Yesterday, I spent the afternoon with Adeline at the Hershey Feeding Clinic. Her speech therapist also accompanied us which was above and beyond the call of duty. We met with Dr. Williams and discussed Adeline's food routines and food related behavior. It was hard to describe how hard she could be during a feeding when she was a sweet angel for the two plus hour consultation. By the end of the visit she was curled up in the doctor's lap saying, "Hi!"
After spending much time discussing her eating habits, Dr. Williams placed her in a high chair with yogurt, applesauce and bread on the plate. I informed him that she really likes matchbox cars and that is what he used for motivation. He would take the tiniest bite of bread and place it on the spoon. After telling her over and over again that she had to take her bite if she wanted to play with the car, Adeline would finally give in. She wasn't real willing but she wasn't fighting him as hard as she does me at home. Each bite was followed by time playing with the cars. The car would be removed after 30 seconds or so and the process would start again. The timer was set for 15 minutes and when it beeped she was done.
In the 15 minute minute time period, Dr. Williams was successful at getting Adeline to eat all three foods. There was very little caloric value due to the small quantity but he assured me that practice makes perfect. She will eventually like food, stop gagging and WANT to eat. He does this day in and day out so I guess I will believe him.
After her feeding we went back into the consultation room and talked about family mealtime. I told him it was the most stressful part of my day, especially dinner. When most families are finding relief during dinner, I am low on patience, fighting three kids to eat food they typically don't want to eat and doing this on my own as there is no Daddy at the end of our day. This lead the conversation to both Lila Grace and Savannah. Both girls contribute to the stress. Savannah never wants to eat what I cook and Lila Grace is either hot or cold. Some days she will shovel it in and then want down in two seconds and other days she will scream and tantrum over what I put in front of her. Dr. Williams wrote a plan for both:
Lila Grace - When behavior isn't acceptable put her in time out for five minutes. Let her come back and try again but adhere to a "three strikes you're out rule." He promised she would learn to sit quietly for 15 minutes. I am not supposed to push her to eat if she doesn't want to.
Savannah - She is supposed to try pea sized bits of all our food. If she doesn't like them she doesn't have to eat it. The only after dinner snack she can have is fresh veggies and fruits. No more bowls of cereal and bars. She is what he considers a classic "avoider" by using a bowl of cereal as her supplement to dinner.
The above sounds great but putting it into practice is another issue. I will give it a week and see where we are. I think Lila is still going to exhibit behaviors that put me over the top.
Once I have the other two under control it is his belief that I will have a nonstressful environment and at that point I can turn my focus to Adeline. I think he is simplifying the stresses of dinner time or any meal time for that matter but I am going to try.
Adeline's plan is as follows: Decrease the amount of Pediasure she receives through a bottle. Set the timer for 15 minutes and use pea sized bites of a variety of foods. Gradually grow the bite when she is no longer showing refusal. Eventually, she is supposed to self feed. Boy, won't that be the day!
Dr. Williams thought Adeline would resolve most of her issues in a week's time if admitted to the day treatment program. However, he didn't admit her. Due to the family dynamics of the meal, he felt that there wouldn't be any carry over when brought back into the natural environment. Thus, the intervention must be done at home! Yikes!!
I don't know how I am going to do this on my own. Dinners are a disaster, breakfasts are all of five minutes and then we are rushing to get Savannah to preschool and lunch is squeezed in between preschool pick up and therapy. It isn't like we have all day to work on feeding. I understand his point though. It has to be done at home because there are so many behaviors that are tied into her successful outcome. Savannah and Lila are going to have to step up to the plate in order to allow me to have time with Adeline - undistracted time that is. Any mother of three kids four and under knows how how tall of an order that really is.
Keep your fingers crossed for us.
