March 31, 2010

From Food Phobia to Food Network

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.


  1. T.

    Excellent post! My bio daughter had a few (by no means all) of the same eating issues when she was young. I wish I would have known some of those techniques. Maybe she would be a better eater today. She has a big issue with texture and will never try anything new. I'm hoping as she grows older, she will succumb to her Italian heritage and start eating everything in sight (okay maybe that's not good either.) ;-)

    On the other hand, my little boy will try and eat anything and everything. :-)

  2. Been there...done some of that. Little T didn't know how to chew her food. How can a 26 month old child NOT know how to chew food???? Her bottle from China had a huge hole in the nipple so the milk just flowed down her throat (and chin). Once we got home we worked on her chewing. She caught on quicker than I thought. While out and about one day she got into my purse (imagine that!) and got some gum. The sales lady said - in a very concerned voice - oh no, she's got gum! I said huh? turned around and sure enough she was CHEWING the gum. I started crying! The sales lady thought I was just nuts.

    Textures never bothered her but the hoarding? Oh yeah - she would walk around with food in her hands for months! And she would also keep it in her cheeks. Still does. Side note - Big T got hit by a car when he was little and went to the hospital. While in the ER the doctor asked what he had in his mouth - it was part of his PB&J sandwhich he had had hours earlier!!

    Oral motor - we are still working on that - peanut butter, sticking tongue out, blowing bubbles - working very very hard on it!


  3. I'm crying, thinking about two brand new parents working and praying for months with their little girl. There are so many things to learn in this world, aren't there?

  4. Thank you for posting this. My new niece has issues with eating until she is sick (they were told ahead of time and my sister has witnessed it a few times) and I'm sending her the link to this article right now. Both for encouragement and ideas of the regimented eating schedule.
    Thanks for posting!

  5. Tonggu Mama, I had to jump over here after checking in on your blog. Like little T our Em has a variety of Oral Motor challenges. She has overcome a lot of them but we still have to remind her to chew, swallow and say ahhh. There is the daily, OMG Em is choking scares and mealtime is always an adventure. Thanks for sharing!

  6. "Twice as a toddler she over-ate to the point of spitting up."

    My DD did this quite a few times with her bottles--just gorge and then throw up. Can't tell you how often, but more than a few. Yuck. She could only take in about 4 ounces when we got her, at age 9 1/2 months. How sad that that's probably all that she was fed each time--not enough. And too thin. Not even on American charts.

    Just today I have been rejoicing because our DD has FINALLY tasted broccoli, corn (TWO kernels!!), guacamole, black olive, enchilada (not spicy at all) and Spanish rice (again, not spicy). Notice I said "tasted," not "ate a whole piece" or "more than a couple of bites." Those new tastes have all been in the last 24 hours. HAPPY DANCE. She's 5 1/2 now. I was sure to point out how happy I was that she was brave and tried them, and I also pointed out that she "lived to tell the tale." LOL

  7. I remember when we would give our daughter little bits of rice in China. She would chew and suck on those few grains of rice for hours. How the rice did not disintegrate in mouth I do not know. Since coming home, at times she will still pocket food in her cheeks.

    Our food challenges center on biting (as well as a few certain textures). In short, she doesn't like to bite food off, so most of her food is cut into small pieces.

    You would think this isn't such a big deal, but if she sees something she wants she will stuff the entire piece of toast (or banana, watermelon,sandwich,granola bar,slice of apple ect) into her mouth - thus choking.

    We are working with an OT on encouraging her to try to take small bites, and she is having quite a bit of success.

    I smiled when reading about you asking her to open her mouth and show you if it was empty and modeling for her, brings back lots of memories.

  8. Thank you so much for sharing!