of 16 to 18 oz of formula. (he currently is getting 24 oz of formula concentrated to 30cal per oz).
They said that a baby that is his age (almost 10 months) should be transitioning to a cup and eating more on a normal schedule. They want us to continue with our normal appt with out OT and come back to the clinic in 2 months.
I have a problem with this whole plan they have. First of all, I dont think he had a swallow/breath issue when he was an infant. He was evaluated by an OT when he was 3 and 6 weeks old when he was breast feeding. His only issue was he didnt have the muscle tone to stay latched on and he didnt have a strong suck. When he did suck, his pattern was fine and there was no choking. Secondly, this idea doesnt explain why he doesnt care for solids either. I dont know how they expect me to get him to drink thick formula out of a cup and actually get enough to maintain any weight. They want to drop him down to 16oz! Thats crazy! He is barely gaining weight right now and I force 24 oz in him a day. They think that he will make up for the loss of calories by eating more solids. YEAH RIGHT! I’m lucky to get 4 to 6 oz in him a day.
Their treatment plan doesnt address why he has no appetite. By taking away a bottle and giving him thick liquid in a cup isnt going to make him anymore hungry or interested. If anything, he will get really full, really fast cause this stuff is like drinking a milk shake. I just dont get it. I think I actually will have better luck sticking to a bottle and doing sleep feeds. Atleast I know he’ll get more calories in him that way.
What do you think? Am I being over critical or do you think they have some good ideas?
