Eating

Strategies to Help a Child Drink From a Cup – Crowdsourcing Time!

by Tim on June 26, 2011

[I'm promoting this question from 'onlyash' from her comment in another post. Hope she doesn't mind.]

Here’s a great question from ‘onlyash’ that I wanted to try to crowdsource.

“I am a mom to a former micro preemie and I have contacted you before and your suggestions have always helped me, she is 4 now and still drinks water from a bottle. Do you have any suggestions or tricks you have used with the J-Man that you can share here.”

I’m not sure I have much in the way of great insights to share, but I’ll take a stab at a few from our experience. Those of you with particular experience with this, please share your wisdom in the comments.

We had a roller-coaster of results with bottles back in the day. Our J-Man was an ‘extended nurser’ in that he still breastfed a little until he was around preschool age. When Mary worked outside our home, I fed – or tried to feed – him pumped milk from a bottle for a long time. Sometimes this would work great; many times he’d go on bottle strike. This became an urgent problem because he really wouldn’t eat much of anything else. His diet was limited to a small number of pureed things, and even then what he’d eat or whether he’d eat them at all varied depending on mood. We were regularly frightened that he wasn’t getting enough vitamins, calories, or much nutrition in general.

We started feeding therapy with him when he was nine months old. His oral sensitivities and aversions are the stuff of legend. Getting him to let us put anything at all in his mouth took months of therapy. Even now, what he will eat is very limited.

Most of that journey is another story entirely, but with respect to drinking liquids back in those days that weren’t pumped breastmilk from anything other than a bottle, we tried all sorts of things. One thing worth noting here is that he never did sippy cups. This wasn’t because of anything we did. He just hated them and wouldn’t have anything to do with them. We’re all pretty sure it was from the ‘I don’t want anything weird in my mouth like a spout unless it’s attached to Mama’ kind of thing.

Now he drinks from these plastic, kid-sized, open travel cups. (We don’t use the spouted lids at all.) They’ve gotten him to take some drinks from different cups at school, but he’s pretty attached to our cups. Also worth noting that he almost solely drinks lightly-sweetened, decaffeinated, iced tea. Very recently he’s agreed to take a few sips of milk.

Here are some things we’ve tried.

* We eventually got him to experiment with a cup by getting acrylic shot glasses from a party store. I think they were like a dollar apiece. They’re indestructible and only hold about an ounce of liquid. If he spilled whatever was in it, no big deal. Plus it was smaller and fit better in his hands and mouth. He was probably about 18 months give or take at that point, but this is something worth trying for just about any age.

* We played with cups (started with those shot glasses and worked our way up) in the bathtub, tried to pour some water around and on his face some, and occasionally got some on his lips. We let him experiment with the cups, too, filling them with water and pouring them out, etc. Obviously we did this before soap or shampoo got in the water. We tried to make a game of it or at least make it as fun as possible. It took a lot of time, but eventually this started helping his comfort level and willingness to experiment with cups.

* He was very reluctant to let us put the cup near his mouth (as he is with about anything), so this took a lot of patience. Like many things, he wants to be in control of what is near him.

* We eventually tried heavier glasses like small jars that could withstand being dropped. With the J-Man’s sensory issues, he responds better to heavier objects. The weight often calms him. For the longest time, this was all he’d drink out of, but hey, he was drinking out of an open cup! Eventually he worked up to the travel cups.

FYI – The above are mostly from before he turned 3.

* When we want to attempt something new, we try to structure it with some sort of visuals and/or social story. With new foods or drinks, we’ll either use a written schedule-type story to indicate what he’s expected to do or use a visual that shows the same. For instance, for the written story:

1. J-Man is going to drink some milk from a new cup.
2. Take a sip.
3. Take a sip.
4. Take a sip.
5. Take a sip.
6. Take a sip.
7. J-Man is finished!

Seems redundant perhaps, but the point is that every time he takes a sip, we cross off that step. You can obviously do this with pictures, too. For instance, every sip they take from the cup you want them to drink from, you could remove one of the pictures. When all the ‘take a sip’ pictures are gone, they’re done.

I think both the structure and knowing when they’re going to be done with this task they clearly would prefer not to do helps get them started and actually doing it. Even that may take time, but persistence and much patience can pay off. The hope is that they will realize it’s not so bad and perhaps even like it.

So how did you get your child to transition to cups, try new drinks, or taste new foods? Please leave a comment and share your wisdom!

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Let Me Out of Here!

by Mary on January 5, 2011

Yesterday we took the J-man over to do the last part of a research study we’ve been participating in. This was the big part – the in-person evaluation.

Sometimes the J-man does OK with formal evaluations, but usually they can be kind of a mess. I think part of the reason is the transitions – someone gives him a task, then if he doesn’t do it in the time period they want, or how they want, or whatever… they take it away! It’s not like at our house, where new toys can sit for weeks before he will even notice them.

They started off rather poorly by making us wait in the lobby about 10 minutes, although we used that time to re-read the little “here’s what’s going to happen” booklet they had sent. The J-man LOVED that book, and especially liked signing “nice” and “nurse” – he would crack up laughing at those words. (BTW, we never actually saw that nice nurse. Maybe it would have helped.) We all went into a little room, and a lady (we’ll call her Connie Chung* because I don’t remember her name) tried to get the J-man to interact with her, while the rest of the adults talked at another table. That didn’t really happen… until everyone else left, and it was just me, the J-man, and Connie. Unfortunately for Connie, she started off with a sorting game of blocks and spoons.

You could just see the J-man light up – THERE ARE BLOCKS HERE!

He spent the entire rest of that session trying to get the blocks. The spoon and block sorting went as follows: he built block towers, and Connie tried to get him to sort. She handed him a spoon, and he put it in the correct box, but when she tried handing him another, he grabbed the handful from her, put them all in the correct box… and went back to building with the blocks. When Connie tried moving to a different task, she ended up putting the blocks away into her little toolkit. The J-man calmly walked around the table, opened her toolkit, and took out the blocks! We had to draw a little schedule, with blocks as the “next activity” to get him to do ANY other tasks. Connie tried getting him to match objects with a picture in a book, but when I told her he did better with words, she tried getting him to match letters… but the letters weren’t objects, it was just “here’s an L… now which one of these looks like that?” It didn’t work, and she wouldn’t move on to WORDS because he wouldn’t do the letters.

Eventually… Connie gave up. Really. Just decided to give up. That right there really described the tone of the whole evaluation to me.

We were sent back to the lobby (there was a playroom, but it was such a disaster area – and I don’t say that lightly considering our house – that the J-man wouldn’t even go in the door!) to wait again, while they set up the room for the other evaluation. This was one specifically for autistic kids. The J-man played with some of their toys, then decided to stack them. Another lady was doing this part of the evaluation. We’ll call her Diane Sawyer (again, no idea what her name really was). Diane did a little better by not having blocks out, but the FUNNIEST part was when she asked me if the J-man would “watch someone do something, then do it himself.” I said, “you mean, imitate?” “Yes,” said Diane. “No, he doesn’t imitate.” She seemed concerned by that. I thought it was a VERY COMMON PART OF AUTISM, but maybe not?

It didn’t take long for the J-man to get frustrated with her, and he asked me for a snack (and maybe a break from Diane!). I briefly mentioned the Sacred Six, and got out his food card. It took a good bit of explaining before the light clicked on, and Diane realized that REALLY, this is only the food he eats. The Sacred Six. They wanted to get him to ask for help, so put 2 of his snacks into containers. He ate some Veggie Straws, then Diane closed the container. He tried to open it, then took it to her to open, but because he didn’t verbalize “help” she refused to open it. So now, you’ve got a hungry stressed out kid, and you’re withholding food. Hello tantrum!

I eventually got him calmed enough to drink, and then he ate more Veggie Straws. Diane asked if I thought he would show them anything… and I said, “Well, he loves to build with blocks.” We had brought his own personal alphabet blocks with us, and he played with them. I pointed out the matching he does with them (not only does he stack blocks with the same letter together, he stacks them in the same orientation, so all the sides match up), and the engineering it takes to build a stack of blocks that high… but again, I felt that Diane, like Connie, had just given up. The J-man sure had.

Tim was still doing the parent questionnaire when we finished at 4PM – we had been there for three hours at that point. Our portion included taking pictures of the J-man’s hands, feet, ears, and face, sometimes with a ruler held up to compare to. Eventually that set him off again, and we ended up with just the J-man and me, sitting in the eval room on the floor. He asked for “pillows” and we cuddled together on the industrial-carpeted floor. I knew he was really stressed, but not quite how much… until he went to sleep. The ONLY time the J-man sleeps during the day is when he is SO overwhelmed that he has to get away, and he has realized that people will leave him alone when he is sleeping.

There was still more stuff to be done, and it was unpleasant at best… but we finished, and left. Thank god.

Tim and I hope that our experiences with studies, and the data collected, may actually mean something someday. We’ll probably enroll the J-man in more studies (ones that involve only observation/evaluation, not so much with the “take this miracle drug” ones). But, not anytime soon. Because at the end of the day I felt emotionally exhausted, and like a bad parent because a) my son was obviously so upset, and b) the study people seemed to think I was lying when I said he COULD do some of their tasks but just wouldn’t in that environment. So that was my part. I also didn’t want to put the J-man through anything like that again. He was overwhelmed by the lack of structure, and kept saying “I want” but then didn’t know how to express that what he wanted was OUT OF THERE.

Maybe that’s something we need to include in his IEP next time.

*One of our “code words” phrases is, when we can’t remember a woman’s name and can’t get past it, “Just call her Connie Chung and move on.” We’re showing our age here a little bit. Do people still know who Connie Chung is?

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Shut Up

by Mary on August 23, 2010

Last week we had a parents’ night at school, and discussed communication. The topic was so popular that they were a little overwhelmed in the childcare area, so I ended up leaving about halfway through and helping out. (I carried around the 2 youngest kids and sang to them. My arms still hurt 3 days later.)

We talked about picture boards, and choice boards, and expecting MORE from our kids in terms of communication… but maybe sometimes LESS in terms of spoken words. One of the things the teachers kept stressing was that parents need to remember to stop themselves from overwhelming the kids… with words. They really pushed using pictures to illustrate what the kid needed to say, instead of constantly repeating ourselves. For example, we should say “would you like some apple?” – and then if there is no response, pick up the picture card, and point to the applesauce – and be quiet. Just point.

This one is a hard one for Tim and me. I have to keep reminding myself to shut up, and give the J-man time to process and respond. And keep reminding myself. And keep reminding myself.

The teachers also suggested making the J-man interact with us more – by only giving him a little of what he wants, or only part of what he needs. For example, I know that every morning, the J-man comes downstairs and has applesauce, nuggets, and tea for breakfast. For the longest time, we just went ahead and had everything ready to save time. Now though, he has to ask for each of those things. We also have started giving him half a container of Veggie Straws, when he normally gets an entire container of them for a snack. If he wants more, he has to ask for them! (While I was typing, he asked for crackers… I gave him 3, when I’ve seen the boy eat an entire sleeve! So I’m waiting to get interrupted again.) They suggested when he asks to color, to give him the paper, but then wait for him to ask for the crayons, or even make him ask for specific colors.

One last thing we talked about recently was trying to move the J-man toward forming some letters correctly with his mouth – instead of B and P, he makes this “glottal stop” sound with his lips open. We are waiting (and waiting and waiting) for him to close his lips while making that sound, and only THEN does he get to watch Pinky Dinky Doo, or “do pillows” where we squash him on the floor with pillows for deep pressure. The past couple of times, I’ve just needed to tap my lips and say “lips” and he closes his. The sound is still the same at this point, but the lip position is at least beginning to change.

It’s so slow sometimes that I want to scream. And then, like the “P” lips closed position thing, it’s quick.

One more thing that has nothing to do with communication, but is just too awesome to not mention: I steamed some carrots for Dale Jr, but then couldn’t get him to eat them in pieces, so I ended up pureeing them. I added them to applesauce, and he ate them just fine. Hmmm… how would the J-man react? I am proud to say that he now eats applesauce with pureed carrots (OR pureed butternut squash) AND a dollop of plain yogurt mixed in. I think he may even like it better than the plain applesauce. That makes… NINE FOODS!

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The Second Time Around – Having a Child Not in Therapy

by Tim on March 18, 2010

I realized the other night that the second anniversary of what we’ve called Diagnosis Day is upon us. On that gray, March day two years ago, the doctor said the words “diagnosis of autism”, and we jumped down the rabbit hole into this grand adventure. It’s hard to comprehend how far we’ve come in those two years.

But really it started long before that. The J-Man began feeding therapy at 9 months old. We had an evaluation just before that through our county’s child developmental services agency because he was showing significant sensory aversions not only to food but to all sorts of other things. He seemed ill at ease with many things around him. Something just didn’t feel right to us.

The evaluators referred us to a feeding therapist, and off we went on a road of diverse therapies that’s run the gamut of acronyms and has continued ever since. A little over a year-and-a-half after we started that first feeding therapy, we took the on-ramp onto the autism highway, and here we are.

Dale Jr. is now about 10 1/2 months old. It has been like learning how to parent all over again. He eats everything in the house; there’s almost nothing we give him that he won’t eat. We still catch ourselves being completely amazed by how well he eats. He even self-feeds finger foods. He mimics us, uses a few words and signs a little bit, intentionally asks for some things, and shares his interests with us. He’s proving to be quite a daredevil, he explores everything, and he wants to be the life of the party wherever he goes.

We’ve noted many times how very different they are. It’s a wonderful thing to have two such complex, wonderful, and unique little people in our house!

And he’s about the age we started the J-Man in therapy. This fact isn’t lost on us. We are so programmed at this point to look at every part of our day in terms of the therapeutic that we sort of don’t know what to do when things are just moving along fine with one or both of the boys.

I realized that we’ve been at this a while when I praised the baby for his skillful bilateral coordination and object transference and developing his pincer grasp so rapidly (which is wonderfully useful as he eats Cherrios on his own while we do kitchen chores). I have no idea most times whether he developed any of these or other skills ‘on time’ or not, though from a few years of therapies I know the technical names of many of them.

The term ‘developmentally appropriate’ is usually lost on us. I’m not sure we’d know it if it bit us. Perhaps we’re becoming more at home with the mystery of it all. Our two boys have changed us in very different ways, and we know we have more mysteries still ahead of us than we do behind us.

As they say, “‘Normal’ is just a dryer setting.” We get the privilege of experiencing a completely new parenting adventure, and we have two wise little teachers who will help us learn and value all the diverse and beautiful gifts that make us human. The J-Man does things that boggle our mind. He’s only beginning to manifest many of his incredible gifts, but he has already changed the lives of so many for the good, especially ours. And Dale Jr. is quickly following him down that path.

We have two boys who share perhaps the most important gifts of all. They are loving and kind, they brighten every room they enter, and everyone who meets them loves them immediately. Regardless of where the adventure takes us next, we start from this foundation, from which anything is possible.

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MOAR PUFFS nom nom nom

by Mary on January 13, 2010

When we first heard about Signing Time [affiliate link], it was because I had read about teaching a baby to sign – that it reduced frustration for them to be able to communicate before they could speak. I ended up thinking that all of those children had to be BRILLIANT to be able to learn to sign, because even though the J-man loved watching Signing Time, he couldn’t (or wouldn’t) sign. He didn’t have the fine motor skills to pull off doing any sign that had finger movement or shaping.

The only sign the J-man ever used was “more” and I’m still not sure that he understood what he was asking for. The only time he ever used it was when we were playing a game where we carried him around and stopped suddenly, and he had to ask for “more” before we would move again. So he understood that we would start running again, but I think he just thought the sign meant something like “go.” Once the J-man was able to actually say the “g” sound (for GO!) he stopped with signing “more.”

In the span of something like 5 minutes, I just taught Dale Jr to sign “more.” He was sitting in his high chair eating (also something new this time around), and I asked if he wanted “more” or “all done” – signing each thing. (Our “all done” is like an umpire making the SAFE signal at home plate, because the other way to do “all done” looks too much like stimming for the J-man to ever differentiate.) Dale Jr would open his mouth like a baby bird in a nest, and I would pop in another Gerber Puff, each time signing “more!” before.

Suddenly, when I asked if he wanted “more” or “all done” he clapped his fists together. “MORE” I shouted, and gave him another puff. “More or all done?” Again, he clapped his fists together. “MORE!”

Then, before I could ask the question, Dale Jr looked at me pointedly, and clapped his fists together. “MORE!”

I called Tim downstairs to make sure I wasn’t reading more (heh) into the situation than it warranted, and Dale Jr showed Daddy that he could sign “more” with a bit of resignation – all, “I just want the dang Puff, people, so could you give it to me?”

And, we celebrated.

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A Tale of Two Babies

by Mary on August 19, 2009

[In case you're wondering about the whole 'Dale Jr.' thing, for you non-Southerners, the son of Dale Earnhardt - a stock car racer of Biblical proportions - is often referred to as Dale Jr., but originally his nickname was Little E. So it looks like our Little E is now Dale Jr.! If that made no sense, just go with it.]

It may have been the best of times. It may have been the worst of times. I really can’t tell you. I remember very little of the J-man’s first year. It was really a blur. I was SO TIRED all the time then that now, when Dale Jr does something, I ask Tim if the J-man did that too… because I truly can’t remember. So, for your reading pleasure, a comparison of the two so far:

Sleep:

J-man: what’s that? Why would you think I needed to sleep? I have to be up to eat every 2 hours anyway, so why would you force me to try to nap (for 25 minutes initially, although we did get that number up to FORTY WHOLE MINUTES)? I sometimes will only sleep while in a carseat with the car moving, so Daddy perfected “driving naps on 540.” Also, putting me down “drowsy but awake?” HA HA HA HA HA. Seriously, just nurse me to sleep, then hold me for at least another 30-40 minutes to make sure I’m really asleep, then carefully, carefully, carefully put me down, leaning your whole upper body into the crib so we are touching until the very end. Plan to be back soon! If I make a noise, or shift slightly, go ahead and get up, because I will be. I was still waking every 2 hours at 7 months, and didn’t sleep through the night until I was 18 months old.

Dale Jr: obviously read those “sleep books.” I love this. I love my crib. Is my thumb there? Then we’re good. I started sleeping 10-12 hours straight per night at 2 months old. I am the poster child for “put me down drowsy but awake” which Mama figured out only because she really had to go to the bathroom, so put me down in my crib for just long enough to do that… and I was out when she came back. I enjoy napping, and have been able to self-soothe from the beginning pretty much. Mama and Daddy spent several nights waking up to make sure I was still alive because they couldn’t believe a baby could sleep that long.

Eating:

J-man: I will nurse and nurse and nurse and nurse and nurse. And hate the bottle. And nurse and nurse and nurse and nurse and never let go even while sleeping. PS: and nurse.

Dale Jr: I nurse when I’m hungry, and then I’m done. I don’t especially like to go to sleep nursing. I have taken a bottle a few times, and seem to be OK with it. I DO nurse about every hour during the day (when I’m not sleeping) but since I don’t nurse at all during the night, Mama is perfectly happy with that.

Size:

J-man: I am HUGE and outgrew some clothes before I ever got to wear them.

Dale Jr: I am HUGER and outgrew a LOT of clothes before I ever got to wear them. Also, I’m out of sync with brother’s clothes sizes, so the hand-me-downs aren’t helping at all. Also, I’m growing out of the 9 month summer clothes that Mama bought when I was 2 months old because I outgrew the 6 month clothes she bought when I was 1 month old.

How Mama’s work is going:

J-man: I occasionally made Daddy drive me to Mama’s office because I would go on bottle strikes and refuse to eat. I ate enough during the day to not starve to death, and then nursed until I could not nurse more at night which made Mama tired. People in Mama’s office got very angry when she went to pump every 3 hours. Mama is surprised she didn’t wreck driving to work everyday in a daze state from lack of sleep.

Dale Jr: Mama’s work people have heard me on conference calls because sometimes I need to eat, and are perfectly fine with that. They also realize Mama gets way more work done now that she’s home.

How Daddy’s work is going:

J-man: Daddy doesn’t get to work during the day. Ever.

Dale Jr: Daddy can work while I nap. Sometimes.

Maybe now is the best of times. It’s not the worst of times. It is a good time.

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Shining More and More! Quarterly IEP Report

March 31, 2009

In our last IEP goals recap from last quarter, the J-Man had a great nine weeks overall and showed great gains. This past quarter just ended last Thursday, and our little superstar continues to make great strides toward what we thought were some pretty ambitious goals for this year. As a refresher for those curious [...]

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What’s Your Autistic Toddler Like Now? (Part 2)

February 22, 2009

This is Part 2 of our series “What’s Your Autistic Toddler Like Now?”, a journey through what’s happening these days in the life of our autistic 3 1/2-year-old son and sequel to our very popular original article, “What’s Your Autistic Toddler Like?”. Note: Wherever you see “DSM-IV” below, this means that attribute is part of [...]

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