Thursday, October 18, 2012

Attacking Problem Eating in a Toddler: Round One

Those of my readers who know me well know that Aias is seeing a team of specialists for problem eating. Don't worry, he's perfectly healthy, just very stubborn about food and very limited in what he's willing to consume.  He's small for his age so we want to make sure that he gets help with this sooner than later.*

We've tried all the basic "tricks" and tips for getting a picky kid to eat, and those haven't been very successful for us.  We recently met with a nutrition consultant and having seen the limited list of foods he's ever been willing to taste in his life (under 50) and the number of foods he's willing to eat on a regular basis (under 12), she decided the best approach for us to take would be to go back to the basics of a good old fashioned eating plan.  We are to try this plan until early November, then we will meet with our pediatrician again to talk about seeing an Occupational Therapist.  She said that the Occupational Therapist will want to know if we've tried this already, and if we didn't, they'd insist we try it before anything else anyway, so we've begun this plan and have been sticking to it pretty rigidly for a few days.  I thought people may be curious about the plan, so here are the basic rules.

First off, we have to eat on a schedule instead of grazing. This is of the utmost importance for success.  Aias was the kind of kid that wanted to graze on breast milk and cracker-type foods all day, so he was never really hungry enough to want to try something else.

Second, we need to either all eat the same thing, OR if there is a restaurant situation, Aias needs to be offered what each of the adults are eating so that he can be in the presence of someone eating the same food.

The schedule is sort of like this for us:

Breakfast 7:30am
Snack 10am
Lunch 12:30pm
Snack 3pm
Dinner 5:30pm
Snack 7pm

She said the most important is that 2-3 hours passes between meals.  For smaller kids 2, for larger kids 3.  

Food needs to go in front of the kid for NO LONGER than 30 minutes.  After 30 minutes, the meal is done.  No big deal should be made about how much food wasn't eaten, but it's ok to praise food that has been eaten.

Each meal needs to consist of a full serving of one item the child will almost certainly eat... rice, noodle, etc for us.  This means something healthy; not potato chips or something.  It should also include at LEAST one other thing that is "new."  This doesn't mean that it always has to be something different. It's ok for the same "new" items to appear a few times in a week.  In fact, that's good, because then the child will get familiar with it.  Often the child won't eat the new thing or even try it, and that's ok.  No big deal should be made of what they ate or how much they ate of it.  Adults should also be seen consuming the "new" item. 

No bribes including food can be used as rewards incentives during this time, especially not for tasting or eating food. It's ok to say "If you taste your peas, we can read a book after dinner" but if it doesn't happen, just let it go.  It isn't ok to badger the kid, and it isn't ok to offer a dessert or "yummy food" as a reward for eating a new food because that implies that you think the new food is yucky and that someone should be rewarded with better food for eating it.

If the kid sits down at the meal, eats the thing they like, and ignores the thing they don't like, then asks for more of the food they do like, it's advised to not indulge. 

Between meals, there shouldn't be any snacks.  There should also be no juice or milk.  For some kids, water will fill them up, but for others it won't.  (I personally wouldn't withhold water from Aias).

Snacks and meals should be rotated regularly so the kids never anticipate what foods they will be having, either.

Our job: to be in control of the schedule and the foods that are offered.
His job: to decide what he will eat, won't eat, and how much.

Finally, in our case, nursing needs to be limited.  Aias has been reducing the number of times he nurses in a day, but for the most part, he's been using grazing on breast milk as an excuse to not eat things he doesn't like.  We are nursing when he wakes up, and before bed, and I encourage water when he asks during the day.

We're not certain what to do if he goes a whole day without eating at all, but luckily that hasn't been an issue yet (touch wood).  So far, the plan has been working out nicely.  I have to admit, it's been the hardest on us.  I'll keep everyone updated on his progress.

*Please note: this plan is behavioural, so it operates under the assumption that physical or sensory issues with food, phobias, and other serious psychological issues aren't the cause behind the problem eating.  Part of the reason we are trying this is to help narrow the problem down because generally, over time, this type of plan (if used consistently over a period of time) will produce success in many kids. 

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1 comment:

  1. I am the mother of 5 children. The oldest three are mine biologically, and the youngest two are mine through adoption. My middle child, H, was a very, very challenging child. He didn't eat, sleep, talk, or grow the way most children do. We began seeing specialists when he was 16 months old, because I knew there was something not right with him. By that time he had switched to a bottle from breast feeding because he never showed any desire to nurse. He would only drink about 10 ozs of fluids a day and he refused to eat solid foods. Over the course of the next three years, his eating did pick up, but only a little bit. We had to make him eat, refusing to let him leave the table before he ate a certain quantity. He was never attracted to a certain flavor or texture, he simply wouldn't eat when given the choice. Our specialists included occupational therapists, speech therapists, ENT's, pediatricians, developmental pediatricians, among others. No one could figure out what was going on with H. At the end of December 2011, we ended up at our ENT because H had an extremely sore throat. We has already been through urgent care, and it was determined that he did not have Strep throat. At the ENT, the Dr. discovered that H had an abscess on his tonsils. We were given the choice to have the abscess drained, with the possibility that it would return, or to have his tonsils removed. We chose to have his tonsils removed that day. H weighed 28 lbs and was for and a half years old on the day of surgery. He was still unable to sleep through the night and wouldn't eat a full meal if his life depended on it. The day after surgery, he ate two whole slices of pizza for lunch without being prompted a single time. (You aren't really supposed to eat pizza for a while after a tonsillectomy, but we were so startled that he was actually eating that we couldn't say no.) Within a week he was sleeping through the night for the first time in his life. Within a month, he went from an angry, clingy little boy, to a child that was full of mischief and laughter. We are almost 10 months post surgery. I will forever look back on that day as a life changing moment for me. H has gained almost 10 pounds. He is finally starting to grow. He sleeps, blissful, glorious sleep. He eats, so much variety in what he eats. He started talking so that he can be understood. He became a little firecracker and we certainly enjoy him do much more than we used to.


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