Many of you who read this blog probably already heard the big news about the feeding eval, but I'll share some of it for those of you who haven't...plus, my OC(D) need to document forces me to...hahahaha. I'll say up front that I wasn't thrilled with our evaluation and spent a fair bit of the past week fuming about it, but I'm feeling a little calmer now and hopeful that comes across in my writing. And I'll try to keep this brief...I hope.
We met with a pediatric nutritionist, a speech and language therapist, an LCSW (who did not impress me to say the least, but I'm not an LCSW so who knows), an occupational therapist and a pediatrician who specializes in gastrointestinal and feeding issues. They took weight/height measurements and proclaimed that she was 22lbs 4oz (3-5th%) and 30.75in tall (below 0%) with her clothes on, although she is EXACTLY proportional, which is good. She also told me that after reviewing the feeding journal I submitted to them, that Reese is only getting about 75-80% of the necessary calories for a child of her age/size. Not good. Then they interviewed me and Reese based on the intake packet I submitted to them two weeks ago. Of course Reese put on a little show for them and walked around on her tippy toes...for goodness sake Reese, please don't do that or they'll have us labeled with more than we need to be labeled with right now. Then the team went behind the mirror and watched as Reese and I "ate lunch together" at a little table and chairs. I had brought about 10 different foods, some that she likes and some that she doesn't, and they were watching to see how we interact, how she reacts to the foods, how she eats/chews/swallows, etc. After that we met with the pediatrician and then the team came back and gave us their findings and a preliminary treatment plan for us to follow at home.
So here's the bad news. She was diagnosed with Sensory Disorder and Feeding Difficulties and Mismanagement....yeah, can you see my HUGE eyeroll on that last one. My personal (and professional since I kinda think I'm actually more qualified to say so than half the people we met with) is that a few minor behaviors of Reese's (and mine and daddy's) distracted the team from the actual issue at hand. And I was given a list of high calorie foods to give her and a list of things they would like us to do with her for the next few weeks. I (nicely, yet firmly) advised them that if I was able to get her to eat high calorie foods of any type (other than cheese doodles), I would have no need for the evaluation. I also at this point in the eval advised them of what I do (I'm not going to spell it out here, but most of you know anyway) and that I do have a fair bit of knowledge in this area...thus, the feeding tips they have given me have already been implemented consistently for the past year with results equaling nada. What I'm looking for is help with the sensory issues so that we are hitting these issues both at home and in therapy and can hopefully nip this in the bud. Then they told me that our girl has a strong personality and that this is what is causing the problems (oh, for f$!%'s sake!). They finally agreed that occupational therapy is probably going to be in her future, as well as possibly behavioral therapy (good grief), but for now we are supposed to follow the pediatrician's orders and come back in a few weeks/months when they call us.
Ok, so on to the somewhat good news and what the pediatrician told us. She was by far the most reasonable and helpful of the bunch and agreed that the behavioral issues may be an issue, but the sensory issues are going to need to be addressed in order to make any real progress. She has a hypothesis that Reese may have silent reflux and that it is the reflux that is causing Reese not to eat enough. She does not show any of the typical or obvious symptoms of reflux, but she has 3 mild issues that MAY be related to having reflux. (1) She has food quantity limitations, meaning she can't eat much at one sitting. The pedi said that this may be an unconscious method that Reese uses to prevent being in pain from reflux, and was interested in the fact that Reese never ate/drank much milk at a time as a baby. (2) She has a strong preference for salty foods, which ultimately stimulate the salivary glands, thus diluting the food/acid in the stomach. She stated this is often seen in children with reflux. (3) She has ginormous tonsils. So, what we always thought was just poor genetics from my side of the family, may in fact be tonsils that are being aggitated by acid from reflux. And she agreed...they are ginormous! Based on these three odd and unrelated issues (I felt like I was with Dr. House), she is prescribing a pediatric antacid for two months to see if there are any changes and to rule out the possibility that all of Reese's problems are medical rather than behavioral or developmental. Her opinion is that if Reese does in fact have reflux, this medication will over time help her to eat larger quantities of food (even if it's just more milk/pediasure mix) which will boost her calories. This will not help with the sensory issues other than to possibly help Reese feel more comfortable trying foods that she has somehow decided will cause her stomach pain.
So that's where we are at. Once a day antacid for our girl, continue with the behavioral treatment plan that we have already been doing at home, a follow up in two months with the specialist pediatrician, and possible occupational therapy in the next few weeks/months. Tomorrow I have Reese's 2 year well visit at her regular pediatrician's office and will be discussing all of this with her as well to see what her take on it is. I'm glad we started this process and that even though some of the results were bogus (in my opinion), we have a plan...sort of.
We met with a pediatric nutritionist, a speech and language therapist, an LCSW (who did not impress me to say the least, but I'm not an LCSW so who knows), an occupational therapist and a pediatrician who specializes in gastrointestinal and feeding issues. They took weight/height measurements and proclaimed that she was 22lbs 4oz (3-5th%) and 30.75in tall (below 0%) with her clothes on, although she is EXACTLY proportional, which is good. She also told me that after reviewing the feeding journal I submitted to them, that Reese is only getting about 75-80% of the necessary calories for a child of her age/size. Not good. Then they interviewed me and Reese based on the intake packet I submitted to them two weeks ago. Of course Reese put on a little show for them and walked around on her tippy toes...for goodness sake Reese, please don't do that or they'll have us labeled with more than we need to be labeled with right now. Then the team went behind the mirror and watched as Reese and I "ate lunch together" at a little table and chairs. I had brought about 10 different foods, some that she likes and some that she doesn't, and they were watching to see how we interact, how she reacts to the foods, how she eats/chews/swallows, etc. After that we met with the pediatrician and then the team came back and gave us their findings and a preliminary treatment plan for us to follow at home.
So here's the bad news. She was diagnosed with Sensory Disorder and Feeding Difficulties and Mismanagement....yeah, can you see my HUGE eyeroll on that last one. My personal (and professional since I kinda think I'm actually more qualified to say so than half the people we met with) is that a few minor behaviors of Reese's (and mine and daddy's) distracted the team from the actual issue at hand. And I was given a list of high calorie foods to give her and a list of things they would like us to do with her for the next few weeks. I (nicely, yet firmly) advised them that if I was able to get her to eat high calorie foods of any type (other than cheese doodles), I would have no need for the evaluation. I also at this point in the eval advised them of what I do (I'm not going to spell it out here, but most of you know anyway) and that I do have a fair bit of knowledge in this area...thus, the feeding tips they have given me have already been implemented consistently for the past year with results equaling nada. What I'm looking for is help with the sensory issues so that we are hitting these issues both at home and in therapy and can hopefully nip this in the bud. Then they told me that our girl has a strong personality and that this is what is causing the problems (oh, for f$!%'s sake!). They finally agreed that occupational therapy is probably going to be in her future, as well as possibly behavioral therapy (good grief), but for now we are supposed to follow the pediatrician's orders and come back in a few weeks/months when they call us.
Ok, so on to the somewhat good news and what the pediatrician told us. She was by far the most reasonable and helpful of the bunch and agreed that the behavioral issues may be an issue, but the sensory issues are going to need to be addressed in order to make any real progress. She has a hypothesis that Reese may have silent reflux and that it is the reflux that is causing Reese not to eat enough. She does not show any of the typical or obvious symptoms of reflux, but she has 3 mild issues that MAY be related to having reflux. (1) She has food quantity limitations, meaning she can't eat much at one sitting. The pedi said that this may be an unconscious method that Reese uses to prevent being in pain from reflux, and was interested in the fact that Reese never ate/drank much milk at a time as a baby. (2) She has a strong preference for salty foods, which ultimately stimulate the salivary glands, thus diluting the food/acid in the stomach. She stated this is often seen in children with reflux. (3) She has ginormous tonsils. So, what we always thought was just poor genetics from my side of the family, may in fact be tonsils that are being aggitated by acid from reflux. And she agreed...they are ginormous! Based on these three odd and unrelated issues (I felt like I was with Dr. House), she is prescribing a pediatric antacid for two months to see if there are any changes and to rule out the possibility that all of Reese's problems are medical rather than behavioral or developmental. Her opinion is that if Reese does in fact have reflux, this medication will over time help her to eat larger quantities of food (even if it's just more milk/pediasure mix) which will boost her calories. This will not help with the sensory issues other than to possibly help Reese feel more comfortable trying foods that she has somehow decided will cause her stomach pain.
So that's where we are at. Once a day antacid for our girl, continue with the behavioral treatment plan that we have already been doing at home, a follow up in two months with the specialist pediatrician, and possible occupational therapy in the next few weeks/months. Tomorrow I have Reese's 2 year well visit at her regular pediatrician's office and will be discussing all of this with her as well to see what her take on it is. I'm glad we started this process and that even though some of the results were bogus (in my opinion), we have a plan...sort of.
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