My introduction to the world of feeding challenges coincided with me becoming a mother.
My firstborn son – a perfect, squishy newborn – refused to eat. He had no physical limitations or reasons for refusing food, he just didn’t see the need nor possess the desire to fulfill his hunger by eating.
The first six weeks of his life were the longest of mine… and are honestly a hazy blur of frustration, exasperation, and of feeling utterly helpless to provide for my baby. We persevered but the scars from our first tango with feeding challenges went deep.
My picky infant turned into a picky toddler who morphed into a picky preschooler and is now a ‘particular’ kindergartner. We should have investigated things with an occupational therapist, but my son managed to sneak back onto the growth charts, and we got busy with having another baby and ultimately bringing a child into our home through adoption.
Our second son ate like a champ. I took great pleasure in watching him gleefully experience food and was relieved to learn that my other son’s feeding issues were not really about me. I wish this lesson stuck.
And then we set out to adopt. And of course, we made the terrible-in-hindsight joke that as long as we don’t have to deal with food issues, we would be golden.
We were prepared for some eating and feeding challenges. We had taken the classes, read the books, and talked to enough veteran adoptive parents to expect our little one to have some challenges based on a history of neglect. We anticipated confronting issues of hoarding, overeating, and fear of lack of food.
So I adjusted my expectations, packed lots of toddler snacks and lollipops for our trip to China, and set out to meet our daughter Mila – and face whatever would come our way when she walked in that door.
In that door Mila walked (or actually, she was carried) and our world got a little topsy-turvy as our dreams and expectations were brought to reality… and a tiny, sniffling three year old was pushed into my arms.
Our training kicked in. Out came the snacks and toys from the miniature backpack we had prepared for her. She ignored them completely. We caught Mila’s attention with our camera and while we attempted to make the meeting of our daughter meaningful and intentional, we were also feeling pressure to get any and all answers about our newest addition answered by the person who supposedly knew her best – the orphanage director standing before us. Seizing the opportunity, I asked about Mila’s sleeping schedule, what she liked to be called, if she was potty trained, and finally what her favorite foods were.
The director hesitated when I asked about food, exchanged a questionable glance with our guide, and then went on to explain that our daughter only took a bottle of formula. She then amended to say that we could add rice cereal to the bottle and that she would drink ‘soup’ from a spoon. I asked what kind of soup and the director responded, “Only ‘soup water. No chunks.”
Ok… a little warning bell began ringing in the back corner of my brain, but I shushed it into silence with the thought that bottle-feeding your adopted child was great for attachment and that surely Mila’s orphanage just hadn’t given her solid foods yet due to being short staffed or something.
We would overcome this tiny challenge!
Our time in China was stressful and emotionally tough. Our daughter’s eating habits made it more so. Mila’s single source of sustenance came from a bottle. We had a can of formula from the orphanage and large packet of rice cereal that she allegedly ate (she never ate the rice cereal). We learned rather quickly that Mila’s list of acceptable foods was extremely small. She liked formula, milk, very smooth yogurt, and ‘soup water’ – aka clear broth. Any tiny amount of texture was unacceptable.
Mushy grains of rice in congee – absolutely not.
Soft fruit from the bottom of the yogurt – heaven’s no.
Even a lump of unstirred formula at the bottom of her bottle -grounds for induced vomiting and a whole meal’s worth of nutrition wasted.
We tried offering a few new textures and tastes in China but quickly realized it wasn’t worth the added stress. And the added laundry that vomit-covered clothing required.
Once home we consulted our pediatrician. Mila was far below every growth chart so getting calories in her was a priority. Mila began a high calorie diet of toddler formula, pediasure, and donated breast milk. We also introduced more smooth textures – apple sauce, fruit purees, and different flavors of yogurt. She begrudgingly ate baby oatmeal if it was of uniform texture as well.
I made large batches of bone broth, and we had a friend deliver homemade soy milk every week. In just a few weeks, she was gaining weight and height. We continued to offer other foods, but they were refused every time.
This girl wouldn’t even eat candy!
The high calories and other ‘good stuff’ she was getting began to show. Her hair grew quickly and her nails grew strong, her face began to fill out, and in general she seemed more content.
At three months home, Mila still had not taken a bite of solid food.
We turned again to our pediatrician who referred us to occupational therapy and a feeding team. At our first appointment, Mila charmed the therapist and showed great promise as a future eater. She happily licked applesauce off of a graham cracker and ‘pretend chewed’ various foods. The therapist, who was enjoying working with a slightly different type of client than usual, declared Mila ‘ahhh-mazing’ and gave us some homework and a follow up appointment.
We were to encourage playing with food, touching different things, and eating ‘sticky’ foods to encourage tongue movement. And for the next few weeks, we rocked our feeding therapy homework. Mila developed a deep and sincere love for peanut butter – so we put it on everything! Pretzel sticks, carrots, apple slices, graham crackers – all with the hope that she would accidentally get a little taste of something else in her mouth. But she never did and never demonstrated any desire to do more than lick the carrots clean of peanut butter.
At our next feeding therapy appointment, I explained our predicament. Our therapist, still enamored with Mila, decided that we needed to be in the ‘accelerated program’ of feeding therapy.
She took accepted foods and altered them for Mila. For example, smooth applesauce was one of Mila’s favorite foods that she would always eat. Our therapist crushed up graham crackers and sprinkled them on top. Now Mila had to go through the ‘chunks’ to get to her favorite apple sauce. And to my utter amazement, she did! Right there in the therapy room, in front of the therapist. We were instructed to alter all of her food – we called them ‘parfaits’ now. We were also told to dramatically cut back on the formula and other liquids to encourage her to eat other foods…. and to return in a month with our amazing eater.
We went 18 meals without Mila eating. A desperate hunger strike. All the things she ate in front of the therapist were refused at home. And she was hungry. At mealtime Mila would climb into her high chair and eagerly babble. Her food would be put in front of her and immediately her mouth would turn down and her tiny hand would smack the table. She might take a bite or two but would then spit out everything and refuse to eat anymore.
Her face lost the plumpness that it had gained the last four months home and her behavior tanked along with her blood sugar. Mealtimes were an angry battle and every other in-between time we all tolerated (or didn’t tolerate) an angry, hungry, tiny three year old.
I struggled mightily with accepting her mealtime rejections and dealing with the bad behavior all other times. I tried everything I could think of. Letting her self feed. Feeding her. We tried tricking her into tasting her food. She turned it all down.
I dreaded meal times and the battle that would ensue. I hated seeing Mila get so excited to eat and then dump her food on the floor or spit it out all over her clothes. I took it personally and frankly I could feel myself start to place my frustration on Mila instead of on the situation. I wanted someone to blame for this problem and the tiny human covered in chunky oatmeal and screaming at me was a good target. But I knew that was wrong. So I distanced myself emotionally from her.
At six days into the hunger strike, I reached my breaking point. I was scared that she was losing too much weight, angry that we were in this situation in the first place, and just sad that I felt myself growing further and further away from Mila.
After a day of phone calls and email exchanges with doctors and therapists, I got a few more guidelines to follow for the feeding plan. We brought back the pediasure and gave her some unaltered safe foods.
Mila tentatively began to eat once again.
I felt like a feeding therapy failure – and I wasn’t even the patient! Mila’s feeding challenges were deeper than lacking the mechanics of eating. They were more than lack of exposure to different foods.
Her feeding challenges were a result of something that all adopted children must address in one way or another: trauma and the inability to trust.
I learned from our adoption process that if you need answers, social workers and doctors are great, but the real wisdom lies in the experience of other adoptive moms (and dads) who frequent facebook groups. I turned to these moms and was introduced to the book Love Me, Feed Me: The Adoptive Parents’ Guide To Ending The Worry About Weight, Picky Eating, Power Struggles, and More by Katja Rowell, MD.
I read the whole book in about a day and furiously began highlighting the parts that my husband needed to read to be on board (c’mon – I know I’m not the only one out there who provides the ‘Cliff’s Notes’ versions of things for her husband!).
The Division Of Responsibility (DOR) seemed to be the missing piece to our feeding challenges.
At its simplest, the DOR says that the responsibility of whether to eat and how much to eat is on the child while the parent determines where the child will eat, when they will eat, and what they will eat (what choices are provided). This division gives the child voice, offers choice, and provides structure and predictability. This all sounded an awful lot like Karyn Purvis and her techniques in The Connected Child. As proponents of Connected Parenting, committing to the Trust-based feeding program described in Love Me Feed Me was a logical next step for our family.
And it changed our meal times – and our lives.
When researching this method, I learned a lot from Mandy’s post on her family’s experience with Trust-based feeding. We served every meal and snack at the table and we served family-style rather than pre-plating food. Since all of our kids are pretty little (ages 2, 3, and 4 at the time) instead of allowing them to serve themselves, we offered each food item to all of them, and then helped put it on their plates. At every meal there was at least one food that each child would find appetizing. And then we would eat our meal without commenting on food or our kids’ choices. And that was the hardest part… giving up the control my husband and I had (or had attempted to have) and allowing the kids to take their responsibilities.
Here’s how it all went down:
For the first week, Mila ate only the safe foods. She also still had her pediasure, but we served that at the end of the meals.
My oldest – the picky preschooler – ate bread for a solid week. He was thrilled. I was horrified. By the seventh day of his bread diet, he decided to eat a little chicken at dinner all of his own volition. He continued to add more and more foods – all completely on his own- and even tried some new fruits and vegetables that he had previously deemed inedible.
For my youngest son – the foodie – he ate normally, as he has his whole life.
After a few weeks of allowing the kids to choose how much food and whether they would try it, Mila started pointing to different foods at the table. She pushed some of the new foods around on her plate for a few meals. And then one day she spooned a semi-mashed banana into her mouth, chewed, and swallowed.
And the clouds parted and the angels rejoiced and we set off fireworks in celebration! OK, perhaps the celebration wasn’t quite as involved or heavenly, but I may have shed a little tear amidst the cheering and I certainly shared our excitement over Mila chewing on Instagram!
We continued to make small steps of progress with Mila and her eating. She actually ate a fairly balanced diet – just most of her foods tended to be soft.
At the beginning of summer, our family set off on a four day road trip across the country to visit relatives. We spent countless hours in the car, visited many hotels on our journey, and returned home after 10 days, slightly less sane than when we (I) set off.
I don’t have any hard evidence to point to or a true scientific explanation, but after our road trip, something changed for Mila. Perhaps like a microscope finally sliding into focus, suddenly ‘family’ seemed to make sense.
A deeper level of trust had been forged between Mila and the rest of us and as a result, many of her feeding challenges wafted away.
We did return to Feeding Therapy but after watching Mila use the appointment as a means to control the therapist, I deemed it unhelpful and we happily ‘graduated’.
We learned from the Trust-based feeding program – and just after extended time learning about our daughter – that we had to avoid power struggles at all cost. Food was a major area where Mila could attempt to exert control, and battle for power against me or my husband. By reframing meal time and defining the areas that she actually did have control of, we took away the need for power struggles. And everyone was happier because of it.
Mila eats a variety of foods and textures now. She doesn’t gravitate toward hard foods or typical kid ‘snacks’ like crackers and hard candies, but she eats all meats, veggies prepared different ways, fruit, bread, noodles, rice, cheese, and so much more. She understands that we want her to try new things and that we will always give her food that she enjoys and feels she can safely eat now.
She is still very tiny and hasn’t experienced the rapid growth many kids have once they are home, but she is steadily growing on her own curve and communicates when she is hungry or satisfied now.
Feeding challenges are so very difficult. In the midst of our struggles, I felt like food and the power struggles around meals was like a thick fog – all encompassing and smothering. It was constantly on my mind and I felt like our lives revolved around Mila and her eating.
Would she eat today? Would she ever eat? Will every meal end in screaming?
For those of you with adopted children who did not share our experience, perhaps you have observed how feeding builds trust between you and your child. Food can be a bridge to connection. Karyn Purvis used it often – providing regular snacks and bubble gum to kids with a trauma past. It is in our nature to show care to others by feeding them. But when your child cannot accept food from you, it is also natural feel lost and frustrated. That fog is thick and disorientating.
A child with feeding challenges can cause the most confident mom and dad to question their parenting abilities. And just like that fog, the end may not seem to be anywhere in sight.
If you’re in the middle of the feeding challenge fog, I encourage you to step back and reevaluate the situation. It may be hard to see clearly (remember – fog?) but after ruling out physical challenges and medical concerns, perhaps look deeper.
For us, feeding wasn’t about the physical mechanics of eating but about trust. Once we reframed our perspective and looked for ways to end the power struggle over food, things changed rapidly.
Building trust in a traumatized little person has a way of restoring their soul, giving rest to their heart, and in our case, led to full tummies and happy times around the table as a family.
I am always eager to connect with parents facing these challenges. I am no expert, but happy to elaborate on what worked for us and our experiences.