Wednesday, April 07, 2010

Operation Feed Yourself

That's it. I have had enough. I am at the end of my rope with the endless vortex of time spent feeding these kids. Something has to change...starting today.

I won't go into the history of our feeding woes, because it has been pretty well documented here. What I can say, with a trace of pride actually, is that we have made a TON of progress. Holland and Eden really enjoy food, and they are not picky eaters at all. They each have their preferences and eat their favorite foods with gusto. They have slowly but surely gained weight, and while both are still classified as "underweight" based on their BMIs, they are the closest to "normal weight" as they have ever been (and maybe ever will be).

That's where the pride ends and the guilt kicks in. We have clearly stalled in our operations. Yes, they eat, and yes, they enjoy eating. The problem is that we still have to feed them the vast majority of their meals bite-by-painful-bite.

This was acceptable to me for a long time. It was much more enjoyable than the active resistance to eating that we endured in the past. But I gotta admit that it is getting really old. Meals take forever. They are SO passive about eating that it is annoying. They do whatever they can to distract us, talking, playing, singing when they are supposed to be eating. There are many meals where they won't even pick up their fork and/or put One. Single. Bite. of food in their own mouths.

We are finally at a place where I feel like they WILL EAT if they are HUNGRY. This was not always true, and we resorted to feeding them in a (now deemed successful) attempt to avoid feeding tubes. But now, finally, I do trust that they will not starve themselves.

Soooo. Where do we go from here?

I read a book "How to get your Kid to Eat, but Not Too Much" by Ellyn Satter eons ago (before we were anywhere near ready to go there). It's a good book, with a lot of tips that make good sense to me. Her main philosophy is that it is our job as parents to decide what foods we will provide for our child, and our child's job to decide what and how much they will eat. Outside of our job of providing good, healthy, well-balanced meals, we should be entirely hands off about eating. This is pretty much the opposite of what we have going on right now and at this point our methods are not helping...and are maybe even harming Holland and Eden's relationship with food and with their bodies.

To put our new plan into place I (we) will have to do a lot of deep breathing and relaxation training. We are going to have to change A LOT about the approach we have been using up until now. It means more than just no more actually putting the bites in their mouths. It means no more verbal coaching, "take a bite, take a bite, take a bite." It means no more "5 more bites and you can go play." It means no more "if you finish your whole plate of food you can earn a surprise from the prize box!"

It means that we are going to really have to "keep our nerve" and let them do their jobs of deciding what and how much food they need to grow the way they are supposed to grow.

I started working on it at lunch today. I had a talk with them and told them that Mommy and Daddy and Nana and Papa aren't going to feed them their food any more. I told them that they are old enough now that they are ready to feed themselves. I made them a plate of food that I know they like...macaroni and cheese, sliced cucumbers, and pear cups. I sat with them and ate my lunch. I was finished with my meal before they took a single bite. Eventually they ate a couple of bites each, then they started with the games and I could feel my stress level rising. It was very difficult for me not to pick up their forks and start feeding them. I KNOW they would have finished most, if not all, of what I made for them if I fed it to them. Normally I would sit with them until they were done, but instead I HAD to walk away. I told them I had some work to do, and I set the timer for 20 minutes. I told them this was all the food they would have until later, so they should eat as much as they needed so they would not get hungry. And I left them to it. For the first 5 minutes they were quiet and eating. Then they just kinda sat there and goofed off until the timer rang. Each ate about 1/4 of a cup of pears, 4 slices of cucumber, and five good sized bites of mac and cheese. Maybe 100 calories worth of food...maybe.

About 2 hours later they started asking for snacks, and I set them up again with the rest of their mac and cheese. They each ate maybe another 2-3 bites and I ended up tossing the rest of it.

Dinner was pretty much a repeat of the same thing. We had chicken, rice, and green beans. They each ate most of their rice, and a couple bites of green beans and chicken. Again, maybe 100 calories.

If I can stay strong, I know hunger will kick in eventually. It's going to be tough to make it through the week though.

I feel like I need a coach, someone I can call when I am locked in the bathroom during meals to help me keep my nerve up and stay strong. I need someone to tell me...

They will eat when they are hungry.
They will not starve themselves.
They will eat what they need to grow.
They will grow at their own pace.
You are doing the right thing.

They will not die.


Anonymous said...

Even my twins with normal eating habits make my blood pressure rise with their dinner time giggly conversations (with each other, as they often ignore their parents). It rarely is a fun time for me. Just wondering, have you ever considered appetite enhancing medication (if it exists)? Good luck with this new eating plan!

Unknown said...

My daughter has no handicaps other that she is the baby of 5 kids, she enjoys being the baby, and I guess I did too until I realized she was 4 and I was still spoon feeding her. its tough but I did exactly what you are doing - put it in front of her saying she was responsible for her own food. Now at 8 she is still very thin, around the 5% for weight, but this year in particular, she is really doing great - Chocolate milk is a big incentive here. good luck - you've worked through harder issues with these girls, I am sure this will go well too.

Kim said...

I think this is an amazing post! And I think it's rig and very brave of you to step back when so many other parents don't. I am so sharing this with my friends! Good luck - you can totally do this! Please keep us posted!

LoneWolfArcher said...

You are doing two things that worked well with our daughter:

1) Time limit
2) No snacking unless you eat

We put a proper amount of food in her plate, tell her that when the big hand is on the (blank) (usually 20-25 minutes) she has to eat that. No treats later unless she eats all of her food.

Early on she tested us. When she realized that we were serious about no snacks she got serious about finishing her food in the allotted time.

The only problem we had after that was the sense of entitlement: "I ate all my food you have to give me candy!!" We had to teach her that eating didn't guarantee a snack, but not eating did guarantee no snack.

It does work. Stick to it. Our daughter even will now ask for seconds! (She gets them too because she is also underweight).

Keep up the good work!

Sarah said...

you. can. do. this.

they will be fine. you will be fine, you just might tear your hair out in the meantime. ;^)

Kristine said...

You're braver than I! :) I'm exactly where you were when your girls were 2. I spend HOURS everyday feeding Katie, coaxing her to eat, giving her incentives (read: bribes) and providing distractions. I HATE it! She's gone from way off the charts at 1 year to almost the 3rd percentile at 2yrs 3mths. It is so stressful, but the alternative is a g-tube or increased developmental issues from malnutrition. UGH!

PLEASE keep us posted and let us know what does/doesn't work for your girlies. I'm looking to can DO IT. :)

Anonymous said...

I love this post! I'm a lurker here, but I have a preemie boy who's just about to turn four. We have the same food issues and the same feeding issues! I've also started to leave the table and lock myself in the bathroom!!! I HATE it, but I can't feed him forever.

You can call me when you're locked in the bathroom. I'll tell you all of that. I understand...I'm locked in my bathroom telling myself the same thing.

anon said...

We had the struggle with our daughter. It took a long time for her to get to the point that she would eat rather than just go hungry.

I commend you on your efforts. I know it's hard.

We had to stop supplementing our daughter with pediasure. Many times we tried and she just lost weight. And last year when our doctor said to try again it was hard and she lost weight. But after a couple months the hunger kicked in and she did start eating more and feeding herself too.

Good luck!

daniel kuntschik said...

Another lurker here. My youngest daughter is full term but has always been way too skinny and small for her age. So I spent the first four years of her life spoon feeding her. And finally I decided that she had to eal alone. So she does. A lot of the time she ends up sitting at the table alone finishing her meal. If she doesn't do so in the alotted time it will show up at the next meal, and there are no snacks in between. Last november, at her 7 year check up she finally made it onto the charts for weight. So all the heartache and worry and gnashing of teeth on my part was actually worth it. Keep up the good work. You'll get there!

alice said...

You're doing the right thing! You're giving them the opportunity to learn how to care for themselves - this is one of the hardest but best things that you'll be able to do for them, and good on you for sticking to your guns! Satter is a great guide on things like this, and I really agree with a number of her points about how important it is developmentally to have autonomy over whether and how much they eat.

Here's hoping that you've got some good bathroom reading to distract you during those interminable 20-minute stretches!

Anonymous said...

"They will eat when they are hungry.
They will not starve themselves.
They will eat what they need to grow.
They will grow at their own pace.
You are doing the right thing.

They will not die."

Allowing this to happen will be the difficult part for you. Just remember the decisions you've made in the past have been successful. This will be, too. You're in my prayers. Connie W.

Diane said...

I cannot imagine the stress and worry that would linger after experiencing the very real fear of your children not consuming enough nutrition to survive and thrive. My twins sometimes eat only a couple of bites of cheese and a raisin at a meal and I get nervous, and they're average weight and we haven't been through anything close to what you guys have.

You've done an amazing job listening to your inner mommy-voice so far and I'm sure that voice isn't going to fail you now, just make sure it stays louder than the voices of doubt and fear. I've followed you since I went into pre-term labor over 2 years ago and am cheering you on big time. Please keep us posted!

Katy said...

You should totally get on Twitter and then you can tweet whenever you need a pick me up!

You are doing the right thing and I completely trust mommy's instinct. Charlie is only two, but he' a good size and he eats a lot of small meals throughout the day. I don't know how you feel about this, but maybe a snack tray that's out that they can pick off of when they're hungry?

KimN said...

First time commentor here and I have to say I love your blog. Reading this post gives me hives. I have a 9 month old baby girl (born with hydrocephalus) that has hated drinking and eating since the day she was born. She is not even on the charts for anything. I get so stressed out over what she eats and when. I track every calorie she consumes. I swear, I probably spend about 75% of my day thinking about feeding her, pumping, or attempting to feed her. I can definitely relate to your early posts on this topic. I thought things were going to turn around when solid foods started since she seemed to like them better than the breast milk I so painstakingly pump for her. However, this week she has decided to go on a hunger strike. Sigh. I hope the girls start to eat their meals and you are quickly posting your success. Maybe it will give me hope that things will turn around here as well.

Kendra Lynn said...

Believe it or not, my girls do the same thing, and they aren't preemies. Its absolutely torture to get them to eat by themselves...but it is true that they will not starve themselves. I used to agonize over it until I finally realized that they WILL eat and they will eat on their own terms. We use the timer for Kelsey...if she won't eat what I made...we set the timer for five minutes (or two minutes, depending on the amount of food). If she doesn't eat by the time the timer goes off, she gets no snacks, and will have to finish her dinner when she asks for a snack. We also, occasionally take away a toy or movie if she won't cooperate.
You will get into a system that works...praying it happens quickly for you.
Love ya.

Anonymous said...

If it helps at all...I was born with a growth disorder called Russell Silver Syndrome. The main symptom I have now is that, as a woman in her mid-40's, I am just shy 4'7". However another symptom that I had until just around the time of puberty, was lack of appetite. I was just never hungry, was very picky with what I was willing to eat and even then, I ate very little of it. My mother worried VERY much about my lack of eating and described my appearance as a Holocaust survivor (although, in looking at pictures of me when I was a kid, she seemed to have been exaggerating). And yet, as little and slowly as I ate, I lived and flourished and grew up without a problem.

You can do it and they'll be fine.

Catherine said...

MOST kids fall into your assumptions, but not all. We don't know where Holland and Eden lie in the spectrum of eating disorders. I can tell you that I have friends with adult children who have to force themselves to eat, and really have someone making sure they are making that effort because they do not get hungry, and eating is not enjoyable to them.

Are there any specialist in eating disorders that can work with you? Once you know where the girls fall on this spectrum (if they are there at all), you can put a strategy forth. Right now, you don't know where they are in terms of eating. Do they get hungry? How hungry? There are those who don't get very hungry and can drop to the not eating status with very little effort.

Anonymous said...

You are strong, tough, and one of the most loving and devoted moms I have ever seen. Don't ever doubt your decisions to better your girl's lives. I truly believe you are doing the right thing and you are using good techniques. I used these same things with my kiddo when he was younger. The timer, no snacks, etc. It does work, even though it can be frustrating at first. And if, over time, they don't seem to adjust, then you know you tried and can talk to the doctor about therapies. I do believe that this will work. Keep your chin up! You are strong and you are loved!

Kellie said...

Sending prayers for strength for you to get through this tough week Billie. Why,oh why does eating have to be such a frustrating outcome from extreme prematurity. I know that we have it easier than you with Eli and Carson but C still gags/throws up at least once a day on his food (usually at dinner time) and Elias could care less about eating unless it's fresh fruit and veggies. We're still on the pump with no end in sight and just accepting that E may have his tube for a LONG time.

The girls are head strong which is a good thing and has gotten them so far in life already. Unfortunatly in terms of feeding success, it is a drawback. They will get there and your plan sounds promising. ((((HUGS))) You are an amazing mom and H and E can do it!

Catharina said...

I just recently spent three months working with Dr. Irene Chatoor, a specialist for feeding disorders, and saw firsthand how incredibly hard (which is an understatement) it is on parents when their children don't eat. The behaviors you are describing make me think of what Dr. Chatoor calls Infantile Anorexia, which is basically a lack of appetite. In her words: "These kids have an appetite for everything in the world, except for food." What you are doing is right on track with what she would recommend: Eat meals WITH your kids, but don't feed them and don't comment on their eating (you CAN praise eating skills "Great job using your fork!"). No distractions. Don't give too much food at once (it can be overwhelming), but allow them to ask for seconds and thirds. At least 3 hours between meals (she recommends breakfast, lunch, snack, dinner) and only allow water between meals. I know this is SO hard to do when one feels like every calorie counts, but in the long run this is what will help them learn how to recognize hunger and fullness. She has a book available on Amazon and is currently writing one specifically for parents.
I really hope this doesn't come off as assvice, I just really wanted to send some encouragement your way and say you are doing a great job! Your girls are adorable.

liz.mccarthy said...

Billie how funny you shoudl post on this, Ellen's book 100% changed how I fed Kaitlyn too. We did force feed her (which was the only way to get her off the tube and it worked, but after awhile I saw what you saw, that Kaitlyn DID know how to eat when she was hungry, but most of the time she made us feed her, as she knew she had power over us. So a year ago, I stopped. If she was done, i let her be done. It took about a month, but ieventually it worked.

And now, I NO longer go through the pain at eating (you can read my recent blog post), but hang in there, it WILL work, I'm example of it. You know where Katilyn came from, yes, she's small, yes, she could eat more, but you know what I'm so much happier and I wanted to install long term healthy eating habits...

Call me if you want to chat/commiserate or need support! I think you have my number, if not email me!

Zack's Mom said...

If it weren't for Liz McCarthy and your blog, I would have jumped off a cliff long ago. My son and Kaitlyn were VERY much alike...constant vomiting...6-7 times a day. Since he turned 2 the vomiting has almost stopped...i am thankful for that every day..but thanks to fear and no hunger cues, my kid just HATES eating..I have to get him off the bottle (which I hold)'s so passive and he just isn't being helped...I KNOW that, but I'm just a nervous wreck. I know in my head that I have to stop the feedings, but in my head I'm scared to death...keep us posted.

BusyLizzyMom said...

I wish you luck lots of luck. Eating is such a struggle but you are right there is a time when you need to let go and give them the reins. Hopefully it doesn't do you in the process. Check out my last post, I have solved some of our eating problems (I hope).

Bethany said...

I am a former special education teacher and I have worked with many children who had feeding difficulties. As long as the girls are capable of feeling hunger, then you are doing the same type of plan we would have implemented in a school setting. When they are hungry they will eat. They will test you, but they will also eventually figure out you are not giving in and will feed themselves. They will not allow themselves to starve. You are doing this because you want what is best for your girls. They can do this - you can do this!!

Megan said...

You rock. You can do it!

Keri said...

They WILL do it. Have faith and patience, and keep your sense of humor! It will be so worth the hard work that you continue to do with your beautiful girls.
I'm a dietitian and mom of a 2 1/2 year old and a great believer in Ellyn Satter's work.

Anonymous said...

Good Luck. you can call me when you're locked in the bathroom!!!


Anonymous said...

Hi Billie,

I haven't checked anyone's blog in FOREVER so I'm way behind :)
Coming from a mom of a preemie w/eating probs, trust me it will work itself out (I know, easier said then done). After Julia came home from the inpatient feeding program, we had issues. For about two weeks, we practiced what the doctors taught us and finally we said to hell with it. We put a plate in front of Julia and literally ignored her even when she took a bite. It was hard not to say anything to her but after a few days, I realized ignoring her was nice and I no longer dreaded meal time.

In the case with Julia, there were NO bribes that worked (or it was very short lived) so ignoring her at every meal did the trick. Eventually she figured out that we didn't care if she ate or not.

Carrie (Princess Julia's mom)

Ellen Seidman said...

This is so encouraging and eye-opening for me. I am also fed up with feeding Max. The thing is, HE EATS INDEPENDENTLY AT SCHOOL. Then he's all, YOU do it at home. I am going to try the tough love approach. I want to hear how things go with the girls!