Day Fourteen: Monotone, Adding Drinks and Stalling

Monotone: One of the skills you have to develop as a feeder is a monotone voice and being able to go back and forth from monotone to super excited. This has been a challenge for me and so the psychologist went over the reasons for it which I found interesting. One reason (and I had been told this one) was to show distinctly and without question the request from the reward. The voice is a good way to do this. The request should never be reinforcing by itself. Reinforcement should only come with compliance. The second is that in our normal "dealing with children" state we naturally put on our Mommy singsong voice. If you say "take a bite" in a mommy singsong voice, it sounds more like "take a bite, if you want." Try it and you can hear it. If you talk monotone (although it sounds harsh because we are used to mommy singsong with our children) it simply becomes what it is, a prompt, not forcing, not pleading, not coaxing, just simply a statement of on what the correct behavior is and periodically what will happen if they comply also done in the monotone voice. The third reason the psychologist shared with me she said she doesn't necessarily tell all parents. (The above reasons are sufficient.) She said there have been studies done with children who have had a lot of medical procedures, therapies, etc. and they've found that the encouraging voice actually causes the child's stress reaction to increase. I presume this is because they associate it with their medical procedures that aren't so pleasant. So we avoid that as well using the monotone prompt.

First Session: We started out this morning with blended pancake. He was playing with the shape sorter and watching Max and Ruby which he enjoyed at first. He gagged a few times and about halfway through he stopped eating. His refusal went on for 11 minutes. Lots of crying, turning, pushing away from me, and hitting the spoon. I was trying to hold his chair with my legs act fascinated with Max and Ruby, and deflect blows again. ZZ started laughing at his own hitting and so the ST told me to put down the spoon and just play. I started finding the hidden balls in Caribou and he finally started to be interested in that since I was down to only one ball left, so she told me to try the bite again. I turned him toward me and firmly put the spoon up to his mouth told him to take his bite and he could look for the last ball in Caribou. Amazingly he took his bite! We were down to the last 40 seconds after an 11 minute stand-off. So he worked through his behaviors and ended with a success. It was great!

OT went great. She did some upper body and trunk strengthening driving through cones on his stomach with the scooter board, then did more shaving cream play with full participation!

In ST she worked on drinking. ZZ drinks water only. He will taste other drinks and say he likes them but after 1 sip, he always asks for water. I frequently give him a taste of his formula when I pour it into his feeding bag and he willingly takes 1 sip, but no more. He did well for the ST today with his formula so she is adding it to his menu and the rest of the feeding sessions today will include drinking.

Second session - Adding Drinks: ZZ had heard the other little boys parents talk about watching Elmo during his feeding so before we went in we talked and he decided that he wanted to watch Elmo. It helps to have a plan. ZZ also noticed the bunny craft again and decided he wanted to make another bunny to go with Super Bunny, his first creation. So he started out engaged. He was eating potato soup. The bunny didn't hold his attention completely but he did enjoy Elmo so this feeding went pretty well. We added 3 sips of his formula in a row after every 3 bites. I can't remember if it was in the first session or the second but one of the two therapists told me that if he hits the food off the spoon (which was what I was worried about in his hitting) just to refill it and tell him that if he hits his food off, we refill the spoon for his bite. That helped to know what to do so I wasn't so worried about the hitting. He had a few times when he didn't want to drink or would try and take a tiny or even a fake sip. I was told to tell him that he did a good small sip and now he needed to take a big one. There was a short refusal a couple of times during drinks but he worked through it each time.

Third Session: ZZ wanted to watch Diego again and also chose the guitar to play. I think he had potato soup again. Maybe I guessed wrong earlier because they usually don't do two sessions of the same food?? He did well with the bites but we had great long pauses and stalling with the drinks. He wasn't drinking much so the psychologist told me to squeeze the bottle and that gave him more. The drinks are given in a bear bottle (like the honey bottle) with a plastic straw that fits perfectly in the top. This way it can be lightly squeezed as they drink if their sucking skills are lacking. Some of his stalling techniques include coughing, especially into the crook of his arm because we are working on this and he knows I like it. He usually mentions that he covered his cough and looks at me for a "good job." His other stall that he frequently uses is to fake a burp or sometimes conjure up a real one after which he says excuse me and again looks at me for my approval. I have to keep a stone face so usually he tries it several times or in conjunction with the cough. At least I know now that he's got his cough cover and excuse me down. I'll expect it outside of feeding from now on!

Fourth Session: ZZ chose the hidden animal baby puzzle when we went in. I also put on Blue's Clues and kept the instruments handy in case. Partway through the feeding he asked for the toy laptop. I have to say that the toys they have in therapy are pretty fun. The animal puzzle has one piece with an animal home and you pull on a tab to see the baby animal that lives there and then match it with its mommy or daddy. The laptop has various settings but ZZ usually chooses the letters which show the letter he pushes, says it's name, sound and something that starts with the letter which then does something silly on the screen. ZZ likes the silly part. He took his bites really, really well. It was pureed fruit cup. He would have finished but he had a few stand-offs with his drinks and so it took longer. The psychologist had consulted the speech therapist between sessions and she said we couldn't squeeze the bottle. He is capable of sucking enough but is choosing to fake it. So for this session the psychologist put a piece of tape on the bottle to mark the formula so we would know if he was actually taking a drink or not. At first it looked like he was, but looking at the mark we could tell that he was simply sipping a tiny bit and spitting the rest back down the straw as he finished. He's always been very good at faking/mimicing eating and drinking. I don't know how many times I've been told he ate such and such but really he didn't, he just made all the right motions. The psychologist told me to keep prompting him to take a big drink when he did this. Towards the end he was into just chewing on the straw and sort of laughing when I offered him a drink and the psychologist took over for some of the stand-offs when I wasn't getting anywhere. He did eventually take his drinks for her until the last one but there was just a little time left at that point. All in all not a bad session, the drinks are simply a new challenge.