Feeding Maddy has been a struggle for us almost since we first introduced solids. Remember this face? For the longest time we just thought Maddy was stubborn. Perhaps the most stubborn baby we’d ever met (or at least running in the same league as her cousin, Logan). But, you can probably guess where I’m headed. She’s not as stubborn as we thought (though, she might still have some of that Baynton in her, it’s not nearly to the extent as we thought). Thank goodness for that!
Maddy was skeptical from the first moment when we introduced solids:
Initially, we didn’t think too much of it. I mean, after only having nursed for six months, suddenly new tastes and textures would naturally take some time to get used to. We thought over time she would get used to them and things would improve.
Boy were we wrong.
Not only did they not get better, they actually got worse. The more foods we introduced, the more she refused all foods. At 8 months, we were lucky if we could get avocado into her (avocado having been the only thing she would eat for most of her solid food life). It seemed the only thing she would happily accept were Nutrios, Mum-mums, and random baked goods I would make hiding squash, banana, apple etc. inside. As you can imagine, she couldn’t eat enough of those things to keep her full or happy.
If we tried to feed her she would cry, scream, and meltdown. Feeding had become one of my least favourite things to do during the day (along with bum changes, which were increasingly difficult as well). Unfortunately, both of those things happen more than once a day. I eventually stopped even attempting to feed Maddy dinner and waited for Eric to come home so he could take a turn with the feeding frustration (and by 8 months he was also doing the breakfast routine). My patience was so low I didn’t even try feeding her anymore (except at lunch when I was forced to because Eric was at work).
What was going on? Our OTs helped us to make sense of her bizarre and sometimes contradictory feeding behaviour. A number of things were at play here:
- With low registration of proprioception, Maddy had no idea how close the spoon was to her (as you can’t see your own mouth). Suddenly having food in her mouth was shocking and upsetting to her.
- With low registration to her vestibular sense, being up high is a vulnerable place, and thus, scary. This means she hated her high chair. She would fight with everything she had to not be put in it. Once in it, often she would cry non-stop and refuse to eat until we took her out.
- She is over sensitive to textures. This means she has an extremely sensitive gag reflex. We have tons of videos of her gagging over all kinds of foods. Gagging was almost always followed by a meltdown.
- She seems to be under sensitive to taste (she loves flavour – garlic, tabasco sauce, lemon juice).
The first thing our OTs helped us to understand was that Madeleine needed time away from her high chair. We would need to make her high chair a safe space for her before we attempted to feed her in it again. This began the first round of feeding intervention. We fed her while we held her in our arms, while she crawled on the floor with her toys, sitting out in the sunroom where she could watch the cars, in Walmart while I pushed her around in a cart, in a laundry basket, out at the park, and sometimes, in her baby carrier.
This allowed feeding time to not be meltdown time. Maddy wouldn’t cry when we fed her. And, she started eating avocado again! We also stopped feeding her with her spoon during this time. Instead, we fed her by hand… dipping her Nutrios and Mum-mums into avocado.
During this first stage of intervention, her high chair became a fun place. We would use some of the techniques our OTs taught us to help let Maddy feel her body and calm her, and then we would put her into her high chair to play. I would put toys on her tray, blare music, and sing and dance like a wild woman. For the most part this has worked. Sometimes Maddy is fine in her high chair (and initially, we only put her in her high chair to eat if she had just had a bath as the proprioceptive stimulation would put her in a good place). It’s variable though, and we just follow her lead. If we see she’s having a hard time in it, she’s taken out immediately. No more crying in the high chair allowed.
The next thing our OTs helped us to understand was that Maddy had to be in control of her feeding. If she was the one bringing the food to her mouth, she would have a better sense of when it was coming in. Remember how I said she got worse with the more food we introduced? This was because the more food options we had to give her, the less likely she was able to predict (and prepare herself for) the incoming food. A surprise taste or texture was not a pleasant experience for her (or us!). Allowing her to have control over her food would assist with this problem as well. I mean, it was messy, but it worked.
As you can see, we would also dip her toys into different foods so that as she mouthed them, she would be exposed to different foods. Her puréed foods were mixed with Nutrios to give her something to grab onto.
During this time we also had Maddy explore spoons, allowing her to control when and how they entered her mouth.
We used this intervention for several weeks. It helped to broaden Maddy’s food repertoire. She now will eat: avocado, chickpeas (and hummus), bananas, pears, and peaches pretty regularly. Depending on the day, she has also explored with applesauce, pasta, sweet potato, turkey, carrots, red lentils, goat yogurt, and goat cheese. There are still many things she flat-out refuses, but we keep trying to introduce new things. We still have days where all she eats is avocado, but we are definitely seeing improvement.
We had to move on from her exploration stage of eating, because she quickly learned that if she threw her food on the floor, our dog, Loki, would stay near her (he pretty much runs from her now because she loves pulling on his ears, pulling on his tail, sticking her fist in his mouth… and she loves when he nips at her, giggling non-stop).
Now we’re back to feeding her in her high chair if she’ll tolerate it, otherwise we use the techniques from the first stage of interventions (crawling, playing, holding, etc.). Sometimes we feed her by hand, sometimes with a spoon, and sometimes she feeds herself.
What are we working on now?
- We continue to provide fun play time in her high chair with no expectation of eating so she can continue to develop a positive association with her chair.
- We use distraction techniques while she eats (basically I blare music and sing and dance like a fool for her).
- I use oral desensitization techniques at least once a day (a body massage to calm her followed by a facial massage with a warm wash cloth with repetitions, next I apply firm pressure to her lips, gums, and teeth).
- We allow play time with spoons, and give her a spoon to hold while we spoon feed her.
- When spoon-feeding her we make sure to make eye contact and verbalize food is coming, “Want more?” “Here comes avocado” “More!”
- We still dip her toys in food allowing her to have control over new tastes and textures.
- We offer a variety of textures (purées, chunks, smooth, gritty), tastes, and temperature (warm, cold) of foods at each meal time.
Our goal for the next little while is to reduce her oral sensitivity (ultimately reducing her gag reflex and allowing her to tolerate a spoon and different textured foods in her mouth), and to increase the number of foods she will eat. Long term, we’d like her to be able to eat with us at the table (the same foods we are eating), in a more socially appropriate manner.
We understand that this is a long process and that ultimately it will take her longer to be able to eat in a socially appropriate way than typically developing kids. For now we’ll take what we can get – a baby who no longer screams and cries during feeding time.