This is the third installment in a multi-part story. Catch up on my first “my kid is too picky” entry here, from way back in 2013, and read Part Two, written just yesterday, here.
Meeting the Feeding Specialist: Dr. C.
We had an appointment in the books with Dr. C, and I was so excited. I don’t know what I expected from the visit. Maybe we’d enter the clinic by walking through a magical portal and Peanut would eat everything put in front of her. Then we could strap the portal to the top of our car with bungee cords and take it home with us.
We were scheduled for a three-hour appointment starting at noon. Dr. C asked me to bring four foods with me to the appointment: two she would readily eat, and two she wouldn’t eat (or had eaten it at one point and stopped). I had brought along a blueberry muffin, strawberry applesauce (both ‘yes’ foods), cottage cheese, and a banana (both ‘hell no’ foods—especially the banana).
We got to the clinic and met the super-nice Dr. C, who let us into her suite. We first picked out some toys for Peanut to play with while the doctor and I consulted, and took everything into a small corner room with a round table and four chairs, one with a booster seat. Peanut played on a mat with her dolls and cars while I answered the doc’s questions about her eating habits, what and when she normally eats, and how her eating habits had changed over time.
Then Peanut stood up and announced that she was hungry. We got her settled into her booster while Dr. C explained that I should portion out a bite or two of each food I had brought onto a partitioned plate. We got Peanut comfortable at the table and I told her she could go ahead and start eating.
“What would you like first?” I asked her.
“Boo-buddy muffin,” she said nervously.
I nodded. “Go ahead, sweetheart.”
She nervously picked up the piece of muffin, broke it in two, and put it in her mouth. She ate the second bite a moment later.
“What would you like next?” I asked. The applesauce, banana, and cottage cheese remained.
“Applesauce,” she said, and picked up her spoon and started in. When she was done, I asked her what she wanted next.
She lowered her eyes and looked at me through furrowed brows. She gave a little shake of her head. “I no want that, Mommy.”
Dr. C, seated on the other side of Peanut, leaned forward. “Here, just try a little bit of this.” She picked up the spoon, scooped a bit of cottage cheese onto it, and moved it toward Peanut’s mouth.
Oh, shit, I thought. This is not going to go well.
As I expected, Peanut panicked. She launched herself out of the booster and slid onto the floor, scrambling across the floor into the corner, burying her face against the wall, sobs hiccupping loudly from her little body.
“Come on, it’s just a little bite,” Dr. C said, advancing toward Peanut with the offending cottage cheese.
She dashed from the corner to hide behind me, burying her face in my back. Dr. C sat down in her chair as Peanut climbed onto my lap, still sobbing, snot streaming from her nose. Peanut laid her head on my shoulder, wiping a significant trail of snot across my collarbone.
Dr. C lays out the master plan.
I had known it was going to come to this as soon as she lifted that spoon toward Peanut’s mouth. So what now?
Dr. C took a deep breath. “This is how every single one of my kids starts,” she said. “Every single one.”
Over the next half-hour, Dr. C explained how she treated kids like Peanut. It’s basically exposure therapy. Just as you’d do with someone who was afraid of elevators: first you’d stand outside the elevator, then you’d put one foot inside, then two, then you’d stand inside a while, and finally, after a lot of work, you’d actually have them stand inside a moving elevator. Dr. C’s method was similar.
The first step was getting them to see that these foods weren’t scary or deadly by touching them to their lips. She explained that Peanut would have to touch each food to her lips three times.
If it wasn’t so rude, I would’ve scoffed. You’ve got to be kidding. She would never, ever dream of voluntarily touching any of her feared foods to her lips.
“Well she obviously isn’t going to go along with that. So how do we get her to do it?” I asked.
Dr. C looked at me, knowing I wouldn’t like her answer. “We do it for her. We follow her around with that spoon until we can touch it to her lips. It’s not pretty. But it works.”
I am the worst parent in the universe.
My head was spinning. This just felt so… wrong. I couldn’t imagine how forcing food onto my child’s face could ever feel right. I sat there, Peanut on my lap, arms tightly around my neck, feeling like the worst parent in the world.
“What does this look like on the other end?” I asked Dr. C. “The kids you see… what does it look like at the end of treatment?”
Dr. C shifted in her chair, leaned forward. “They’re kids who will try a bite of everything served to them. They may not like it, and they may not take a second bite, but they will try it,” she said.
I tried to picture that reality in my head. It was so far from where we sat today. It sounded glorious.
Dr. C spoke again. “I’ve never had a patient not make progress,” she reassured me. “Not one. Every single kid I’ve seen has gotten better.”
I was sold. “What happens next?” I asked.
She explained that I had a choice. We could leave now without going any further. We could go home with a set of instructions she’d type up for us, and attempt to convince Peanut to touch her challenge foods to her lips on our own.
“What’s the other option?” I asked.
She looked at me, perhaps trying to predict how I’d respond. “We can move forward now with the first challenge. We’ll ask her to touch the foods to her lips in exchange for more muffin, or more applesauce. And if she won’t, we’ll do it for her.”
I sighed. “I’m going to hate myself for saying this, but let’s do it now.”
And then we made her do it, and it was just as bad as you’d expect.
Dr. C nodded and stood. “She can stay on your lap. Turn her around though.”
“What should I do?” I asked.
“You’re going to block her,” Dr. C explained. “But don’t hold her head or her arms; just block her from hitting the food away. She has to be able to move her head. She’s going to feel very out of control and that’s the only way she can really show us if she’s participating… or not participating.”
We explained to Peanut that she could have more muffin, but first she needed to touch the cottage cheese to her mouth three times. A pad of paper was sitting on the table in front of me, with three large boxes drawn on it. We told Peanut that each time she touched the cottage cheese, we’d mark off a box, and after they were all marked off, she could have the muffin.
The moment she registered what was about to happen, she began to kick and flail, fighting me with all the power her little 3-and-a-half-year-old body could muster. She spat and screamed, while I struggled to keep my composure.
A minute later, my lap was spotted with cottage cheese. I had food in my hair, as did Peanut. She fought us at every touch, wiping the cottage cheese ‘juice’ from her mouth with her sleeve. When the third box was checked, we clapped and cheered for her. I grabbed the muffin from the lunchbox and placed it triumphantly in front of her.
Suddenly, Toddler Satan left the room.
It was as if a switch had flipped. The tears and snot ended instantly. She picked up the muffin and nibbled it, turning toward me. “Mommy, I like muffins!” she said, sniffling back her already-drying tears.
I was dumbfounded.
Dr. C smiled. “This,” she said, motioning toward the happily eating Peanut, “is how you know that she’s not upset about the food. She was saying no, and we weren’t listening to her, so she’s going to tell us exactly how upset she is with her entire body. But now that it’s over, she’s fine. She’s fine.”
I remembered that Dr. C wasn’t a dietitian, or a doctor specializing in the digestive system. She was a pediatric psychologist. Kid behavior was her specialty.
A few minutes later, the muffin just crumbs, it was time for challenge #2: THE BANANA.
We repeated the same routine. It was just as ugly. But something odd happened when it was time for the second touch. Peanut paused for a split second, almost as if she was holding still to let Dr. C smear banana on her lips. (How the food is touched to the lips depends on the food. If it has a sauce or residue, a simple touch with a sauce/residue covered spoon works. With banana, a touch wouldn’t leave anything behind, so it’s more of a smear or wipe in that case.)
On the third try, she without a doubt paused for the banana touch—but only for a second. We cheered and clapped again, and declared her done with food touches for the day. Just as before, she was right as rain in a moment, cheerily scooping applesauce into her mouth like nothing had happened.
All that remained to give away the afternoon’s carnage was my food-spattered clothes and bits of banana and cottage cheese in Peanut’s hair.
Our plan moving forward.
Dr. C went to her office to type up our instructions.
- Institute a meal timer. Set it for 15-20 minutes at the beginning of the meal, and nobody leaves the table until the timer goes off. Not even Mom, Dad, or Squeak.
- Determine a “challenge food” at each meal, and provide Peanut an incentive to touch it to her lips three times. The incentive could be another food, a special toy, screen time, or an activity, like an art project. The reward has to be immediate after the touches; it cannot be “we’ll go for ice cream after nap” or “we’ll watch Wall-E tomorrow after school.” Immediate gratification. If the reward is a toy or activity, have it nearby so she can see it.
- Tell her at the beginning of the meal about the challenge and her reward if she does it. Remind her every 4-5 minutes, but no more. Don’t nag her.
- At least one bite of the challenge food must be on every one’s plate. That means Mom, Squeak, and Dad will all have it, and best-case scenario, Mom and Dad will have a lot of it. (Dr. C recommended using the small Take ‘n Toss spoons for each “bite”.)
All of this is optional — she has the choice to say no to her challenge food. But she’s got a lot more incentive to say yes. If she declines to try her challenge food, the reward is moved away and out of reach, or if it’s something like screen time, she just doesn’t get any that day. The next meal, she can try again.
Dr. C said we could call her to schedule Peanut’s next appointment after we see how things are going with the food challenges. We also scheduled a time for Squeak to come in, about 4 weeks away.
As we left that day, I thought about my husband’s involvement in all of this. I had wanted him to come with me, but he was traveling for work. Thank heavens for that; if he’d been with me, he’d have scooped up Peanut and walked out the door the minute Dr. C suggested we force her to do anything.
On the menu: extra love from Mommy.
I took Peanut home and put her down for a nap, with lots of extra snuggles and kisses. I told her how proud I was of her for doing a good job at the ‘Doctor Restaurant.’
She talked about it all afternoon: “Mommy, I was sad at the Doctor Restaurant, because I no wanna eat my banana.” Each mention of it brought a new pang of Mom Guilt, but I tried to remember this: We are teaching her a skill that will bring her a better quality of life. A healthy relationship with food is a fundamental part of living. And I can’t do this three-separate-menus crap for the next 17 to 30 years.
At home, I posted the page of instructions on the kitchen wall and made sure my husband read it. We started challenge foods the very next day.
Two weeks in… a progress report.
It’s been about two weeks, and Peanut has successfully tackled seven food challenges. We aren’t forcing her; she gets to choose whether or not to take the challenge. She’s successfully touched mashed potatoes (twice), cottage cheese (twice), ham and bean soup, banana, and pears to her lips. After her pear touches, she remembered that she likes pears, and ate a handful that day. Score!
Amusingly, she’s started asking for cottage cheese as her challenge food. Which is a good sign—she’s realized cottage cheese isn’t the antichrist. But also a bad sign. If it’s not challenging, it can’t be a challenge food.
We don’t have a challenge food at every meal. Sometimes there isn’t anything on the menu that makes sense (i.e., nothing with a sauce or residue). We’ve learned that Peanut prefers to do the touching herself, but these past two days, she asked me to do it for her. That worked well when we did banana yesterday, since it required more than a simple touch. She also needs some time to psych herself up for these touches. She rarely does the touches at the table during mealtime. Usually we have to leave the challenge food out after dinner is over, and she eventually makes her way back to the table, announcing, “Okay Mommy I’m ready for my touches! I want ice cream!”
We’ve rewarded her with her favorite Pixar movies, and a couple of art projects, but typically it’s other foods, like a cookie, or a scoop of chocolate ice cream. She’s highly motivated by sweets. Dr. C says that’s okay. We’re on a mission. A little sugar never hurt anyone. Everything in moderation.
The meal timer is working well. I use the microwave timer, which is loud and easy to see from every spot at the table. Squeak isn’t very happy about the timer though. We’d trained him to sign “ALL DONE” when he was finished eating, and now we ignore his signs until the timer goes off. He gets frustrated, but we try to distract him with silly faces until time’s up. He’s getting better every day.
The next steps we’ll take.
The next step in the process—which is still a long ways off—is for Peanut to put a challenge food on her tongue and hold it there, without swallowing. The final step is to chew and swallow it.
We’re a long ways from there. I can’t see that version of reality, even when I squint. I’ve asked Peanut if she’d like to actually try cottage cheese, since she seems no longer afraid of it, but she emphatically declines the offer. “I no like codge cheese!” she insists.
Oh well. Baby steps.
Squeak’s first appointment with Dr. C is next Tuesday. For his appointment, a speech/language pathologist will join to evaluate his chewing and swallowing. I am curious how she’ll recommend we tackle his challenges, given that his issues are complicated by throwing food and his almost complete refusal to be spoon-fed.
Just as with Peanut, there’s a long way to go . We shall see what happens.
Image courtesy of Flickr user ClayBitner.