Monday, February 9, 2009

The New Feeding Plan- the Stress-Free Approach


I absolutely hate mealtimes.

In fact, at mealtime prep, before I take anything out of the fridge or open one capsule of the DAN! doctor's vitamins, I pour myself a glass of Shiraz. Klonopin is no match for the stress these boys cause me at dinner.

Both of my kids have feeding issues but Spencer has a feeding therapist and he has made great strides so I'm not worried about him right now. It's Logan. He's 5 and I'm still not happy with how he eats. I need to find a more effective and less stressful way to feed him. For the last two weeks, this is what I've seen from looking at him closely:
  • He wants carbs and must be cajoled to eat protein and veggies. He doesn't love meat, not even hot dogs.
  • Hiding veggies in food doesn't work. Sorry Jessica Seinfeld, you are no match for Logan.
  • He asks for things and then eats just two bites.
  • He eats better when someone is sitting next to him and encouraging him, but I can not always do this because Spencer (2 yrs.) still needs me to feed him.
  • Spencer's feeding issue requires that he must eat in front of the t.v. and so to be fair, I put Logan there too but the t.v. distracts Logan so I end up having to move him away from the t.v. in the middle of the meal. Of course, he protests and gets angry.
  • He barely eats lunch at school. He likes things for a few days and then he is sick of them. Rotating doesn't help. Once he's turned off, he's turned off.
  • He comes home, probably starving but sometimes still doesn't eat snack. If he does, he wants carbs- no protein. I'm worried about that this isn't good for him since ADHDers are supposed to eat a lot of protein. As a behavior mod measure, if he doesn't eat the snack, I tell him, he will not get food until the next mealtime but that has its drawbacks.
  • If he forces himself to eat something he doesn't like, he will later yak it up, especially if he ate his vitamin prior to this and skipped his snack so it is hard to give him things and tell him, "You get what you get, and you don't get upset." I think he needs food to keep those vitamins down but he likes nothing nutritious that I cook so I don't know what to do.
  • Have tried prizes, desserts, money as incentives, but I can't get him to eat things he doesn't want to eat.
  • Have used the timer as recommended in the book, 1-2-3 Magic but that doesn't work either especially since he stuffs his mouth at the last 30 seconds (typical ADHD procrastinator), gags and throws up, sometimes everything and then what do I do, does he earn his snack or does he to go to bed with an empty stomach or do we start over again?

I know what you are thinking. I should just put Logan on Ebay and auction him off like that Bavarian couple did their son.

But seriously, I have put back on my guerilla PR woman hat and set up a strategy to conquer this problem.

Goal #1: Make him eat two of the three or four choices given to him- basically he must learn to eat what he is given.
Goal #2: Make him eat within thirty minutes.
Goal #3: Make him eat at set mealtimes.
Goal# 4: Make him keep his food down since he needs it for DAN! meds and vitamins and possibly for psych meds down the road.
Goal #5: Make him learn and respond appropriately to his body's hunger. I am avoiding future malnutrition and obesity. Yes, obesity. Hey, anything can happen, right? I've met obese adult ADHDers in my old job publicizing ADHD awareness.

I've consulted my team of experts from Theracare to help me with Logan's feeding plan. I got a lot of inspiration from Spencer's feeding therapist Anastasia Pieri (pictured) who also received OT and ABA training. I've also consulted my ABA therapist Natalia Cardenas as well as my social worker to help me build this plan:

1. Breakfast: He's gotta eat it. Continue my tactic with making him eat two spoonfuls of sunflower seed butter (protein) with toast or cereal for as long as possible. If he eats enough, he can have his DAN! vitamin but we have a back up vitamin for that if he doesn't. He will get two quarters if he finishes before the timer rings. Since he's still just 5, Anastasia wants me to put the quarters on display so he can he can readily see how much he's earned has instead of using a piggy bank.

2. School lunch: If it comes back mostly eaten then he can have a fruit leather, bunny snacks or 3 quarters, his choice. His school always sends back uneaten food so that Mom will know. “Tell the school that you will reward him for eating his lunch, so that they can reinforce it at school since Logan will either not remember nor be too motivated if he does not get consistent reminders and reinforcement,” said my social worker.

3. Afterschool snack: He is given a choice to eat it. Forget the protein, I'll deal with that for dinner. If he doesn't eat it at the time it is offered, then he must wait until dinnertime.

4. Dinner: Start with VERY small portions to not overwhelm him and let him feel accomplished. He will eat with Spencer at the t.v. and I won't remove him from there if he doesn't eat. Rather, I'll try to have the t.v. off as much as possible to give him a chance to eat. Maybe I'll play some music. Spencer is likely to protest. There could be anarchy. I'll give him things that I want him to eat and if he finished two out of three, he gets a snack but a super snack if he finishes everything. I will pay lots of attention and give lots of praise. Anastasia believes that his poor behavior was mostly attention-seeking. I must give him more of my time. He also must eat all of his food before thirty minutes. If he throws up, he can have more dinner but no snack.

Other aids: I will frame a picture of him eating and finishing his meal and put it right in the dining area. I did this already to boost his self-esteem and help him with visualization but framing will re-emphasize its importance. I will rewrite my food rules (pictured, yes, it looks horrible, I know) and put it in a more prominent place. (sitting, using utensils, napkins, no mouth stuffing, no toys, etc.)

I invite you all to add your experience and two cents and even a comment like, "Jenn, this ain't gonna work." I need your help. This is huge for my family and I know down the line, Spencer will learn from it too. He's already copying Logan more and more and now refuses to eat his DAN! vitamins unless Logan eats his first.

7 comments:

Jenn said...

Trying something new and messed up really bad. I'm sorry for messing this up. I'll try to add back whatever comments that came back to me from email. Sorry to all who commented directly onto this post.

Marilyn said...

Jenn--Remember this is coming from a woman whose 9yo had a 1/2 can of white corn, and about 2 bites of cornbread with butter globbed on it for dinner. I am NO expert! LOL! I think you are an awesome mom, dealing with a couple of hard to raise kids, and I admire you to no end! LOVE the feeding poster. :)

Have some question about some of the other aspects of the boys' program. Here
are my thoughts.

I think (please correct me if I'm wrong) that you are driving yourself completely nuts with this feeding thing. Anyone who needs a Klonopin and a glass of wine to feed her sons, IMO does NOT need to be doing what she's doing. Ya with me so far?

IMO, a humble, ignorant mommy, I THINK that way too much emphasis has been
put on food. I don't know if all that effort is going to be healthy for them in the long run. Now, I have a child with ADHD and some feeding issues--although not nearly as severe as your sons'. But I know FOR US--the more emphasis that's put on him doing the "normal" thing, the more resistance and stress we
have. It's hard to realize that our kids aren't eating normally. It's hard to watch them refuse perfectly good food. But it's harder to keep up this battle day in and day out--and I only have ONE child to deal with on this!

Your children get supplements. Not ideal, but it will cover them to some degree. Would it be possible to simply BACK OFF the eating frenzy and see if the boys starve themselves to death (not literally!)? Your son looks normal and healthy--a good weight. I'm assuming the other one does too. So it would be a while before they really got too thin.

Do they have a zinc deficiency? That is one thing affecting my son's ability to eat normally, as it affects the sense of smell and taste. We are addressing it with supplements, and it seems to be having some positive effect. Heavy metals an issue?

Will your boys drink smoothies? You can hide a LOT of things in there! If you call them milkshakes, and they are sweet, will they be accepted? They can thrive on these for quite some time.

The TV thing. YIKES!!! I would go insane if I had to have the TV blaring while I was eating. I felt sorry for your one son just reading that! I have actually stopped eating breakfast with the family, because my husband insists on playing his records and CD's during breakfast, and I can't stand eating to Led Zeppelin or Little Richard (although I like them at other times :) )! I have enough noise with just the kids! I have NO idea why TV while eating should be part of anyone's "therapy", but I just can't see any reason for it (besides distraction--which defeats the whole purpose of getting the kid to eat
normally anyway). Your child is not watching TV during other meals away from home, and I'm assuming he eats the same wherever he is. Just an observation.

I don't know where all these hard to feed kids are coming from all of a sudden. But I have a sneaking suspicion that if we just leave them alone, they will NOT go into adulthood eating a can of corn for dinner. And hey--if they do, they are no longer OUR problem! LOL! And anyway, if they do, it proves that they ate enough to survive to adulthood. Which tells me we may not need to be driving ourselves quite so crazy now!

I don't know. I go back and forth on what to do. Some days, I insist Jimmy take ONE BITE of something. Sometimes it works, often it doesn't. It's not worth getting drunk over. Most days.

Again, JMHO. YMMV. :) Marilyn

Marcie said...

My son when we started the diet would not eat for the first four months. Nothing I put in front of him he would eat. I would cut up food and put it beside him as he watched tv or did something and nothing would be eaten. For four months he did this.

Honestly I don't know why I didn't worry. Yes, I was frustrated but what can you do. He was doing fine he was starting to talk and connect words and looking at me again. He was making such big strides I just let it go.

And than one day I called two kids to the table for dinner and I put dinner on the table and went to take care of a screaming baby, I came back and the dinner was gone. And there was my 4 year old asking for more dinner? Since that day he has been eating like a pig. Since that day he has gained 14 pounds and has grown many inches.

When you started on the gf/cf road you tossed any and all normal out the window. It's gone but it should return. It's a whole new way of cooking and baking and such. And it will happen. Take it from someone who 17 months ago when I started on this road and my head was spinning and trying to figure out labels and how do I cook this and that.

His body needs time to heal. His gut is a total mess. And I am willing to bet he feels good.

So take your time, things will happen when they happen. Until than leave food out where he can grab it when he is hungry not when you are ready for him to be hungry. Keep pushing the fluids and leave apples around or safe chips or what ever and when he is ready he will show it.

Relax because you are doing a great thing for him. Just take it day to day. And hay now is a great time to practice some baking.

Marcie

Marcie Dingerson
Burger Professionals
REALTOR
Your Home Buying Specialist
www.MarcieDingerson.com
360-292-2569

Elyse said...

My son would only eat peanutbutter for a year. I called MIL, she had 7 kids, and she told me that my husband was the same! My son is the gourmet cook, now. Warmly, Elyse

Trina said...

You never know, Jenn! It all sounds plausible. You have some great ideas to reach your goals. Let us know how it works. Different things are gonna work for different kids.

I had to laugh...You hit the nail on the head about not being able tohide veggies in other food! No matter what, Connor knows it's there! LOL!

Trina

Tina said...

Hi Jennifer,

I was finally able to get on to your log...my computer was stuck for awhile for some unknown reason. My son is a picky/junk food
eater. A couple of suggestions for ya that I do....don't buy junk food...buy healthy snacks...trust me, if he is hungry, he will eat.
Some how I got my daughter who would not eat any veggies at all (except corn) to eat peas. I just kept introducing them to her and told her to try them one time after introducing them a ton of times and she did and she eats peas now...yay. Still working on the
broccoli for her. My son does not eat a lot or protein either so through a doctors suggestion I give him 1/2 a scoop of the protein powder in the morning that you can buy at WalMart, granted I buy the chocolate flavor so he will drink it, but he drinks it. Some parents even use the instant breakfast and I think that may have protein also. Does he eat peanut butter or like peanuts? Those could be used for a snack or as a protein option. My son not eat much at school
either or his lunches and truthfully I have no control over what he does eat there if he has money. Another thing I would like to
comment on is the fact that he is getting a snack or a supper snack, he's not going to eat because he knows this is coming. Make him eat or no snack. I finally got my son to follow this rule because I used to be the same way. I'd think, okay he ate some so he can have a snack and then the food started getting less and less and the snack
more and more. Now he has to eat before he gets a snack. Okay, sorry for going on and on here, I tried to post to your blog and it erased on me for some reason.

Tina

Jiming said...

Hi Jenn,
I saw your rules for Logan’s feeding plan and started laughing because all your rules are the issues we keep bringing up with Aidan at mealtime. We are adamant that we sit down as a family to eat and if he grazes before dinner (which he does since his class doesn’t do snack before I pick him up like his last class did) he still has to sit down and eat something. We try not to cook separate meals for him but when we make meals for ourselves which we know he won’t eat then we will make the old standbys (chicken nuggets, fish, etc.). Aidan used to love meat and before he was a year he would dance every time we fed him meat. Now he is not so into it unless it’s a hamburger from a fast food joint or came out of a frozen food package. We lament how I breastfed him for 12 months and fed him only home made baby food until he was well over a year and now he only eats processed foods. Anyways, we are constantly telling him to stay in his seat and keep a booster nearby and often end up strapping him in to keep him at the table. He is getting better although we are constantly threatening him with the booster seat or taking away a toy (we give time outs to his toys – they go on top of the fridge and often don’t come out of time out for days because we all forget). We are constantly reprimanding him about not making a mess or scratching up the table, wiping his mouth with his napkin, and he will often stuff his mouth with a bite way too big and then gag and then spit it out. Luckily for us he hasn’t thrown up but it’s his way to get out of swallowing food he doesn’t want.

One of Aidan’s favorite foods is dried fish which you can get in the Chinese store. Kai might be familiar with this. They have dried pork too but Aidan likes the fish for some reason. Probably because it is salty. Whenever I worry he hasn’t gotten enough protein then I give him a bowl of the stuff. He hates to have it mixed with rice which is how we usually would eat it so I have to give him a separate bowl.

One way to get Aidan to eat certain foods is to have him help make them. We make oatmeal in the morning which is just letting him put the measuring cup of whatever ingredient which I filled into the bowl. I microwave it because it is faster than the stovetop but having his involvement means he will eat some. (He will eat all if I feed him which we need to work on.) The same with eggs. I will let him crack the eggs while I hold his hand and if he is afraid I let him stir. He is really into dying his eggs because of Green Eggs and Ham so I let him pick a color and he eats whatever color scrambled eggs. We also let him put salt and pepper on his food – one piece at a time and he will eat the piece only to season the next piece. Sean also lets Aidan grate a hunk of parmesan onto pasta or bribes him with slices of fresh parmesan. Veggies are hard so we try to make sure there is a lot of fruit available and if he doesn’t have enough of those then prunes. After a recent bout of constipation he is very open to eating prunes to avoid a repeat.

To get him to the right height in the kitchen we have a wooden stool from Ikea which is a perfect height so he can reach the counter comfortably.

Not sure if any of these ideas can help you as I know there are a lot of diet restrictions between the boys. I just wanted to let you know that some of the issues you are dealing with are normal. I think is it more common in boys as all my girlfriends with daughters do not have these problems whereas the boys are more rambunctious and don’t care about being neat or following rules.