Can anyone here tell me what to do?

[TTCH785]

Hello,

 

Edited by TTCH785 - 5/16/11 at 4:17am

[Polliwog]

What happens if you take her outside, to the pool, for a walk, whatever? Have you talked with either a specialized pediatrician or a child psychologist who's worked with children coming from poverty and/or neglect?

[TTCH785]

If, g them to her.

Edited by TTCH785 - 5/16/11 at 4:19am

[Sienna-forever]

My (biological) son was born prematurely (29 weeks) and came home 9 weeks old weighing 4lb9oz. He was breastfed. He was very slow to gain weight and I was advised to give him Nutriprem (high calorie formula) and to wean him when he was approx 16 weeks old actual age making him just 5 weeks corrected age!

I think due to the fact that he was so slow to gain weight initially, he did the same thing that your daughter does. He couldn't get enough of food, he didn't want to wait. If he saw you preparing bottles/food he would go crazy until you fed him.

He would finish eat bottle until there was nothing left at all. He would want to eat whenever he saw us eat. He had three meals a day, plus a full bottle of formula with each meal!
On several occasions he DID throw up.
This was not nice for us or him. But, it seems that by this happening, he was then able to realise ok i'm full now, I'll stop eating. It was as if he needed to experience being literally so full that he would throw up before he was able to 'know' he was full before that happened IYKWIM
This only happened a couple of times over a few weeks, and he was fine. In fact, after throwing up, he'd be like 'ive got an empty tummy, feed me!' Lol!

He is now a healthy, happy 3 year old with completely 'normal' eating habits and healthy weight.
I'm sorry I can't help you regarding the adoption side of things, and it could be for completely different reasons that your daughter does this, like you mentioned, maybe the waiting in the orphanage and that type of thing. But I hope I have reassured you, that even if she DOES want to eat to the point of throwing up, it could be that she'll then 'know' that feeling of being full.

I hope others can advise you with regards to the adoption side of things.

[GranoLLLy-girl]

Are there weight issues with your other children? Or in your family?
The amound of food you listed as her intake seems very small to me.
My first child had/has feeding issues--but it was the lack of calories that were a concern.
We went to a feeding program through Children's Hospital, worked with MANY nutritionists and other professionals---but we found New Visions to be the best: http://www.new-vis.com
Contact Dr. Morris...she mostly specializes in kids who won't eat--like mine--but being that she is feeding specialist, I would seek her advice over your pediatrician (or any feeding specialist over a general practice pediatrician)--because I'm almost certain that if she understands over-feeding that she understand under-feeding.

The other thing that seems out of balance is that she lost weight. Unless she is out there exercising a lot, she really shouldn't be losing weight. That advice seems like it might cause more harm than good.

I would feed on demand until she starts walking on her own and can then eat more "regular" meals with the family. You don't know how her family of origin ate, but there is a real possibility that these feeding needs are totally normal.
But to limit the food--that just doesn't go over well with me--especially if she is crying for more right after eating.

Bottom line--seek advice from feeding therapists and not pediatricians.

[zombie]

Have you tried a binkie? Maybe sucking on something would help. Probably not a helpful suggestion, but it's the best I've got. Good luck.

[Diane B]

Originally Posted by ram3113

If, after a sufficient meal (even if she wanted more), I took her outside, or even to another room than the kitchen, she is fine. She now can go 2 hours without looking for anything except maybe asking for a bottle, which I think is just when she is tired. Sucking on a bottle of water satisfies her as much as milk. But again, she would drink 10 bottles in a row if I kept handing them to her.

I'm not sure exactly how old your daughter is, but the amounts of food and size of bottles you listed (3 oz bottles) seem really minimal to me, especially if she's not gaining weight. Even after our daughter was eating solid food, she was still taking 2-4 8 oz bottles a day - probably until about 18 months or so. Would your daughter REALLY drink 10 bottles, or is that your fear?

Our internationally adopted daughter was extremely attached to her bottle, and very anxious around feeding. It has only been in the last few months - and she's six years old now - that she can tolerate the sensation of hunger for a few minutes - we are working with her on that. But basically, we just fed on demand, both formula, and later, solid food. We made "snack trays" for many years, which were a muffin tin with each cup containing nutritious snacks, so she could graze as she needed to all day. She had a bottle at bedtime (we gradually watered it down so it was eventually just water) until she was 5. She can eat as much at mealtimes as she wants. We eat healthy, whole foods and limit (but not ban) unhealthy snacks, but have never restricted quantity. Our daughter is a very active, normal-weight child who eats A LOT - often, more than me. She just seems to burn it up.

Have you tried letting your daughter eat on demand, as much as she wants? My daughter really needed to know that she could control her food intake, that food was available to her, and that she didn't need to be hungry. My guess is that she was fed "on schedule" as a baby, and often quite hungry in-between. Once those needs were met, she was able to regulate her food intake appropriately (judging by her appropriate weight).

[TTCH785]

Follow up

Hi,
 

Edited by TTCH785 - 5/16/11 at 4:20am

[Polliwog]

You really need to consult a child psychologist. Preferable one who has worked with young children who've been neglected. This isn't something that a feeding therapist can solve since it isn't really a food issue in the traditional sense. She needs psychological intervention.

[Diane B]

Disclaimer: I'm not a feeding expert nor an adoption expert, I only have my own experience to share, plus what I've learned from other adoptive parents.

I would say that making food available without restriction is worth trying. That's the advice I've consistently read and heard about for kids with your daughter's issue. I don't think that means leaving her in her highchair for 3 hours; is your daughter mobile yet? The "snack tray" was so helpful for us. And yes, I was scared at first that with unlimited food access, my daughter would just endlessly eat.

So perhaps there's some way your daughter could have access to food without your having to keep '"feeding" her. The snacks can be healthy; unlimited fruits and vegetables are really not a problem in terms of weight gain, for example. Also, you could consider it an experiment for a limited period of time. Once your daughter realizes that food is available, as much as she wants, I think it's possible she will relax about it. That's what happened in our case. The snack tray approach also took us out of the middle (daughter constantly asking for food, us having to decided yes or no all of the time) and kept food from becoming a battleground and a control issue between us. If you give this a good try for a couple of months and feel your daughter is unable to regulate her hunger/satiety cycle, then I would consider additional professional help.

Finally, I think someone experienced with kids coming from neglect situations domestically, or from institutions abroad might have a lot of help and insight for you. I would look more generally for post-adoption advice and support; perhaps your public agency has a support group you might be able to attend, or if there are any large adoption agencies in your area, they might have post-adoption resources. This is not an uncommon issue for internationally adopted kids, especially those from institutions.

[TTCH785]

Snack Tray

Hello,

 

Edited by TTCH785 - 5/16/11 at 4:20am

[GranoLLLy-girl]

Did you look at the link that I sent you for New Visions?
Dr. Morris is a feeding expert and understands the psychology side of this as well.
I do hope you'll contact her--she is worth her weight in gold.

[Diane B]

Originally Posted by ram3113

Hello,

I want to thank you all for your patience and time. It helps to know that there are people that I can express this all to, since everyone tells me this is just "normal" and she is just a "baby". I, however, agree that this is not good behavior and it needs to be addressed. I have an appointment with an attachment specialist, as well as a feeding team that has a psychologist on it. I KNOW this is not about hunger/food necessarily. But at least I will have access to a child psychologist.
Regarding the feeding tray, which I want to try, I am curious about one thing: Did you refill it throughout the day? Because I know that she will sit down and finish it immediately, and not move until it is done. Then what do I do? Do I keep it filled up? Then what if she finishes it again. I have seen her with food, and I KNOW she will not walk (or crawl) away until it is empty. And even then, at least in the beginning, she will probably cry that it is all done.

Thanks,

Renee

Yup. As much food as she wanted, always available. In our case, she did learn to self-regulate, rather quickly. I think she just needed to know it was there, and I needed to not be trying to control her food and having that occupy a lot of time and energy in our relationship.

But I think it's great you are checking in with professionals. I'm not an expert, once again, I'm just sharing my experience.

[sbrinton]

The book, How To Get Your Kid to Eat...But Not Too Much by Ellyn Satter is very good.

In a nutshell, she says feed on demand, but the book is full of very good information and encouraging stories. She also write about the roles the parent and child play in feeding. Your job as parent is to provide healthy, yummy food at reasonable times - your child's job is to decide how much to eat.

I am a family nutrition educator and work with families with a variety of feeding challenges. We're also in the process of adopting a little girl from Rwanda.

I like the feeding or snack tray idea. This could be a fun game and a good way for her to practice her fine motor skills too. You could fill the tray mostly with small pieces of fruits and vegetables and add other things like cooked beans, cubes of tofu or chicken, small crackers or bits of toast.

I would focus more on the quality of food she is eating than the quantity. I would also make sure every meal and snack has some protein, some healthy fat and some fiber.

Our youngest biological son was born prematurely and has had some feeding challenges. He eats a huge amount of food. He is still tiny. It's hard to figure out, and some days I'm completely blown away at how much he eats - he recently had 15 meatballs along with noodles and vegetables for dinner. That's probably 1,000 calories in one meal (he's 17 months old and weighs 20 pounds!). I try to trust his cues and I don't limit what he eats, even when I have no idea how he could possibly eat more.

Our oldest son tends towards overeating out of boredom or just when something tastes really good. With him, my approach is to let him have what I think is an appropriate amount of the calorie dense foods and then as much as he wants of fruits and vegetables. For example, tonight he had 6 slices of chicken quesadilla and complained he was still hungry...I didn't give him more quesadilla but I let him have as many carrot sticks as he wanted and then a banana.

The other thing that comes to mind is that this is a process of building trust. You are learning to trust your baby and she is learning to trust you...

[londug]

Anna - could you please share your outcome?

Hi Anna,

I was just directed to your post as I am in similar boat as yours. I would love to hear back what you learned from your visit with the specialists.

My story - we adopted internationally an 8 month old who was in foster care. From the time we received her birth info to her first update at 3 month old, her weight jumped from 20% in the U.S. charts to 98% while her height remained steady at 25%. She continued this trend until we got her. She displays all the behavior you have listed: eating with no end, crying hysterically when she saw her bottle (even when she is about to get it), crying hysterically when there are any signs the meal is about to end despite her having eaten a full meal, crying because she can't get the food in fast enough, crying because I scooped up too much food and her small mouth could only eat half of what is on the spoon and there was food remaining when I pulled the spoon back, etc.

In our case we suspect the foster mom pacified our daughter with food. Based on the foster mother's instructions she was given nearly 50 oz/day. Our daughter's pediatrician who specializes in international adoption medicine strongly believes this was the case. For months she was conditioned to find comfort in food.

Here are a few things we've done that has seemed to positively affect her behavior so far, some suggested by her dr.

When she cried hysterically in the high chair we waited it out until she calmed down before we fed her. She cried initially for her bottle. Later when we transitioned her to solids, she cried hysterically because she wasn't getting the instant gratification she got from inhaling a bottle. Then it was because we weren't feeding her fast enough or putting down food fast enough. We gave her the food, but only when she was calm. We sat through a lot of screaming & crying meals and eventually it began to abate.

When she cries because of something we did that may have signified the end of a meal or she was expecting food in her mouth and didn't get it, we repeat the same behavior over and over. The idea is to desensitize her from whatever action that sets her off. So if she cries because we set her bowl or spoon down, we pick it up and set it down several more times throughout the meal and subsequent meals. Eventually, these actions do not evoke the same crying response.

We prepare the food out of her sight and the food just magically appears when it's time to eat. This prevents her from working herself up when she sees the food getting prepared.

We give her boring/bland, but healthy food, sometimes served cold. I give her a lot of fresh veggies mixed in with her food, including big chunks of green bean. This has had limited success depending on how fixated she is on the food during mealtime. When she is not as fixated, she will usually reject the big chunks. When she is fixated, she just mindlessly gulps down the food.

Lately I have resorted to starting her meals with the TV on and within her sight. The tv seems to be doing a good job of distracting her and not having her fixated on the food. I have also allowed her to play on the floor while I try to feed her. This hasn't been as successful as I would have thought - she just sits there and stares at me waiting for me to feed her and crying hysterically when I don't (because I'm waiting for her to play).

While close friends have reported significant changes in her behavior & attitude toward food/feeding/ I feel we've hit a plateau. I am out of ideas. I have spoken briefly with my social worker and she wants to refer me to a specialist with an adoption/child psychology background.

I feel your pain. I find it's hard for people I know to understand the full extent of the feeding issue without seeing it firsthand.

Looking forward to hearing your update
LT