Saturday, September 18, 2010

Just Take a Lick

You can lead a horse to water but you can't make it drink. We can lead Matthew to food but we can't make him eat. Transitioning Matthew from baby food to solid food has been one of our biggest challenges. It's an extremely frustrating process.

He eats a decent variety of textures (crispy, crunchy, hard, lumpy, and smooth) but has a very limited selection of food. His diet consists of yogurt, applesauce, regular cheerios, goldfish crackers, wheat thins, pretzel twists, toaster waffles, apples, peaches, pears, canned oranges, and just in the past month, pasta (shells and elbow macaroni). He gets meats and vegetables from jarred 3rd stage baby food.

New and unfamiliar food is typically met with him shaking his head, saying doh! da! da!(no! done! done!), crying and turning away from the food. Sometimes, he gets so obstinate and mad that he'll try to clear the table with his arm in one swift sweeping motion. (Let's refer to this behavior as "Mr. Hyde.") He gets a 2-minute time out for that.

This is a frequent occurrence at our dinner table, as frequent as we offer new food to him. So sometimes we opt not to offer new food to avoid this food battle.

Perplexing Behavior
Sometimes Matthew reacts the same way to favorite or familiar food as he does to new food. It's a phenomenon that we do not fully understand.

If we offer peas and carrots in a plate, Matthew turns into Mr. Hyde. But when I sneak the peas and carrots into his jarred 3rd stage baby food, he doesn't even flinch.

If we offer pasta with cheese sauce, Mr. Hyde comes to the dinner table. When we start singing, sometimes Matthew returns and eats.

Sometimes Matthew will ask for an apple. We always cut it into potato-wedge sized pieces. Once we put it on a plate and set it in front of him, Mr. Hyde shows up! We give him a minute to get over the mood and sometimes he'll start eating on his own. Or sometimes giving him a fork helps. The newly introduced idea of using a fork for the apple is enough to distract him into eating. We're not lucky enough to have that happen all the time though.
eating a slice of apple

Where Did We Go Wrong?
It's been over a year now that we've been trying to transition to solids, seeing that I wrote "Transitioning from Baby Food to Solid Food" in July 2009. On the bright side, we've had some progress during the year - just not the quantum leap we had envisioned. We can't pinpoint exactly how he developed a strong aversion to food but we have a few theories.

Maybe we didn't introduce solids early enough. His inability to chew food when he was younger due to the hypotonia made me hesitant to try.

Maybe we didn't offer a wide variety early enough so he has limited exposure to different tastes and types of food.

Maybe he developed the aversion from the numerous times that he gagged and threw up the solids that he did try, associating a negative experience with solids or new food. These gagging episodes also made us gun-shy about pushing solids.

Maybe we didn't do oral stimulation activities often enough.

Maybe he's just plain picky. After all, he is a toddler. Most toddlers are picky. Bill and I are picky to some extent too. It's in his genetic make-up!

At this point, the reason didn't matter as much as the next course of action.

He's proven to us that he can chew his food, although he still gags on the smaller bits that are too small for his mouth muscles to detect and chew yet too big to swallow without chewing. He has a psychological barrier to accepting more types of food. We need to get past it.

Exposure and Interaction
Thanks to some guidance and ideas from Matthew's occupational therapist and speech therapist, we have a new plan of action in place:
- frequent exposure to new food.
- branch out to new food using the guidelines in the book "Food Chaining: The Proven 6-step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child's Diet" by Fraker, Fishbein, Cox and Walbert.
- use a continuum to have Matthew interact with new food, which means having the new food on his plate, touching the food, kissing the food, licking the food, holding between his teeth and ultimately putting it in his mouth, chewing and swallowing.

We've had some success with the new plan and an equal amount of unsuccessful attempts.

Success Story #1 - Mac 'N Cheese
In introducing the homemade mac 'n cheese, we convinced Matthew to feed Bill. Next, we showed him to kiss it first before feeding it to Bill. Then when he was getting comfortable kissing the pasta, we moved on to licking it before feeding it to Bill. Being the wonderful dad that he is, Bill ate the pre-moistened pasta for the sake of getting Matthew to accept being at the same table as the pasta. It was for the greater good! And I showed him how I put my pasta in my mouth. And with a little bit of hand-over-hand guidance, Matthew put a piece of pasta in his mouth and started chewing! He ate his whole bowl of mac 'n cheese after we got the first piece in.

Success Story #2 - Porkloin
I had Matthew feed me a slice of pork for lunch. He was interested in how I'd have a big chunk on the fork and only bite pieces off. I walked away from the table and when I returned, he had my fork and pork and was licking the pork on the fork and giggling. Then on his own terms, he took a bite and started chewing. He must have bitten too big a piece though because he spit some out. He was definitely chewing though! Then he was done.
kissing pork

Success Story #3 - Ice Cream
He had a spoonful of ice cream on his 1st birthday. He has never had it since then, always refusing to try ice cream. He recently took 10 licks of ice cream using a miniature ice cream cone. Just the fact that he licked the ice cream is enough to call this a success.
licking ice cream

Tracking Method
Using a monthly calendar to keep track of when and what new food we introduce has helped. Some days we feel like we've been exposing Matthew to bread for a month without any success. But when we look at the food tracker calendar, we see it's only been 10 days. We also note if he interacts with the food at all (touch, kiss or lick) and how many times.

Pressured and Stressed?
Maybe Matthew feels pressured to try new food. Maybe most of our attempts to transition him to solid food simply causes stress and summons Mr. Hyde to the table. There were a few things he started eating that weren't introduced at the dinner table such as waffles, wheat thins and pretzels.

Maybe we just need to back-off. But not completely especially since it seems we are making some progress with the expose-and-interact strategy. We'll back off from "Just take a bite" to "Just take a lick."

Or maybe our new plan won't work either and we'll be wondering, once again, what else there is to try.

Related post:
Transitioning from Baby Food to Solid Food


Far Above Rubies said...

Ria, Ella went through the same thing and my Speech Therapist helped me out. Keep introducing new foods, have her imitate the chewing action as she watches you and the children, and something that seemed to work better than all else was - transitioning her from highchair to booster seat.

She loved being with the family in a more intimate setting. She thrived.

She has successfully transitioned. Now if I could just muster up the strength to potty train. ;-) xox

Great job, Ria.

God Bless.

Rochelle said...

Yeah for success. Oh we can't imagine life without ice cream Matthew so thankful you decided to give it another try.

Looking Up said...

Ria, I don't think that you "went wrong" anywhere. My son Josh seems to have an issue with trying new foods as well. I think that it's pretty common with many toddlers, and especially common with kids who have DS, as they tend to have particular probs with accepting different textures. My son loves most things with cheese..grilled cheese, mac n cheese, etc. He will also eat homemade turkey meatballs & roasted chicken, but that's it in the meat department. He will eat applesauce or ANY pureed fruits, but try to get him to eat pieces of an actual banana or grape, & it's a battle. And eggs? It took me months before he would actually swallow a tiny bit of scrambled eggs without spitting them out the second they hit his tongue. I used to get frustrated, wondering if I waited too long to introduce him to different things, wondering what I was doing wrong....But I've finally come to the conclusion, that Josh accepting new foods is just going to have to be a gradual process. Like all of the other milestones, we'll get there eventually....

Brandie said...

Goldie struggled with liquids, but not solids. However, my son has a horribly sensitive gag reflex. At 8 months he is only able to tolerate purees or baby cereal. So, I don't think you did anything wrong. Every child is different and these things just happen sometimes.

Food chaining also has a blog

Rosa said...

Ria, we haven't had feeding issues with our boy, but our OT gave us a few tips during this transitioning:

- keep offering new food to him as much as you can.
- Offering the food he doesn't like it over and over again. I used to give him the same food for a week or until he began eating it without any trouble.
- Let him touch the food before he eats, then he kisses the food and lick it and finally let him to try the food. You can make a demonstration for him and make a game of it.
-Try to give him frozen fruits or popsicles as snack to aware his oral muscles before the meal. Or you can rub lips and tongue with ices before he eats.

Hope this can help you and Matthew.

Anonymous said...

I love this post Ria. I would agree with everyone else & say that you didn't do anything wrong at all, and I would add that while I have been there myself (my 4 yr old is extremely food averse and 90% of his diet is milk with Carnation Instant breakfast in it), you may as well steel yourself to that now. Unfortunately, as the mom of a food averse child, you are probably bound to bump into a self-appointed food/nutrition expert at some point, who will suggest that you did do something wrong, and will summarily list what you can do to instantly fix it. In actual fact, while eating is perfectly natural to some children, it is equally, if not moreso UNNATURAL to other kids. To some kids, the flavors and textures of food that are so rewarding to some are terrifying, threatening, and wholly unpleasant to others. The problem, at least for my son, is that even "fun" food like cupcakes & cookies have to get past his senses of taste/texture, smell, sight, etc, and they are not at all pleasing to him. When I am feeling down about it & asking myself "why", I try to remember that there are neglected kids with moms on crack that will happily down a burger. This is not to say that we can't as parents always be evaluating how we are doing, but some things simply come down to the wiring of that child, and the very best we can do is help them cope with it and with a little luck grow a bit in that area in spite of it. You are doing a fantastic job with Matthew in every way imaginable, including the feeding issues. You are an amazing mom, and Matthew is incredible. (Not to mention so darn cute!) Love, Auntie Kris :)

Ria said...

@Jasmine, thanks for the suggestion. Doing more "big boy" things at the table like self-feeding has helped a bit too. He's had his own chair since he turned 2 last year and that has worked well. Good luck with potty training Ella!

@Rochelle, thanks! Alayna needs to come visit and show Matthew how yummy ice cream is. :-)

@Looking Up, thanks for the encouragement and reminder that is a gradual process just like all the other milestones. We'll get there eventually. :-)

@Brandie, I do remember reading that on your blog many months ago. What a struggle that was! Thanks for the link to the food chaining blog. I will have to bookmark that.

@Rosa Maria, thanks for the tips!

@Kris, I enjoy your insights as always. Wishing us both luck in the food department!