AnonymousHi Laura,
*** I’m just editing this to apologize from the start with what a long rambled reply this is!***
After hearing the details of the situation, I’m glad to hear that Ari doesn’t have reflux or any other medical cause for his eating issues. Because that means that it’s likely a normal (though challenging) feeding situations, and from what I’ve read, those types of feeding issues typically resolve with time, exposure, and development.
Both my kids have been strange eaters- Sarah was a bottle binger, I swear that she could chug one back in a minute flat! Then she was a fussy eater, but would eat good volumes of what she liked. I was worried that she would never try new things, but she did come around eventually. And then there’s Hailey, and well, Hailey is Hailey- a whole other story.
I’m not sure if you’ve read this book already, but my favourite feeding bible for normal kids is called “Child of Mine- Feeding with Love and Good Sense”, by Ellyn Satter. She’s a world renowned guru in the feeding world and I really like her approach. It’s very balanced and child-centred. I used to get a bit worried about Sarah’s eating behaviour when she was small and someone recommended this book to me. What I liked best is that she has a philosophy about eating and feeding called the division of responsibility in feeding. Basically, it says that parents are responsible for the what, when, and where of feeding. Children are responsible for the how much and whether. Reading this book and hearing this made me feel a lot better about her eating- I realized that there was only so much that I could do in terms of getting her to accept and eat new foods, and that whether or not she ate them was not my job, only to give her the opportunity to eat properly.
The difference is though, that Sarah ate a lot of what she likes, even though it was only a few items, and she was not hurting in the least for calories… basically she was above the 90th percentile for weight (because she loved her bottles).
But because of our situation with Hailey, I do know how stressful it is to watch your child drop on the charts, and not eat well (regardless of the cause). I had a friend who was going through a very similar situation to what you describe at the same time as I was going through the feeding aversion with Hailey. Her child also was on the lower end of the curve, and was reluctant to be spoon fed, didn’t much care for bottles, and didn’t eat a lot or a large variety of anything. It might make you to feel better to know that what actually helped this child a lot was daycare. Our feeding therapist(s) have all felt that daycare has a few benefits as far as feeding goes- Firstly, the role modelling and “peer pressure” to eat is amazing. There are actually group feeding therapy programs for kids with feeding aversions that use this premise as a main part of their therapy because it’s so effective. The other thing is that kids act differently outside of their home environments then they do within the home with their parents or a typical caregiver. My favourite feeding therapist that we used said that in all the time she’s worked with kids with feeding problems, she’s NEVER seen the feeding get worse at daycare, and often recommends this as part of their therapy in some cases. With Hailey, I know there was an initial hump where things didn’t go very well, but that lasted for about a month, and once she got more comfortable there and the crying lessened, the feeding improved too. Not a lot- she still doesn’t eat a lot, but she is more willing to try new things. Last night to my utter and complete SHOCK, I almost fell out of my chair when she said “I want BROCCOLI too, mummy”!!! (Of course, in typical Hailey style, she then proceeded to smell it, and touch it to her mouth, then lick it, then pitch it on the floor, but she still asked and tried it, which is amazing!)
Is the doctor worried about his dropping percentiles or his position on the curve? As I said, I can understand your worry b/c it’s hard to see them in the lower end. But I would talk to your ped about it, and if the ped isn’t worried, then I would try not to worry either. But if you’re feeling worried anyhow, then maybe your doctor can suggest a pediatric dietician through your home care program to come to the house. They can recommend ways for you to add more calories to the solids that he does eat, though I suspect that you know this already. There are supplements that you can add to foods, and even to EBM, I believe. Beyond that, if you’re feeling really anxious, then you can ask for a referral for a feeding evaluation by an ST who will come to the house and watch what he eats and how. They will be able to tell you if it’s just normal behaviour, or if you need a bit of guidance.
My opinion is that it sounds like normal behaviour (I know that doesn’t make it easier to deal with), but that Ari is one of those babies who might be independent and strong willed. Sarah was like that, and so she wanted to spoon feed and finger feed herself way before she could ever really manage it, and she was strong willed, so she might taste something new, but if she wasn’t sure about the first bite, that was the end of it. I really do believe that those types of feeding issues tend to resolve slowly over time as their actual abilities start to match what they want to be able to do independently, and as they become more interesting in doing what others are doing, and experimenting.
The other thing is that he might be wired to be a long and lean kid who will never be on the high end of the growth chart. A lot of reading I’ve done really suggests that healthy kids will self-regulate, that they won’t starve themselves, and that they’ll eat enough to get their energy requirements from the foods that you provide. It doesn’t sound like he’s overfeeding on BM, but what would happen if you cut out one of his breast feeds to see if his behaviour changed if he was hungry. The therapists we’ve seen have all said that initially it might not, but overtime it might.
Have you tried to introduce a sippy or a straw cup yet? What if you tried a variety of different cups to see if there’s one that he’d drink EBM from. Then maybe you can pump a bit and try to add something to increase the calories. If you plan to start him on whole milk at a year (which sounds like you plan), our therapist used a technique called “food chaining” that worked well for Hailey. At first we tried a million sippy cups on the market until we found one that Hailey would accept water from (because she only liked water)- for her it was the first years disposable but there are lots of staged trainer cups out there now. The premise is that you take what they will accept from the cup and add a tiny amount of whatever you ultimately want them to drink. So for Hailey, we took the water and added literally one tiny drop of soy milk. It was just enough to cloud the water but not enough for her to balk at the taste. Then you keep with that amount for a few days or a week, and then double the amount (so we added two drops). If the child refuses the new concentration, then you go back down one level, but never return to the original. Then you wait a few more days, and maybe add a bit more (not necessarily double) and see if they accept that. You keep adding more and more over time until you eventually have them drinking whatever you wanted them to at full concentration. This worked really well for Hailey and after a few months, she was taking soy milk fully concentrated from a sippy cup independently, though for her, volumes were always an issue. She was about Ari’s age at the time we started. If you were able to get him drinking something from a cup (or a bottle, if you wanted) by the time he started daycare that would probably cut back the stress a lot.
Even though his eating sounds frustrating but not abnormal, there are things that you can do at home. Here are some strategies that we found really helpful:
1. Role modelling- Put him near Jonah in a booster seat like Christine suggested, and let him watch Jonah. At the same time, everyone at the table should verbalize how much they enjoy what they are eating by saying “mmmhh” or “yummy” or go on about how delicious whatever you want him to eat is. If you want him to try something new, make sure that you all eat it too and that he knows it’s yummy.
2. PRAISE, PRAISE, PRAISE!- I can’t say enough about this one. Kids his age love praise and will do almost anything that gets positive attention. One thing that’s great is to praise Jonah (and even you and dh) when he eats something new, or eat well. We used to clap and cheer and get really excited and make a big ridiculous production. For example, if we wanted her to try carrots, as part of dinner we’d each have some on our plates. When Sarah took a bite of hers, I’d say “YAY Sarah! Hurray! Sarah ate her carrot. (clap clap clap)… etc”. We’d do the same thing “Hurray for Daddy! (or mummy). The funny thing is that this would usually get Sarah to eat really well, and she would keep shoveling in the food too.
We would also praise Hailey for smaller achievements that were at her level- so if she picke up the food and put it to her mouth and liked it, or bit it and spit it out, we’d make a big fuss and clap and cheer. Then we progressed upwards until she was eating it. It’s amazing how well this worked over time. Also with siblings, they love to get the same attention and copy the other one, so we found that getting Sarah involved really helped.
You can also use this for spoon feeding. You start where he’s at, and if he lets you touch his lips with the item, then you praise him. Then when he actually gets to taking a bite, you praise him a lot. If he refuses, you don’t pay attention to it, and stop there. It’s important to offer but respect their boundaries and let them decide (whether it’s for spoon feeding or self-feeding)
3. Keep the feeding environment fun- offer different foods, cut up different ways, in different bowls, on different plates that are visually appealing. We used to use the little IKEA plastic bowls that are nice bright colours and would put it down and rotate that way to keep her interest up. Christine already mentioned the use of different toys to keep them interested or distracted, which works well for a lot of people. We didn’t use that technique much b/c of our situation, but also because Sarah was also at the table and I didn’t want her playing with toys all the time. Also, make sure to keep the environment relaxed an fun. It’s important that he knows that it doesn’t matter if he eats or not, and that he won’t be pressured and that you don’t let him “see you sweat” so to speak.
4. If you can’t beat ’em, join ’em!- There are some kids who want to be independent far before they’re really able to do it proficiently. Also, some kids feel a better sense of control over the food if they feed it to themselves (just like we would if we’re apprehensive about eating something new- you’d rather put a spoonful of something into your mouth yourself, instead of having dh do it for you- it just feels safer). If Ari will finger feed, then let him do it as much as he can. That’s the way we had to go for Hailey. We just prepared things so that she could finger feed- we cut up foods into TINY bite size pieces (the size of a cheerio, at that age) and let her feed herself as much as she could. We found that most foods can actually be cut up that way with a bit of effort. It also helped with distraction, b/c while she was trying to feed herself, she was more tolerant of us spooning some of the pureed food. So she might be trying to pick up carrot pieces (which she then proceeded to throw on the floor b/c of her feeding aversion!) while we would offer a few spoons of blended carrot with flax seed oil or olive oil for calories and good fats.
Also, we would offer a variety of child friendly bowls and utensils, that even though she couldn’t use them well herself, she liked to try.
5. Keep on Trying: persistence pays off!- It takes most kids 10-20 times to try a new food. It can take an apprehensive child even more times to try something new. It can take a child with a feeding aversion more than 100-200 times to try something new. There’s a hierarchy of food acceptance that our feeding therapist gave us- kids can start anywhere on the hierarchy and then move upwards to eating. Any new stage shows progress (look at the new food-> touch the new food-> squish the new food-> smell the new food-> bring the new food to the mouth-> lick the new food-> bite it and then spit it out-> bite it, chw it, then spit it out-> bite, chew and swallow!).
6. Small bodies, small amounts- Don’t offer too many foods at once and start with small amounts. For kids who aren’t big eaters, they can get easily overwhelmed seeing large volumes of foods or lots of different foods on their plate/tray at the same time. Offer two or three pieces of manageable pieces at at time. You can put more than one kind of food out at a time, but don’t put too many. We used to use rotate 1-2 items at a time with Hailey, and we still do. If she would eat up all of one item, then we’d let her try the other, or add more of the one she liked.
7. Try to offer something that you know he likes at eat meal, a guarantee if you have one. That way at least you know that there’s something he likes. For most kids this is carbs- usually bread or rice.
8. Use modified forms of things he likes to encourage him to try new things. For example if he likes puffs, then try broken up pieces of whole wheat cracker. Then you can move on to whole crackers, and add a spread or use breadsticks and add a healthy dip of some kind.
9. Encourage food exploration/play and let them get down and dirty (this is something I could never stand because of the mess but got over it pretty quickly with Hailey). Food play lets them explore food in a nonthreatening way, so basically if they’ll touch the food, then the theory is that they might accidentally try it, or learn more about it’s properties so that they become comfortable trying it. For example, with the yogurt, if he doesn’t like the Yobaby, firstly you can try other yogurts. Hailey hated yogurt! I tried about 50 times to get her to eat a variety of different flavours and brands- actually she hated yobaby the most for some reason, but wouldn’t eat any of them. I started by putting a little bit in a bowl for her, and let her touch it, then we moved to putting a bowl with a little spoon and letting her fool around with it. At the same time, I would offer Sarah one and let her pack it away so Hailey say how good it was. She eventually started letting me feed her some, but she definitely had her favourites. She liked minigo, and danone la creme vanilla (I only offered the high fat ones, b/c we needed calories). I also introduced the drinkable yogurts, I would try to spoon feed her that, because the texture was thinner and she accepted it better until she got used to the thickness of the other ones.
Anyhow, good luck. Keep us posted.
