Friday, January 28, 2011

Graduated Exposure

Last week Nathan had a follow up visit with the feeding clinic. I really must say that I wish I had known this place existed 2 years ago. I could have (maybe) avoided a lot of heartache for all of us. I wish Nathan's pediatrician had taken me seriously when I said something was wrong and I wish I had been a stronger advocate for my son when I knew this was not something he'd grow out of. But I guess you just live and learn.

The visit confirmed their suspicion that Nathan suffered from reflux. He has gained 1/2 pound since his first visit there 7 weeks ago. His appetite is really improving which provides us with an opportunity to start introducing new foods and better eating habits over all. Another added bonus is that he is finally sleeping through the night. Clearly taking Pepcid when you have reflux is beneficial.

So the next step for us is The Triangle Game, a graduated exposure therapy designed to increase his ability to encounter new foods. So far I've introduced five foods that I'd like him to eat sooner rather than later. We've gone with a bean, red bell pepper, tomato, pasta and cheese. I have to add a sixth one tomorrow (I could have sworn there was something else, but I really can't remember and Nathan says no too.).

First we put them in a triangle formation on a plate. I tell him to touch it, he has to in 5 seconds or I show him with my finger. If he still refuses, I have to make him. I felt like that was kind of harsh at first, but I noticed right away (because you know he refused and I had to resort to that) that he was only not doing it to be stubborn. He realized we were doing this whether he liked it or not and, I'm surprised to say, he is actually going along with it. Every time he touches a food, we play for 20-30 seconds. That's not always incentive for him, so I've also done a count down of touches left and tonight we read a page per touch of the new books we got.

We've moved on to step two, which is for him to pick up the foods and hand them to me. I am in shock because he has always run away when I've put food like this in front of him. I'm very surprised at his willingness to participate. He still gives me a hard time when I tell him we need to do this, but he is at least coming to the table and trying.

Once he can do the picking up (and that's going really well so far), we will move on to putting the food to his cheek, then to his lips to kiss it, then touching it with his tongue. Once he is willing to lick it, he do one chew, two chews, three chews, until he swallows it. On the one hand I feel like we'll never get there since I can't imagine him ever eating a piece of cheese or a vegetable, but on the other I never thought he'd hold any of these foods either without screaming.

I know to most people this will sound ridiculous. Most children, even the pickiest ones, don't run screaming from food as though it could kill them. But his food aversions are so strong that just smelling a food was making him gag. Now he is at least interacting with very common kid foods. And if I can get him to eat these things, he will nearly double the kinds of foods he'll eat and it will open up a world of possible meal options.

Last weekend, only 2 days into the therapy, he actually tried a new food. It was the tomalito at a restaurant. Basically just a mushed up corn muffin, the site of it was not appealing to Nathan. It was, after all, mushed up. And he could see bits of corn. We lied a little and said we didn't think it was real corn and he should try it any way, and, must to my surprise, he ate it! He ate actual corn. That was the first non-pureed vegetable I think he has eaten since he was a year old. I was so proud and excited for him I cried at the table.

I am optimistic, for the first time in years, that this child will someday eat like most kids eat.

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