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Feeding Therapy Evaluation

I feel like I live at the Pediatric Therapy Clinic. We (I had to take Nadia too) went this morning to Nora’s feeding evaluation. I had no idea what to expect, but they asked me to bring three foods she will eat, and three she won’t. The first half hour or so was just information gathering, we discussed Nora’s premature birth, acid reflux as an infant, her breastfeeding issues in the NICU, her posterior tongue tie and upper lip tie, how even after correction she still took forever to finish a bottle… I gave a list of what Nora will eat, how we still rely a lot on Pediasure and toddler formula, the how she spits out a lot, even before she’s really had a chance to taste.

The therapist really wants to see Nora twice a week, but we’re already there once a week for Nadia’s physical therapy, once a week for Nadia’s speech therapy, and now once a week for Nora’s feeding therapy. Adding three appointments a week to our schedule is enough for me, I can’t do four. I feel bad, but I can’t, not now anyway. Maybe in a month when I get a new sitter hired and we’re into a routine.

I was able to see a little bit of the actual therapy today…  The therapist started with one of the foods that Nora likes, sour cream and onion goldfish crackers. A few were put on a plate for Nora, and the therapist put a few on her plate at well before going on to talk to Nora about how crunchy the crackers were when chewed. She made a big display of it, and of course Nora thought it was hilarious and then wanted to crunch them as well. Next they moved on to a food Nora doesn’t like, pumpkin banana snack bars from Plum Organics. Again the therapist took a bit of the bar as well, talked to Nora about how it was soft, didn’t make noise when she ate it, could be smashed with her fingers, etc. She asked Nora to first touch the bar, then kiss it, etc. until finally asking her to ‘send it down to her tummy’. Apparently they aren’t supposed to always or even often use the word ‘eat’… This process went on with the other foods I’d brought, almonds, fruit snacks, yogurt, and bits of actual fruit.

The therapist seemed to focus a lot of Nora’s acid reflux as an infant, suggesting perhaps Nora has learned that eating is actually painful and thus she has somehow learned what she can eat, a very limited variety of foods, that won’t cause her reflux. I’m not sure I believe this theory…

One of the questions I was asked was whether or not Nora is overly concerned with her hands being messy. I’m not sure on this one. She does ask me to wipe them off if she gets a lot of food on them, but she certainly doesn’t freak out about it. Looking back though, I never really let Nora eat with her fingers… You know that spaghetti picture everyone has of their child? We never did that, rather tried to teach Nora from a young age to use silverware. I more blame giving up on the idea of baby food so soon for the issues we’re having now. Nora spit out a lot of baby food at first, and being a first time mom I figured she didn’t like it and quickly moved onto baby led weaning. Having seen Nadia spit the baby food out a few times before liking it and figuring out how to eat it, I now think maybe I just didn’t give Nora enough time. Who knows… Can’t go back now I guess.

Our next feeding therapy session with Nora is this Friday, so rather soon. We were given a few instructions to work on at home in the meantime:

  • continue our usual routine, sticking with the Pediasure and toddler formula for the time being
  • during family meals prepare for Nora foods we know she likes and will eat, even if that means mac and cheese and fruit snacks for every meal; the goal for now is just to make sure she is eating with us
  • during family meals talk a lot to Nora about what we are eating, meaning about the foods we want her to eat; for example if I’m eating a green bean tell her how it’s soft and green, doesn’t make a sound when chewed, can be cut into smaller pieces, how yummy it is, etc.
  • plan time for one-on-one therapy meals with Nora, perhaps when Nadia is napping (ha); during these ‘meals’ introduce Nora to new foods but also incorporate familiar items she likes while completing this feeding log Screen Shot 2017-07-25 at 3.02.28 PM
  • the idea with the log is to start at the top and attempt to move down the list by encouraging her, playing with the food, doing these things myself with the food, etc.; if she won’t move down the list, go back to the top and start over

So… this all sounds great and wonderful, but ah, finding the time, and preparing new foods to try is already a bit overwhelming to me, not to mention also finding foods to take to the actual therapy sessions, oh, and going to the therapy sessions. I know, this is just one more thing I’ll look back on and think, oh, remember that? But still, right now it feels like a lot for me. Especially since my specialty is accounting, not playing with kids and their food!

8 thoughts on “Feeding Therapy Evaluation

  1. Is Nora underweight and that’s why you’re in food therapy? Does she have a milk allergy or just not like cow’s milk?

    1. She is on the charts, but just barely. It’s more because she has an extremely limited range of items she will eat. As in, like less than 10 things.

      1. This is good information. Do you mind if I share on my blog? I’m still new to wordpress, but I think I added your blog to mine.

        1. Of course, if I can help someone else that’s great!

  2. Reflux and oral aversion are definitely linked, I see it at least a few times a year in my own practice.

  3. 1. Infant reflux might not be the (main?) source of Nora’s limited eating, but it also might be–all that pain can re-wire infant brains in unexpected ways. My son had hideous reflux (and it went on past his 1st birthday), but he responded by trying to drink constantly–he learned that if something was going down, he didn’t hurt as much (even though it always came back up and made him scream hysterically). So now, even at the age of 4 (when he definitely doesn’t have reflux), he has a tendency to bolt his food, and at least a few times a week he eats so much that he feels ill. Essentially, he’s carrying over his feeding habits from when he was a baby, and his brain has taught him to ignore all the I’m-full messages his body sends him. We’ve found we still have to keep encouraging him to slow down, take breaks, and pause to consciously query his stomach….

    2. You’ve mentioned that there are a lot of early-childhood-education students near you (from a local university?). In lieu of that second feeding therapy appointment, could you hire a student (perhaps recommended by one of the professors?) to come a few times/week for an hour to just *play* with food with Nora? And then clean up afterwards? Reading the feeding performance log, it seems to me that it’s essentially trying to get children to become curious and interested in physically exploring food to the point where they want to bite it, so they eventually will find out that some of it tastes good….But that can mean letting them (and wherever they eat) get really filthy, which is hard for a lot of parents. (I am one of them, for the record–if the food isn’t on a plate or in someone’s mouth, I get twitchy.) So perhaps it’s better to outsource the whole thing, at least a few times/week, to get the ball rolling. (I, personally, am a bit rigid when it comes to food and cleanliness, and when my twins had speech therapy 2x/week + OT 1x/week–all at home, as we’d have never managed it otherwise–I found it really helpful to just watch other people work with my children. They made messes that my husband and I would have *never* allowed (shaving cream, sand, and paint everywhere! Food up the nose! An entire avocado in their hair! & etc.), and besides helping the children, it made it easier for me to do/tolerate similar things….)

    1. Thank you for this! I actually thought of hiring someone to come work with the girls, either for feeding, speech, or physical therapy. But then the mom guilt sucked me in. I know this type of therapy isn’t my specialty, not what I’m trained in, not what I really know how to do, or even feel comfortable doing… But I guess a part of me feels like, as their mother, I’m supposed to go out of my way to do everything I can for them… Ugh, guilt sucks me in every time!

  4. Reblogged this on Gerd Baby and commented:
    This blog has some good info on feeding evaluations for those who are interested.

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