Evaluation with Dr. Patel

Tonight Dr. Patel came to our house to do an evaluation of a feeding with Abby, and to talk with us about Abby's history.  From the moment she walked in the door we knew we were going to love her - she was very personable and friendly and Abby immediately took to her. This is a big thing because Abby doesn't have a great track record of being "friendly" with people haha, she usually clams up or just gets stone faced, but with Dr. Patel she was waving, smiling, laughing and really engaging with her.  If that's not a good sign I don't know what is!

We started off her feed with cut up pieces of avocado, which for the first piece Abby put in her mouth and started chewing, within a few seconds she spit it out.  I tried to offer her another piece and she turned her head and whined and was pushing my hand away.  On to the next food choice.  Pear & Squash puree, she wouldn't open her mouth, just kept whining. Then we gave her an empty jar of food to play with and got her distracted, then offered her another bite and she opened her mouth.  She did this for a few bites then would refuse again, and as always we tried to distract her with something else then she'd take a few more bites.  Once she refused it and no amount of distraction was going to get her to open her mouth again, we gave her one of her "favorites" - yogurt.  I first offered it to her and she didn't want it, then she stuck her tongue out just a smidge to get a little taste, realized it was a "safe" food and ate about 1/2 an ounce of it.

Dr. Patel was thrilled with Abby's oral motor skills, her mouth and tongue are working properly, though her chewing could be better, but that will take more practice as she begins to accept more chunky/textured foods down the road.  She agrees, the problem is simply she is not taking in enough food (better yet, calories), yes she's "eating" well but the quantity is not nearly what it should be.  From Dr. Patel's point of view she says that it looks like Abby has some fear over eating and seems to do better with foods that Abby has deemed "safe" (yogurt, water, vanilla wafers) but Abby is still limiting the amount of food she allows us to get into her.  What is that fear from?  Who knows, but the most logical thought is that the silent acid reflux has caused some major discomforts and she associated eating with pain, and that then created habits that have gotten her to where she is now.

As our treatment week won't begin until July 8th, Dr. Patel in the mean time has drafted up some tips for us to start working on with Abby.  She should be emailing them to us by tomorrow, but from what I can remember here are some things she says to start trying.  I hope if any moms (or dads) out there are dealing with what we are with Abby that these things will be things they can try as well - this is one of the purposes of this blog, that people who have babies with feeding problems can get more hands on tips and ideas of new things to try - I wish I had this information when I first began researching, so here it is now for you!

- Add Safflower oil to a preferred food - start with 1/4 tsp in 1/2 oz to 1 oz of a preferred food.  Safflower oil is high in calories yet has no taste so it will not alter the taste of the food. Do this at every feed.  If the child stomachs the addition of the oil fine, increase the amount of oil in increments of 1/4 tsp.

- Begin offering water (Abby's preferred safe beverage of choice) in the bear straw "cup" - we want to teach Abby how to drink from a straw and the bear cup gives us control of getting stuff out of the straw without her having to suck initially. (Thanks to my mama we already have this cup!)

- If Abby refuses a bite three times, switch to a new food.  If she refuses that three times, switch to offering her just water on the spoon, if she accepts do it a few times, then go back to adding food.

-  Add to our collection of "distraction" toys that are only offered to her when she eats.  We already have some, but will add a few more.  Eventually we will fade out the distractions but for now if it's going to help her eat, then use it!

- Keep meal times to a maximum of 20 minutes, even if she is still eating and 20 minutes is up, stop.  We want Abby to learn that there is a time to eat.

- Do not take her out of the high chair if 20 minutes is not yet up even if she is refusing or whining.  She has to learn that those actions will not result in her getting out of the high chair.  Use the toys or other things to distract her, even if she's not eating, make the time positive.

- Do not allow others to "try" and feed Abby by coming up and shoving food in her mouth or trying to get her to eat.  There is a method to the madness and Abby needs to learn when and how to eat, so stick to her feeds being with the parent and in a controlled atmosphere.

That's all I can remember for now.  These are things to just start working on with Abby, but once they come in for the week of treatment they will figure out what exactly is going to work for Abby and how to get her to take more calories in per feed.  We look forward to working with them and are trusting that the Lord has placed us in this program for a reason - hopefully to get ourselves a chunky monkey! :)

More to come in the days to come as we implement these things!

Adios!