A couple of weeks ago, I read a post written by a fellow adoptive mom about her son's recent choking scare. It got me thinking about something... when you are waiting to adopt, social workers use phrases like "attachment issues" and "institutional behaviors," but you don't often break those phrases down to recognize what specific issues you might face. But they can occur, no matter whether you adopt through the special needs program or - like we did - through the non-special needs program.
Institutional behaviors. They range from self-soothing techniques to institutional autism to the far-less-scary-sounding food issues. You know, "small" things... like choking. And hording. And oral defensiveness. And oral-motor delays.
When we first met the Tongginator a little over five years ago, in Nanchang, she ate like a champ. She opened wide whenever we presented her with steamed tofu, watermelon, stage three baby food and congee. She loved mashed bananas and scrambled eggs. She didn't enjoy her bottle all that much, but we just figured we weren't getting the temperature or thickness right, not to mention the personal nature of bottle feeding during the early stages of bonding and attachment.
Then we arrived home.
Within the first week home, we met with our pediatrician, who happened to be very concerned that our twelve-month-old was less than 14 pounds and severely malnourished, with rickets. Our pediatrician decided that the biggest obstacle we faced were the hundreds, if not thousands, of empty calories in the Tongginator's daily bottles. Although we'd been slowly lessening the amount of rice flakes in each of the Tongginator's bottles, she reacted with stiff resistance to our efforts. Now... I'm one tough cookie when it comes to parenting. I used to be a teacher, often with students who displayed significant behavioral challenges. And *insert sarcastic tone of voice* it might surprise you to learn that I'm strong-willed. (Just a tad, mind you.)
Unfortunately, so - too - is the Tongginator.
After two more weeks of oh-so-gradually reducing the amount of rice flakes in the Tongginator's bottle... and patiently introducing the Tongginator to new foods that WEREN'T the consistency of steamed tofu (did y'all notice that texture trend in her list of accepted foods?)... the husband and I felt ready to cry uncle. The Tongginator expressed her frustration in many strong and various ways, including one 72-hour hunger strike. That's when we all came to realize that the Tongginator didn't simply dislike her new diet, she also didn't know what to do with it once it reached her mouth. She didn't like the new textures, but she also did not know how to chew. Or swallow properly.
She choked on thin liquids especially.
To teach her how to suck, we bought countless bottle nipples, in both China and the United States, making each hole slightly smaller in China, then transitioning to X-shaped slits, then the size four bottle nipples. Our pediatrician and occupational therapist asked us to go one step further, switching to size three bottle nipples, so we did. And the Tongginator gradually learned how to better suck thick liquids.
She still didn't know what to do with thin liquids however.
It took four months of extreme patience; therapy; countless trips to the grocery store to purchase organic juices, regular juices, smoothies, shakes and all manner of other tempting drinks; and a God-inspired idea to try decaf iced tea before the Tongginator successfully drank her first sip of thin liquid. Without spitting it back out. Or choking. During those four months, we also worked on strengthening her oral-motor skills by trying to drink through straws, blowing cotton balls across tables and bubbles into the air, chomping on chewy tubes, waggling our tongues and licking peanut butter off of our lips.
And yes, I did everything she did, including the tongue waggles.
(And yes, I'm sure it was a sight to behold.)
We also worked VERY hard to overcome her extreme oral defensiveness, with the coaching of her OT, by gently inserting different objects into her mouth to help her get used to different textures. She screamed and thrashed during each experience, which occurred at least ten times a day for about a month. I know that seems like cruel and unusual punishment, but our occupational therapist insisted on this. And it's a good thing she did... otherwise how would we have ever gotten the Tongginator to tolerate such strange, yet necessary objects like infant or toddler toothbrushes, infant medicine droppers, infant or toddler eating utensils (including chopsticks), straws and sippy cups, thermometers, and on and on? How about dental tools and musical instruments and all manner of things as she grew older?
Once we overcame the worst of the Tongginator's extreme oral defensiveness and oral-motor delays, we encountered a new challenge. The Tongginator? Was a hoarder. She hoarded food by hiding it around the house and in her mouth. She often displayed what we called her "chipmunk cheeks." And she also didn't know how to recognize when she'd had enough to eat. Twice as a toddler she over-ate to the point of spitting up.
All of this put her at high risk for choking, especially since she continued to struggle with some oral-motor delays.
The Tongginator's pediatrician, occupational therapist and registered dietitian gave the husband and I many helpful coping skills. We learned to measure her amounts of food and record how much we served and how much she ate. We learned to serve small portions in timed installments during each meal. We learned to cut up her food pieces into much smaller bites than is typical for a same-aged child. We learned to say, "show me... aaaahh" and open our mouths, so that she would then do the same and we could check to make sure she was not hoarding food in her cheeks. If she was, I'd tell her to "make it gone or Momma will have to." Most of the time she'd swallow what we'd jokingly call "her leftovers," but sometimes I would have to scoop it out.
The husband also got great at hanging the Tongginator upside-down by her ankles and pounding on her back when she DID choke.
And we learned to navigate her fears that the meal she was currently eating was her last. We did this by serving food on an extremely regular schedule, every two hours, on the two hours. Friends nicknamed her "The Hobbit" because she ate first breakfast, second breakfast, elevensies, lunch... well, you get the idea. We also kept some food visible, yet out of reach, at all times so that the Tongginator could feel reassured that food was available, if not accessible. And we remained patient.
Now? Five years later? The Tongginator is an incredible eater, willing to try all manner of new foods and self-confident enough to eat food that other children tease her about. She eats healthfully and knows to stop when she's full.
She's also a tad obsessed about food.
She still thinks with her stomach. And her favorite television channel is The Food Network. And she still won't drink milk without Carnation Breakfast added to it. And she constantly talks about food and looks at food and loves to cook food. So no... I don't think her food issues have disappeared.
But I do think that - at age six - she's doing a darn good job learning to control them.