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New Story has been published on https://enzaime.com/joy-eating-foods/

The Joy of Eating Foods

Unable to eat on their own for their first three years of life, these quadruplets overcame their feeding disorders with the help of specialists at the Instiute. The quadruplets It seems like an obvious fact of life: if a child is hungry enough, he will eat. Yet for some children with a history of prematurity or developmental disorders, eating is a skill that does not develop automatically.

When quadruplets Timmy, Edda, Lily, and Wyatt were born prematurely at 24 weeks’ gestation, their parents, Anne and Rob, knew their babies would face continuing medical complications. But they didn’t anticipate how much of a struggle the simple act of eating would be.

All four babies had severe reflux and were not consuming sufficient amounts to grow. No matter what Anne and Rob tried, they could not get their babies to take a bottle. At times it seemed their lives revolved only around trying to feed their children, and with each feeding came more stress. As the days and weeks turned into months, their tiny babies remained the size of newborns. With their pediatrician’s advice, Anne and Rob made the difficult decision to get G-tubes (feeding tubes that deliver nutrition directly into the body) for their children.

While the feeding tubes resolved their immediate concerns about nutrition, a new set of problems emerged. Typical daycare centers weren’t equipped to administer tube feedings. Going out required packing and lugging an enormous amount of feeding supplies. And family activities like going to a restaurant, hiking, or visiting relatives were just too much work.

Advice from others, though well-meaning, made matters all the more frustrating: “make eating more fun,” “try giving them applesauce,” and “eventually they’ll grow out of it” were some of the suggestions offered. “Everybody thinks they have the solution, only it just never really works,” recalls Anne. “It was a very isolating experience.”

No one seemed to understand the depth of the problem or how to address it until the family found the Feeding Disorders Program at Kennedy Krieger Institute, a nationally recognized program that specializes in treating children with feeding disorders.

“It was the first place we had been that looked at, and investigated, all the possible reasons why each one of our children might not be succeeding,” says Rob of the program, which the children entered when they were 3 years old.

Solving the Puzzle

Many factors can contribute to a feeding disorder (a child’s inability or refusal to consume enough food to meet nutritional needs and grow normally). Some children have medical problems like gastroesophageal reflux, while others lack the oral-motor skills required to chew and swallow food. When issues like these arise, eating can become such an aversive experience that children may begin to refuse food. It’s much more than just picky eating; children with feeding disorders need medical intervention.

Successfully treating a feeding disorder is a complicated endeavor that requires tackling multiple medical and behavioral issues all at once. “Every child had a different medical history and experience, so each child needed a unique approach,” says Peter Girolami, PhD, BCBA-D, director of the Pediatric Feeding Disorders Program. “We had a team of specialists—from pediatrics, behavioral psychology, nutrition, social work, occupational therapy, and speech-language pathology—all working to identify and address the multiple factors that may have been contributing to the child’s feeding disorder.”

Senior behavior analyst Carrie Borrero, PhD, BCBA-D, who oversaw the quadruplets’ care at Kennedy Krieger, explains, “The first thing we do is watch parents feed their children so we get an idea of what they are dealing with at home.”

Unless you are a parent of multiples, it’s hard to imagine how formidable a challenge it can be to persuade four toddlers to do anything they don’t want to. At the sight of a spoon, all of the quadruplets would turn their heads and cry to avoid taking a bite. Chaos ensued.

Reward the Good, Ignore the Bad

Therapists needed to create a new normal for feeding time. Behavioral modification is easier said than done, but experience has shown that children respond best to positive reinforcement.

In practice, it happens like this: when a child performs the desired behavior (takes a bite), the therapist gives praise and positive reinforcement, including a reward, which might include clapping, singing, or the opportunity to play with toys, watch TV, or whatever activity the child loves best. Any negative behaviors (crying or refusal) are ignored. Before long, the child learns that taking a bite and receiving the reward is much preferred to not complying and being ignored.

Sometimes therapists need to get creative, as was the case with the quadruplets. “We tried to take advantage of the fact that there were four of them,” says Borrero. “We would give each child a badge if they took all of their bites. They’d walk around with their badges and they would keep up with what each other was doing.”