Tuesday, May 19, 2009

Feeding Evaluation

I took Nolan up for his feeding evaluation today. I hadn't received any instructions or paperwork on this little event, so I cleverly packed the boys some food - just in case. Turns out that was a good idea, seeing as how the parents are supposed to provide the food for the feeding evaluation.

Basically, both my boys sat at a little plastic picnic table and ate their lunch in a speech therapy room. For a medical appointment, this is about as fun as it gets. Nolan ate his typical lunch, which was 2 strawberries (cut up into pieces). Then he was done. Yup- that's about as much as the boy ever eats!

The speech therapist tried to get him to eat a piece of sandwich, and he pulled it out of his mouth. Typical Nolan behavior, and I'm glad the SLP was able to see him in a typical eating pattern. He did eat a bite or two of applesauce she brought out, and ate part of a graham cracker.

The really good news is that there is no swallowing problem. Everything that he chooses to chew up gets swallowed completely. Unfortunately, something is at play because most 21 month olds eat more than 2 strawberries for lunch. She looked at the "feeding symptoms" and a few other things (he snores at night, occasionally spits up) and said that his symptoms are typical of a kid with gastric reflux.

The texture aversion and "guarding" behaviors (not letting food into his mouth, or being very cautious with food) are common with reflux kids. I asked what we could do to widen his food repertoire, and she will be sending me some ideas with the written report. She cautioned me, however, that nothing would really work if there is untreated reflux at work. So we need to find out what is going on physiologically before we can treat the behavioral side of things.

The scintiscan is on the 29th, so we will be able to confirm/rule out reflux at that point in time. She also wants the ENT to take a closer look in his mouth, because he snores (apparently toddlers should never snore) and because his speech is a little nasal. Because of the hearing loss, we can't tell if his speech is nasal due to hearing levels (we've never gotten an aided audiogram) or because of a structural issue (like enlarged adenoids).


Loudest Mom said...

So interesting! And, smart mom Leah :) I LOVE that picture- too cute!

tammy said...

Wow ... you really have been busy this year. I'm glad to hear he doesn't have any swallowing problems and hopefully they can get the reflux under control (if that's what it is). Poor little guy! When I was prego with Aiden I hated eating because of the horrible reflux I'd get. Can't blame him for not wanting to eat if that's what it is and then not being able to communicate it on top of it. You're another step closer though! You're so on top of it Leah. Way to go!

Ericka said...

What a cute picture :)
I have to disagree about the not typical for toddlers to only eat two strawberries. I am on my third toddler and I can tell you that it is very typical. They are at the age where they are just on the go. What I did when my kids were little is worry less about mealtimes. I had a little tikes picnic table and I put snacks that they enjoy on it all throughout the day. Also, don't let them sense your anxiety about them not eating. They pick up on that really quick. There are very few things toddlers/preschoolers can control. Eating, sleeping, and potty training are the ones they can control. So those things can quickly turn into a power struggle! Miles seems to be hardly eating right now too. And I'm really worried that he will fall off his curve and our Dr. will send us for testing! I hope everything goes well for Nolan! :)

leah said...

I really need to write a post about true feeding problems vs. normal picky eating- it is true that all toddlers will go through phases of low eating. A child who drops from the 60th% to below the 3% (he's even off the specialized endocrinologist's charts) and stays there for almost a year is in a different category. Nolan eats the equivalent of 1/2 banana for breakfast, 2 strawberries for lunch, and no solids for dinner. EVERY single day. For the course of a year. He basically consumes no solids, so he's not in the "normal toddler picky eater" category.

I liken it to when people say, "well, my kid didn't talk until they were three, so don't worry about it." When Matt was 2 1/2 he wasn't talking, but we KNEW there was a problem. Sure, some 2 year olds don't talk and have no problems. My 2 year old, however, would say "fah-vah" when trying to imitate the word "ball."

Likewise, some kids are always in the 3% and it is their normal genetic weight. Kids who fall to the 3% (and have fallen more than 2 percentile categories) and can't get back on their growth chart for an extended time are considered "failure to thrive." Some FTT is inorganic, meaning they have a lack of food available. Some is organic, due to metabolic problems, kidney issues, inability to take in enough food, GERD, etc. They think Nolan's in the organic FTT category, hence the referral for the scintiscan.

Ericka said...

Hey, I just wanted to say that I didn't mean to make it sound as though I was giving advice. Hope I didn't upset you. I know I hate when people tell me "oh my kids say huh all the time" and making it as though my kids hearing loss is in my imagination. Sorry!

leah said...

No worries, Ericka. We're just a little stressed over the whole Nolan-doesn't-eat thing. I really hope it is a simple case of reflux and a little prilosec/zantac will take care of it!

Anonymous said...

I can relate to this anxiety as Ethan has had reflux and been through feeding therapy. He continues to have reflux but ever since going the gluten and casein free route he has not only opened the door to all types of foods and textures, he actually has a healthy appetite. We waited for two years to see this. His reflux was managed by prevacid yet he still didn't want to eat, so changing the diet and putting him on some supplements made a huge difference. Unfortunately though none of this information was available through mainstream means but we did find a great metabolic clinic in our new city that has changed our lives. You're on the right path Leah, as always. If you are interested in a good book there is one I like called Just Take a Bite.

That is the cutest pic ever by the way! Can he be any cuter?!!!