Abby's Update - Better Late than Never!

I just logged into my blog and realized I hadn't logged in since August - eeek! Sorry everyone for the lack of updates! So many days I have written it on my to do list and I just have not gotten to it.  So much has happened with Abby's progress, lots of ups and downs, regressions, triumphs etc.  I will try to give as much of an update as I can!

To start off with great news, Abby is now 19 lbs 5.5ozs and I'm pretty sure she is almost 30 inches!! We just ordered a new car seat - so thats a good sign :)

In the past few months we have continued to struggle with  getting Abby to eat savory foods, drink anything other than water out of a drinking container, and her volume intolerance.  For a while there Abby was testing us big time, she wouldn't open her mouth to accept the food, if she did accept it she would spit it out or start gagging, but finally after I'd say 4-6 weeks we aren't dealing with that anymore! She is still however coughing/gagging/choking her food once or several times during a feed - we simply ignore it, make sure she's not actually choking by watching her cues, then we continue on as if nothing happened.  I'm still at a loss as to why she continues to do this, even with us completely ignoring it, she gains nothing by doing yet, yet she still does it. hmmm...

We have slowly increased Abby's food intake, both with her Carnation Instant Breakfast milk and with her solid foods - while I have backed up on breast feeding, now only doing it twice a day, and throughout the night (insert long sign and banging head on the desk).  We literally increased one item at a time by 1/4 of an ounce for 3-5 days, then would increase another meal by 1/4 ounce - and now we are at 2 ounces of puree'd food 3 times a day, and 1.5 ounces of CIB milk 3 times a day.  This still doesn't seem like much at all compared to other kids her age, but it's what her body needs and is thriving off of - she has been consistently gaining about 1 pound per month - this is AWESOME!  Since I have backed off of the breastfeeding, it's a little tricky to make sure she is still hydrated since she cannot tolerate much additional volume - so we keep it slow and steady and offer her a sip here and there of water throughout the day. Wet diapers have been normal, so hooray!

In the past we were distracting Abby with a plethora of toys throughout the meal, but we have somehow moved on from that (yay!) and now she gets to watch a movie while she eats - currently she only wants to watch Nemo... over and over and over..just keep swimming! LOL  She is actually eating her finger foods great - we start each meal with finger foods now instead of ending it with them, as we saw that she wasn't interested in them after she became full from her puree- but now she eats a good amount of finger foods and then all her puree so it's a lot more calories!  Here is a picture of her from today of her eating spanish rice and kiwi! I think she does best with a savory food when it is in a finger food form - such as rice, lunch meat, cheese, etc - but once we puree something or give her a savory soup shes not such a happy camper.

We continue to have Allyne at our home 3 times a month, and we've been approved by our insurance for 18 more visits - Praise God!! We are so glad that we decided to go with Clinic 4 Kidz - the way that their system works is just what we needed! Even though they are only physically here 3 times a month (and all day long from Breakfast through dinner!), Allyne is available any time via text, phone, email etc - so it's really been great for us and she has helped us through a lot so far!

Here are some more pictures where you can see how good Abby is looking - she has a little belly and some cheeks now :)  Thank you all for following our journey and your continued prayers!

We hope to get Abby to drink milk on her own one day soon - lots of work ahead!

Mama Bear

2 Pounds, 2 Inches!

Hey Everyone!

We are still alive over here! Sorry I haven't posted an update in weeks!  We are in the middle of moving and remodeling some of our new home so things have been hectic to say the least!  But I made it a point to post today as Abby is officially 14 months old today and are you ready for her stats!? She is 17 lbs 13 ounces, 28 inches... which means, she has GAINED over 2 pounds in 2 months and has grown 2 inches!!!  Isn't it amazing how food really affects the body so much and so quickly!

Abby overall is doing great, she's growing into a feisty little one and definitely knows what she wants!  We love her laughs, giggles, kisses and yes chubby squishy legs and arms and cheeks are coming in!!!! :D

Allyne came to work with us again August 6-8 and we were able to up Abby's daily purees to 1 and 3/4 oz which is a 1/4 oz increase.  It's not much but with Abby's volume intolerance we have to go extremely slow or that food will just be thrown right back out, and I HATE when that happens, I feel so helpless :(.  Allyne would also like Abby to begin to have more savory "tastes" during the day, so we are to give her 3 savory bites before each meal (like chicken noodle soup broth, or refried  beans, etc etc) - to be honest (Allyne I hope you don't read this! haha jk) this has been a bit touch and go on consistency because we have barely been home and it's been really difficult to implement this into each meal, I need to do better!

With the current types of foods Abby is eating (fruit purees), she is at about a 6 month old's level eating wise, so our goal is to get more savory foods/veggies in, and then slowly add in meats!  Meats will be a tough one as they are harder and longer to digest so that may be a factor in that small tummy of hers.  We'll see!

Pretty much a few days after Allyne left this month, Abby started to regress in some of her eating behaviors - she has been twisting her tongue so that the spoon and food ends up under her tongue, or expelling (spitting it out), gagging a lot and just being a lot more difficult to feed/distract!  So Allyne is having us make sure her purees are nice and thin and that we make sure to not offer her the bite until her tongue is in a frontal flat position to accept it.  She is getting better but she still is gagging once or twice per meal, I don't know why??? But besides that, we are really happy and thankful for all the progress Abby has made!!

Hopefully I can post another update within a month, but don't be mad if I don't, theres so much to do with the new house, and work, and oh take care of a little bambina who likes to pull on mommys leg all day, then when mommy gives her attention she runs away and plays! hahaha love her to pieces!

Her new swing at the new house!

Mama Bear

Clinic 4 Kidz: Day 5

Today was our last day with Allyne for this month, she will be back August 6-8 for another 3 days of treatment!  This week went by fast, but slow at the same time, it left me exhausted, physically and mentally but seeing how much progress we've made so far makes it all worth it and I'm excited for her to come back in August!  Matt said she really is like an angel God sent to us!  :)

Matt did today's breakfast and morning milk session on his own today and did a great job!  After talking to Matt on how he felt with everything he commented how the whole process seems so overly simple but then when you go to do it there is much more to it.  We are both just so excited (and relieved) that Abby has been responding so well.  Allyne warned us that now that she will not be with us through the day Abby may try to pull her old tricks on us but we have to stick to the protocol.  I actually noticed this last night when I was doing Abby's milk session - she was trying all sorts of different things to get me to stop and give up (let all the milk spill out, stuck her tongue out and wouldn't close her mouth, sealed her mouth shut, turned from side to side, ripped her bib off, etc) and to get control back, but I just stuck with it - ignored what she was doing and proceeded on.  That is another thing that we have learned this week - to not address or even say anything when Abby pulls her tricks out or starts to fight us but just keep pushing forward like nothing.

With Abby's milk feeds we notice that after about 5-6 minutes Abby gets pretty antsy and irritable, so the new protocol is that once we see her start to do this, we then pour the rest of the 1ounce that she hasn't finished into a little cup and syringe feed her the rest.  This is not something I'd like to be doing, but we don't really have an option, she needs those calories.  I took two small videos of the milk feed, one is here, and the other with the syringe is here.

My mom came around 11 and was trained to feed Abby - she went through the whole being feed and her feeding Allyne approach and though it seems silly, it really is very helpful.  Here is some words from my mom (Mama Brown)..."In preparation for my training today I read the blog, took notes and watched the videos over and over.  Today Allyne went over the techniques using herself and I as examples, I'm glad i had my notes  because it helped to refer to them and I was able to add additional notes.  Then it was my turn to feed Abby, Nico was right, it's a little bit harder when you are actually trying to feed Abby.  So much to remember. In the past, I loved to play around and be silly with Abby when i fed her but now this is serious business.  Even my tone of voice was important.  Over all I think I did ok for my first time.  Allyne thought it was a good idea for me to continue to do more feeding so I could become more comfortable, so I stayed to do the dinner feed.  Well wouldn't you know, a few hours later I had a brain fart and forgot a few of the techniques I had just learned.  You may have not noticed because Abby is doing so good but technique is important because we don't want Abby to go back to her old ways. As for her milk feeding it went well. This is a time when I could be a little silly and interact with Abby while she watchs a video.   So I will have to help with feeds at least a couple times a week so I can fill in when needed and not be intimidated."  Thanks mom, yes get the practice, we need a date night! :) 

In between feeding sessions and nap times Abby enjoys playing around the house, going for walks outside and today, I peeked in the living room and saw her dancing, so I got a quick video of it, she is too cute!!!! 

To give you a quick rundown of what Abbys eating looks like during the day, check out her schedule below.

Breakfast - 1.5 oz of puree with 1tsp heavy cream and 1/2 tsp saffola oil, finger foods to eat/play with (finger foods are on her terms so she can eat/taste or not eat/taste whatever she likes)

Morning Milk Session - 1 oz of whole milk with vanilla or chocolate carnation instant breakfast powder

Lunch - 1.5 oz of yogurt with 1tsp heavy cream, finger foods

Afternoon Milk Session - 1 oz of whole milk with vanilla or chocolate carnation instant breakfast powder

Dinner - 1.5 oz of puree with 1tsp heavy cream and 1/2 tsp saffola oil, finger food

Evening Milk Session - 1 oz of whole milk with vanilla or chocolate carnation instant breakfast powder

To us this seems like so much more food than Abby is used to, but then I really look at the quantity and it is still so little compared to so many other babies I know at this age (or even younger!) - but it is progress and we hope in the coming months we can continue upping the quantity.  I mentioned in my previous blogs that we were going to weigh Abby today, and I did, but it is a little disappointing after she's been eating so much more.  She's up 2 ounces since Monday.  But after talking to Allyne she said we need to give it a few more days to really register on the scale since reaching her caloric goal just started on Wednesday.  So I'll keep you posted!

Tomorrow we do everything on our own, lets see how it goes!

Lets do this mom!!!

Clinic 4 Kidz: Day 4

Today was another productive day with Allyne, Abby's feeding therapist.  We met a caloric goal of right around 600 calories today, this is great!  I believe Abby has been averaging about 15ozs of breastmilk per day so this accounts for 300 calories (20 per ounce).  Before we started the clinic Abby was eating an average of 100-130 calories a day from solid foods, since Tuesday Abby has more than doubled her solid food intake!  WHOO HOO!!!

We are so happy with Clinic 4 Kidz.  Though Allyne is the only one here, she is communicating with Dr. Patel throughout the day and also with their nutritionist - they both seem to respond pretty quickly which is great!

Today I did the breakfast and lunch feeds as well as all the milk feeds.  Matt was trained for dinner and did half of the dinner session...more on that in a bit.  For breakfast we mixed in some yam and carrot into peaches and mango all pureed and she ate all of it without any problems! We are still slowly introducing veggies to her as we've gone straight veggie before and she does not respond well.  We are hoping that within the next month we can get her to enjoy more savory flavors.  A tip she also gave us is when we are out eating or even at home, if we have a soup or something we can dip our finger in, put a little on Abbys finger and say taste it, just to get her used to new flavors.

This is how we introduce new flavors.  First bowl is fruit, second is fruit with veg, last is all veg

 The awesome thing about Clinic 4 Kidz is they are really tailored to your family and what your home environment is like, how you live on a daily basis and they mold a protocol that is going to fit in with what you already do.  This is something places like the Los Altos Feeding Clinic don't address.  I was telling Allyne that I am out and about a lot and I do quite a few feedings outside the house or in the car, so for lunch we headed to Chilis and Abby ate great.

She finished all her pureed food and then had fun with her finger foods, she even went for my salad (she's definitely showing much more interest in food!) put her hand in it and then licked her hand... check out her reaction below! haha at least she tried it!! (If you cannot view the video, click here).

After lunch we took Abby to the park, mostly to kill a bit of time so we could later do a milk feed in the car.  I was able to get an app for the Gigglebellies and purchase some of the song shows she likes that way we could play them on the iPad without any internet/wifi connection during her milk sessions.  The feed in the car went pretty well, though the last few drinks she was getting pretty fussy but I think she was just really tired!

Allyne began training Matt tonight on doing solid feeds.  Here is a video of how the training sessions go.... yes its a bit silly, but honestly it helps so much to have her feed you and you feel in your mouth what she wants you to do with Abby.  They were both good sports and said I could post this... (If you cannot view the video, click here).

Allyne started her dinner feed then had Matt take over.  We were at first concerned because Matt is a lefty and it makes holding the spoon the correct way a bit more difficult, but Matt did great and he even commented how much of a difference it was to feed Abby - having her open her mouth and us be able to feed her so easily.  The amount of progress we have seen in just a few days is crazy, thank you Lord!  We are also so glad that we went with this clinic, it is perfect for Abby and our family!  The video below is a little clip of Matt feeding her. (If you cannot view the video, click here).

If you would like to see how we do the milk feeds, check out the youtube video here.

Tomorrow Matt will do the morning feed and be trained on how to give her milk, then my mom will come around noon and be trained on both solid and milk feeds!  Allyne will come back for 3 full days at the beginning of August and it is at that time that they will be able to train more people, so we'll have Matt's mom come and my cousin - hey we need babysitters to know how to feed her!! :)

Thanks for following our journey!!!

Clinic 4 Kidz: Day 2

Today was day 2 of Allyne being with us from Clinic 4 Kidz.  Our goals today were to get Abby to eat 1oz of puree with 1tsp of heavy cream and 1/4tsp of saffola oil mixed in for every solid feed, and for her milk feeds to get her to drink 1oz each session.  Yesterday I mentioned her minimum caloric goal is 560 calories per day, today we reached 556, pretty darn close!

For breakfast Allyne pureed up a mango/peach puree with whole milk and the additives mentioned above.  Abby ate 1oz with pretty much no fuss, which is great!  She is working on getting Abby's wide mouth acceptance fixed and it does seem like Abby is understanding that when she says "big ahh" that means she needs to open up wide.  The other issue we are having is that many times even though we get her to open wide, her lips shut so prematurely that we have to be lightening fast getting the spoon into her mouth or else she only gets a tiny bit of food off the spoon.  Allyne is trying to teach Abby that if she does not open her mouth wide and keep it open for the bite that the spoon will remain stuck in her mouth until she opens up again to finish the bite (you will see some of this in the second video below).  For each solid feed we first want to get the calories in with the puree, then we open it up for finger foods and allow abby to enjoy herself and eat what/how she wants (to an extent of course!).  Today Abby tried plum for the first time and seemed to enjoy it!  The other finger foods were Sara Lee's soft and smooth whole wheat bread, which she nibbled a bit at, and a strawberry (seems to be one of her favorites).  Check out the video below of Abby enjoying her plum!

An hour after breakfast we do milk time.  The milk is mixed with carnation instant breakfast vanilla powder.  It is presented to her in a squeeze bottle since she will not suck it on her own yet (again, she will only suck water!).  We gave her 10 minutes along with continuous songs of gigglebellies playing on the iPad and she got 1/2 an ounce down.  She did spit some out, block the straw with her tongue and show other refusal behaviors but Allyne just kept on going!

For lunch we made a pear puree with the additives and Abby also seemed to enjoy this.  The finger foods for lunch were a cheese quiche, half a potato like tater tot, laughing cow cheese and a strawberry.  Abby put the quiche to her mouth, tasted it and spit it out, guess she didn't like it!  She did play with it and taste it a few more times but kept spitting it out.  She seems to like the potato and eats little pieces of the cheese here and there, and of course she loves her strawberry, though she mostly gnaws on it.

Her next milk time was coming up and Allyne decide that regardless of the 10 minute time limit that we wanted to go with, she said lets just aim to get 1 ounce in and if it takes longer it takes longer, she needs those calories!  Every time Allyne presents the straw to Abby, if Abby does not voluntarily open her mouth Allyne says "drink" and Abby opens up, sometimes Allyne will have to wiggle the straw in as well.  Abby seemed to be understanding more that she needs to do what Allyne is requiring of her and she did not fight nearly as much as she did yesterday, and guess what, we got 1 oz  in in 8 minutes!  Hooray!!! For now Allyne wants to only give Abby 1 oz and slowly increase it over the next 2-4 weeks to 2 ozs as we want to slowly stretch Abby's stomach!  Abby also took 1 ounce at her last milk feed as well, awesome progress little girl!!

Dinner was a bit more of a challenge today as Allyne wanted to introduce a new food to Abby - vegetable pasta soup (pureed of course).  She first started with her 1 ounce of preferred food, which was yogurt with the additives in it, after she finished the one ounce, she wanted Abby to take 1/4 oz of the veggie puree.  See the video below for how that went... not so well with those veggies!!  Sorry for the quick text transitions, I was in a hurry to get this posted so I didn't fix the time lapses!

As you can see from the beginning, Abby still is not all smiles when she knows its time to eat, but we are working hard to use toys and music, things she likes to get her to relax and enjoy herself.  You can see that Abby is definitely doing better at opening her mouth big and wide, but we still need work on the premature lip closure and tongue thrusting. But she has had  great progress in just 2 days!!  The veggie soup did not go nearly as smoothly, but it was good to see how Allyne reacted and did not back down.  I'm soaking all of this in because she is only here 3 more days then I will be responsible for replicating exactly what she does!  And from here on out (until she is 100% better) anyone who feeds her MUST be trained by Allyne or Dr. Patel - we're on strict protocol here folks! :)

Here are some tips I learned from today:

- More word commands.  "When empty, you're all done" say this while showing the child the bowl/cup of food.  When they finish show them the empty container and say "Empty, all done!" and praise them.  

- When the child refuses or shows behaviors against eating, just completely ignore them.  Don't say "you're ok" or "just take a bite" or "you can do it" - you don't say anything but "open, ahh" or "big, ahh" and you keep the spoon at their mouth until they do so.  The point of not acknowledging the behavior is you want the child to learn that it doesn't phase you no matter what they do, they still need to do what is required of them.

- We do want to keep the atmosphere positive, so if the child shows signs of being anxious, or antsy, or just being over it, then nonchalantly empty some of the contents out of the bowl/cup and have them finish one last bite and then show them "empty, all done!" - that way they begin to associate that once it's empty they are all done.

Tomorrow Allyne will begin to train me on giving the milk to Abby and I will do the last milk feed by myself.  On Thursday she will begin to train me on feeding her!!

During the past few days Allyne and Dr. Patel have made new food lists of stuff that we needed to pick up at the grocery store, and it's been a bit hard for me to go since they are here 8am-7pm, then Abby's bath is at 7:30, so my mom has been a huge help in picking up all the items we needed! Thanks Mom!! Allyne was super excited that after giving us the list yesterday we already had everything she wanted - she says some parents aren't able to get what they need until the last day!  Nice to have a mom who is right around the corner from us and who works right next to whole foods and trader joes!!! :D (and who brings you a Starbucks with all the groceries...teheeee!)

That's all for now, until tomorrow!

Mama Bear

Clinic 4 Kidz: Day 1

Today was the first day of treatment for Abby with Clinic 4 Kidz!  Allyne was the therapist that was given Abby's case, so she along with Dr. Patel were at our home today, from 8am until 7pm!  Along with getting Abby to eat, Allyne also worked on building trust with Abby by playing with her throughout the day, coloring, dancing, playing peek a boo etc.  Dr. Patel was alongside Allyne today to help figure out the protocol and plan for the week, but after today Allyne is our main therapist.

Abby didn't have a very good night of sleep, so by 8am she was still sleeping, I woke her up at 8:10, as they want her to be on a 8am wake up schedule.  Well she was pretty cranky all morning because I woke her up, so we'll give her until 8:30 tomorrow! haha!  Allyne had me do a mini feed first just to see how I feed her and what Abby's reaction was.  She took 1/2 an ounce of yogurt with some saffola oil pretty easily, but she did note that Abby has very premature lip closure (meaning when offered the spoon, she closes her lips way before the spoon even reaches half way into her mouth), has tongue thrusting and also does not have wide mouth acceptance of the spoon.  This is all stuff that they have to work on first in order to be able to work on getting the volume/quantity of food up.

The schedule they want Abby to be on is 3 solid meals a day plus 3 milk/carnation instant breakfast liquids a day (3 ozs per drink).  The biggest hurdle today was getting Abby to drink the milk, she was pretty resistant pushing the bottle away, crying, turning her head, being tight lipped etc.  She only consumed 3/4s of an ounce of milk all day - they want her at a minimum of 9ozs a day so we have lots of work to do!  She also had similar behaviors with the solid foods but not as much, but the main thing that they are working on with her is that none of those behaviors are going to make the food/drink go away, it's still there and she has to eat/drink it.

Each meal is given a certain amount of time, so it's really their goal to get her to take as much as we can within that time period.  Below is a video of Abby during her dinner feed, as you can see she was not too happy, but they still wanted her to eat what she needed to eat, and Abby seems to be beginning to understand that this is what she HAS to do, no way around it!

Overall Abby did okay for her first day.  Each solid meal was only 1/2oz to 1 oz of food, so not too much, but we are hoping to up that amount shortly.  The goal is to get Abby to be eating a minimum of 560 calories a day (includes breast feeding), and she's currently around the high 300s to low 400s, so we need to get that up, and then in order to play catch up on her weight we will eventually want her caloric intake to be 715 calories per day!

Here are some techniques that were worked on today:

- Words commands are important.  Don't say "are you ready to eat?" it's not up to her, say "it's time to eat", or "its time for milk", when she finishes show her the bowl/cup is empty and say "empty, all done" and sign all done.

- Leave the spoon at her mouth until she opens her mouth big and wide and say "big ahh", if she opens big and then closes her lips prematurely you leave the spoon there in her mouth until she finishes opening up more to get the whole spoon into her mouth.

- Distractions for Abby are key, so for solids we play music and get her more toys (the toys we had boughten her she's tired/bored of, so they said lets just try household items like tupperware, spoons, etc).  For milk time we play the iPad with "super simple songs" or "gigglebellies" songs playing on youtube.

-  When drinking the milk we have to use a squeeze bottle as she will not suck it on her own (she only will suck if theres water in there!!), in order to get her to swallow what we squeeze in we have to use our hand under her chin to support/stabilize her to take the drink and not spit it out.

They said Abby definitely has resistance to eating and they seem to think that this all stems from her Silent Reflux which caused pain when eating and that has now been formed into a habit of being averted/fearful of food.  They are hoping that within 2-3 months we will see major improvements!

Dr. Patel left, with Allyne on the right.

And there you have it!  I'll keep you posted on how tomorrow goes as well!!

Thanks for all the support and prayers!

ME

Abby Turns One!

Yesterday, June 23, 2013, Abby turned 1 year old!  Wow a whole year has come and gone!  The time definitely flew by, kinda scary!!  We have gone through so much with this little one over the past year and we are thankful that God has sustained her (and me from sleep deprivation!) and continues to pour His blessings on us every day!

It's crazy to go back one year and remember being in labor and all that entailed, and finally having her enter the world and how our lives changed right then and there.  As we watched her grow in the early months I remember thinking, man I don't want her to grow, but then again I'd think, wow just think in 6 months she will be eating like a champ and sleeping through the night...... and then 6 months came and things were not like that at all, so my mind said, just wait until 8 months... and then 8 months came and went... and then I said okay maybe 12 months... so lets see what 1 years old brings to the table, I'm praying for a fully baby tummy and LOTS of sleep at night!! In Jesus Name, AMEN! lol

Abby 1 Day Old and 1 Year Old!

Check out the video below of Abby eating her first birthday cake.  It was interesting her reaction to it!  She seemed to like the frosting!! :)

In the past few weeks we have continued working with Abby, incorporating the tips that Dr. Patel gave us and she seems to have her good days and other days where she doesn't want to eat much.  We have actually started playing some short videos for her (veggie tales!) on the iPad during her meal times and it seems to help a lot!  We found that trying to distract her with toys was a bit difficult as she would lose interest really fast and just wanted a new toy every few seconds then would throw it to the floor and want the next one.. and in the middle of that we'd have to try and feed her.  Didn't quite work too well for us.  But in the last few days we've been using the iPad and she's been eating pretty good!!  I'm hoping that when we start treatment they will be able to tell us how to get her to eat without the iPad, or how to eventually fade it away - I think it's important for her to want to eat and know that food is good for her instead of only opening her mouth when she's not paying attention, not really even knowing what she's doing.  But for now, iPad or not, we'll take it as long as she's eating!!

July 8th is right around the corner, can't wait!!

Mama Bear

Evaluation with Dr. Patel

Tonight Dr. Patel came to our house to do an evaluation of a feeding with Abby, and to talk with us about Abby's history.  From the moment she walked in the door we knew we were going to love her - she was very personable and friendly and Abby immediately took to her. This is a big thing because Abby doesn't have a great track record of being "friendly" with people haha, she usually clams up or just gets stone faced, but with Dr. Patel she was waving, smiling, laughing and really engaging with her.  If that's not a good sign I don't know what is!

We started off her feed with cut up pieces of avocado, which for the first piece Abby put in her mouth and started chewing, within a few seconds she spit it out.  I tried to offer her another piece and she turned her head and whined and was pushing my hand away.  On to the next food choice.  Pear & Squash puree, she wouldn't open her mouth, just kept whining. Then we gave her an empty jar of food to play with and got her distracted, then offered her another bite and she opened her mouth.  She did this for a few bites then would refuse again, and as always we tried to distract her with something else then she'd take a few more bites.  Once she refused it and no amount of distraction was going to get her to open her mouth again, we gave her one of her "favorites" - yogurt.  I first offered it to her and she didn't want it, then she stuck her tongue out just a smidge to get a little taste, realized it was a "safe" food and ate about 1/2 an ounce of it.

Dr. Patel was thrilled with Abby's oral motor skills, her mouth and tongue are working properly, though her chewing could be better, but that will take more practice as she begins to accept more chunky/textured foods down the road.  She agrees, the problem is simply she is not taking in enough food (better yet, calories), yes she's "eating" well but the quantity is not nearly what it should be.  From Dr. Patel's point of view she says that it looks like Abby has some fear over eating and seems to do better with foods that Abby has deemed "safe" (yogurt, water, vanilla wafers) but Abby is still limiting the amount of food she allows us to get into her.  What is that fear from?  Who knows, but the most logical thought is that the silent acid reflux has caused some major discomforts and she associated eating with pain, and that then created habits that have gotten her to where she is now.

As our treatment week won't begin until July 8th, Dr. Patel in the mean time has drafted up some tips for us to start working on with Abby.  She should be emailing them to us by tomorrow, but from what I can remember here are some things she says to start trying.  I hope if any moms (or dads) out there are dealing with what we are with Abby that these things will be things they can try as well - this is one of the purposes of this blog, that people who have babies with feeding problems can get more hands on tips and ideas of new things to try - I wish I had this information when I first began researching, so here it is now for you!

- Add Safflower oil to a preferred food - start with 1/4 tsp in 1/2 oz to 1 oz of a preferred food.  Safflower oil is high in calories yet has no taste so it will not alter the taste of the food. Do this at every feed.  If the child stomachs the addition of the oil fine, increase the amount of oil in increments of 1/4 tsp.

- Begin offering water (Abby's preferred safe beverage of choice) in the bear straw "cup" - we want to teach Abby how to drink from a straw and the bear cup gives us control of getting stuff out of the straw without her having to suck initially. (Thanks to my mama we already have this cup!)

- If Abby refuses a bite three times, switch to a new food.  If she refuses that three times, switch to offering her just water on the spoon, if she accepts do it a few times, then go back to adding food.

-  Add to our collection of "distraction" toys that are only offered to her when she eats.  We already have some, but will add a few more.  Eventually we will fade out the distractions but for now if it's going to help her eat, then use it!

- Keep meal times to a maximum of 20 minutes, even if she is still eating and 20 minutes is up, stop.  We want Abby to learn that there is a time to eat.

- Do not take her out of the high chair if 20 minutes is not yet up even if she is refusing or whining.  She has to learn that those actions will not result in her getting out of the high chair.  Use the toys or other things to distract her, even if she's not eating, make the time positive.

- Do not allow others to "try" and feed Abby by coming up and shoving food in her mouth or trying to get her to eat.  There is a method to the madness and Abby needs to learn when and how to eat, so stick to her feeds being with the parent and in a controlled atmosphere.

That's all I can remember for now.  These are things to just start working on with Abby, but once they come in for the week of treatment they will figure out what exactly is going to work for Abby and how to get her to take more calories in per feed.  We look forward to working with them and are trusting that the Lord has placed us in this program for a reason - hopefully to get ourselves a chunky monkey! :)

More to come in the days to come as we implement these things!

Adios!