An Unexpected Call

The phone rang today and caller I.D. said "Kaleida Health." Since we don't have any scheduled procedures at Buffalo Children's, I figured there must be a billing problem or something of that nature. I picked up the phone, and it was the speech language pathologist from the feeding clinic.

I had left her a message a couple of weeks ago stating the scintiscan was negative for reflux (per her request) and didn't really expect a call back.

"Well, have they done an upper GI? Did they start him on a trial of reflux meds anyway?"

Ummm... no! The ENT and pediatrician didn't really seem to want a follow up. The feeding clinic SLP told me that I needed to call the ENT now, because dysphagia in a 2 year old is not "normal." She is also calling our pediatrician with an urgent message that Nolan needs to have the cause of his swallowing issues figured out.

All righty then.

I figured it was just behavioral if the scintiscan was negative, but the SLP said that routinely refusing solids and spitting food out of the mouth is usually indicative of a medical issue. His diet is almost exclusively liquid now- he did have some oatmeal for breakfast (about 1/8 cup) and ate some yogurt for lunch (about 1/4 container). Other than that, it's just milk. If anything, his issue with solid food is getting worse, not better.

I called the ENT's office and made an appointment for July 1. If we can't find a medical cause for the refusal to eat solid foods, then we'll start attending the feeding clinic. Either way, we've got to get this kid eating. I might be able to fatten him up on Pediasure, but he will eventually need to eat regular food.

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).