the littlest carscadden: January 2014

If a person is able to look at a situation while still in it, without having gone through the entire process from beginning to end, and accurately say when the situation was turning a corner, then I declare that a corner has been turned in the last few weeks.

We received a packet in the mail from the feeding clinic we're heading to at the end of this month. There were a lot of materials in that packet and among them was an informational article on "applied behavior analysis," the method they use at the clinic to help with feeding issues. This article was a game changer for me. The authors were describing us (and every other parent in our situation). Everything we had been doing up until this point to help with mealtimes, it was... wrong. I mean, we were doing our best with what knowledge we had, but basically, Lucas and I had been reinforcing all his bad eating habits. From the article:

Reinforcement. One of the basic components of treatment for food refusal is reinforcement. Inappropriate mealtime behaviors such as crying and throwing food, often result in favorable outcomes for the child in the forms of adult attention, toys or the meal being terminated. These outcomes simply reinforce the child's food refusal behavior.

Say for example that the caregivers provide soothing statements (attention), a favorite toy (coloring book), and terminate the meal (a break from eating) when their child turns his head, cries, and bats at the spoon. We now have information about what seems to motivate the child: attention, a coloring book, and a break. These data also indicate that they may currently be reinforcing undesirable behavior.

One approach is to provide these same reinforcers following appropriate eating behavior, such as accepting and swallowing a bite, rather than when the child refuses. We strongly recommend that some reinforcement-based component be included in all treatments developed for food refusal, because reinforcement generally makes the meal more pleasant for the child and simultaneously encourages him to engage in appropriate eating behavior.

In the past few weeks I've done a ton of independent research as well as talked a lot to my sister Amy (who uses applied behavior analysis with autistic children). We then implemented some simple but very effective changes:
1. All meals at the table. The table is cleaned of distraction, only food and drink on the table. (Previously he would point at or want things on the table that were unrelated to food).
2. No eating or drinking milk outside of the designated times for meals and snacks (this is to induce hunger).
3. Ignore all negative behavior - crying, asking to get up, throwing food, dropping forks on the floor, spitting food out. He gets no feedback from us for these behaviors, except, possibly, a simple "no" about getting up.
4. Set time limit for meals. This is so we won't end a meal due to bad behavior. If he happens to be crying or whining when the set meal time is up we extend it just a little longer to separate the end of the meal from his negative behavior. If the time is up but he is eating like a champ and isn't asking to get up, we let him eat until he is done and then end the meal.
5. We cheer or sing songs like he has won the Superbowl when he eats!

How have things changed?

He wants to eat. By dinnertime he is begging to eat. Because he is hungry. In the past, when there was constant food available to him, he never got hungry. He would graze all day on low calorie foods and barely take in any substantial food through the day.
With the positive reinforcement of his eating, we now have to stop him from putting too much in his mouth at once. He gets so excited about high fives and songs and cheering that he stuffs his mouth full and gags. We've managed that hurdle by paying close attention to how much he has in his mouth at once and helping him pace his food intake.
Meal time is fun! He dances at the table! In his little chair, his shoulders moving, his head bopping. All the while he's chew, chew, chewing. He asks for high fives, he wants us to sing and to dance and to cheer. And in part meal time has gotten more fun because:
The crying, whining and asking to get down have decreased.
His daily caloric intake has gone from approximately 700-800 calories to 1000-1200 calories on a good day.
He still has bad days of eating, but even his bad meals would have been considered okay meals before we made these changes

A couple people have suggested that since these changes have resulted in a drastic difference in his behavior that maybe we don't need the feeding clinic anymore. I hesitate for two reasons. One, it took us three months to get into the clinic just for an initial assessment. If they think he needs therapy there will be a wait for him to get into a treatment program. Two, I don't think it's all the way fixed. I don't think that the changes we've made (from the research I've done and the information my sister Amy gave us) have eliminated this problem. He still whines. He still refuses food. He still has really bad meals. We need more feedback about how to work with this issue over the next couple of years (or possibly more) and the feeding clinic is the place to get that feedback.

Overall, though, I feel a great burden has been lifted. I don't dread mealtime with Miles anymore. I feel like I see him getting a little stockier. He's definitely a little taller. And this eating issue, it doesn't consume my every waking thought anymore. I was talking about the issue with some peers at work and one of the women, a doctor, sent me an email later that day saying, "Just wanted to say how happy I am to hear that eating is going well for your baby! You guys must be so excited. I can only imagine what a stressful experience it has been for you. You looked positively exuberant today!" Obviously the lifting of this weight is showing on my person.

Because it has been a hard year. Because, if you're doing it right, parenting is hard work. Because, beyond the interrupted sleep, the lack of alone time, the guilt about not being the best parent you could be during his every waking moment, beyond the struggle for me and Lucas to maintain some sense of independence, to partake in our hobbies, beyond all that, our kid wouldn't eat. And he fell off the charts. And nothing we were doing was fixing it. I have seriously thought, this kid could stop eating and waste away to nothing. He could die from lack of calorie intake. That's where my brain was this past year. And now, it's floating clouds and easy rolling waves. It's the notion that we're on our way to making it better. That a simple behavioral therapy could turn it all around.

I feel better. I feel better now that we've turned a corner.

Now, as a reward for reading all that, here is our little dude, twenty whole months old: