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Saturday, December 5, 2009

Amazed and Surprised: Feeding Psychology and Who is Really in Control

Sometimes Hallie does stuff that we find confounding, in a good way. It then becomes clear to us how on the ball she really is, how much she follows even when it's not clear that she's listening, and how smart she is. Here's what happened:

Yesterday, we trekked over to CHOP for our first real session with the psychologist who is part of the Feeding Team. We're always a bit conflicted about the feeding stuff since we never really seem to get very far before we hit another roadblock but we were heartened that the psychologist listened to us when we met with her a couple of weeks ago to go over Hallie's case and figure out some sort of strategy. Our aim was to take it slow (always a good thing in our book since shock tactics backfire terribly around here); use a behavioral approach but one that did not involve force feeding, which is something with which neither of us are comfortable; and, most importantly, create a ritual around eating for Hallie that she could assimilate and then work from there to advance family mealtimes. Rituals really work for Hallie--she likes routines a lot and, while she's never prone to tantrums when routines are disrupted, we do know that whenever we switch things up on her, she tends to withdraw more into herself because she gets overloaded. We absolutely hate it when Hallie shuts down for all of the pretty obvious reasons.

Anyway, the plan was to begin with a snack at the table that did not involve television. We've used TV as a mealtime distraction/reward for pretty much as long as Hallie has been "eating" solids. We find it disruptive and, in the end, counterproductive. Ultimately, we'd like to get away from using it this way even if Hallie does a pretty good job, for her, of eating OK meals while wandering around watching the Wonder Pets and Yo Gabba Gabba. We don't envision living a life where everyone eats meals in front of the TV and TV-watching, while pretty interactive in our world, tends to be anti-social and the last thing we want to do is to stoke Hallie's already proclivity toward preferring electronic friends to real life interaction. Still, the psychologist understood why we can't afford to go 'cold turkey' and change everything up at once. The last time we did this with feeding, when we insisted that Hallie eat at the table and gave her the power to decide how much and whether she ate, Hallie responded by going on a full-fledged eating strike. She's eating pretty well right now and we don't really want to disrupt that entirely.

So we got to the doctor's office, after learning that Hallie grew another quarter inch in the last two weeks but lost about 4 ounces---we're not too concerned with this because she was, after all, pretty sick for about a week and her weight, 31 lbs. 11.5 ounces, and especially her height, which is 39.75 inches, are quite good. I pulled out the preferred snack--a small slice of chocolate cake--and the psychologist plated it up. She told Hallie what was happening: that she was going to sit and take a bite and then get to play with a toy. That if she did not take a bite herself, that V. would help her. And then she'd get to play. And that if she didn't take a bite at all, she would not get to play." Hallie, who is in a hungry phase right now (she seems to compensate for illness-related weight loss by experiencing a burst of hunger that helps her make up those calories she's lost), grabbed the fork and fed herself a bite of cake. Then she played for 30 seconds. And then repeated this process, quite happily and without a shred of protest, another nine times. That was it. The process was over in about fifteen minutes and then the psychologist and I went over the "rules" and how the goals of the process was a. to reinforce that we are in charge; b. get her comfortable with the ritual and craving it (or at least the playing between bites even if not the cake itself); and c. to ultimately generalize from this to bigger things, like getting Hallie to eat non-preferred foods, or more foods, or meals, or whatever we decide we want to do.

One critical feature is that, during this process, whoever is feeding Hallie needs to be able to devote complete attention to her and to the process so that it is basically the same all the time. This is awfully hard to do when one parent is watching both kids, but the reality is that Sharon gets home a bit too late for the snack to be successful once there are two parents in the room. Sharon and I talked over this whole issue on the phone this afternoon and we decided that, around 6:30, immediately upon Sharon's arrival home and after Hallie had already eaten something for dinner, we'd do the cake snack ritual thing.

Well, apparently, Hallie wasn't going to let us take complete charge of the situation. Around 6 o'clock or so, she went up to her high chair at the table and said to me, "Chocolate cake please mama!" Fortunately, Lea was in her swing (during an abortive attempt at a nap) and I was able to drop what I was doing and slice off a piece of cake for Hallie. I recited the rules to Hallie, who was eyeing the cake the entire time and who gobbled up that first piece very fast. Then she played for 30 seconds, handed the toy back to me, ate the next bite of cake, and repeated the process for seven bites. It took a bit -- but just a bit -- of prodding to get her to eat bites eight and nine, but she returned to her eager eater self for bite number ten when I told her that she was "taking the last bite." And that was it. Ten minutes or less from start to finish.

I have no idea how it will go tomorrow or the next day or whenever Hallie returns to her non-eating self.

But what was clear to us is how much she understood of the process and what the expectations we had for her were. It's also clear to us that we need to give her more credit (and be careful what we say around her) because she really does take everything in. And it was also clear to us that, even though this is supposed to be our ritual, our super smart three year old is really the one who is in charge. This doesn't surprise me in the least. And Hallie being in charge is part of the solution, yet also part of the problem.

For those still counting, we are up to 253 vomit free days and hope to make it to the 270s this year. Thanksgiving complicated matters: Hallie went to bed with the beginnings of laryngitis on Thanksgiving eve and woke up with a fever on the big day itself. She was very sick all day, which led to two bouts of vomiting and lots of lying on the couch lethargically all day on Thursday and Friday. By Saturday afternoon she was on the mend and, other than a residual cough, she's fine now. I had the same thing, without the vomiting, earlier in the week so I felt a particular sense of empathy for Hallie. This was a short lived but miserable little cold and I know that I wanted to consume nothing but tea and soup all week. Given all of this, we stayed home on Thanksgiving (we are thankful for Whole Foods which was open until 1pm and provided Sharon and me with turkey and all the trimmings at the last minute). Sadly, we missed out on fun times with cousins, but it's better to have spared them this malady and clearly Hallie wasn't really up to playing anyway. Ultimately, we are thankful that Hallie weathers these little colds so well. It will never cease to surprise us, or her doctors, that Hallie's lungs are as strong as they are.

OK--off to bed. Gotta get up early so that we can go find some shoes for the girls (Lea needs to graduate from Robeez to something that doesn't leave indentations in her little fat feet) in preparation for the holiday card pictures we plan on taking tomorrow.


Jo said...

Sorry to hear that Hallie did catch your cold, Abby...

Great to hear about the eating. Even if it wasn't at the appointed time, at least she was asking for food. That's a plus, right?

A question: if she wants to take two or three bites at once and then play, do you let her do that, or is it always, bite, play, bite, play?

Unknown said...

Good job Hallie!
Thats to bad she caught your cold but at least she was able to fight it, she's a strong little cookie!
Do you guys get paranoid when you get a cold and scared you'll pass it on to Lea? I know my Leah is only a month old so a big differance than your Lea but I am so paranoid to even let my family see her because she might catch a cold.
Thanks for the advice on how to get Jonathan to interact with Leah. I now put Leah next to him for a little bit and he smiles and "talks" to her he has spastic quad cp so he is not very moblie but that doesn't stop him from wanting to be moblie. Again thanks for the advice it helped!