Stubborn child

Our child has an eating disorder...and a drinking problem.

From the very beginning, even though she was great at latching and breastfeeding correctly, Camille has never been a good eater.  To boot, she does not know how to get liquids from any source except for...me.  I've already ranted about that here.  These two issues make for a big source of stress for me.  She is getting skinnier and skinnier.  And as I anticipate going back to school next month (yes, next month already!), I feel sad and frustrated at the thought of her not being able to drink from a bottle or a cup.

A good friend of mine (thank you, Caitlin!) suggested pediatric occupational/physical therapy as an option to transition Camille to a bottle or sippy cup.  I made an appointment a few weeks ago and we were able to be seen today at Seattle Children's Hospital!

The person that we saw was Gayle Bonato, MPH, PT, IBCLC OT/PT (yep, a full bowl of alphabet soup after her name!).  She was so personable and I felt like I could trust her right away.

First thing she said was, "I just reviewed your file (showed me the file and exactly what was written) and, I gotta say, I'm a little scared of your girl."

She should be!

I discussed what I've tried:

• Bottles/nipples (slow & fast flows): Dr Brown, Avent, Born Free, Tommee Tippee, Green to Grow, and some other random brands.
• Pacifiers: Born Free, Playtex, Nuk, Gerber, Soothie, and I'm sure a few more brands.  
• Sippy cups: Born Free training cup, Nuby sippy cup, Playtex Disney Princess sippy cup, Tommee Tippee Explora water bottle, and the Ikea Smaska training cup.  
• Little shot glasses to big tall grown-up glasses.

I have had success with none of these.

Don't be fooled, friends. She's only playing with the bottle.

Gayle asked a few more questions about breastfeeding and solids and my expectations.  She established that my concerns (and goals) are:

1. Camille not [effectively] taking fluids from any source except for me.  Goal: For her to take fluids from a bottle or cup before I go back to school.
2. Camille not gaining a lot of weight (this is a much smaller concern).  Goal: Fatten the girl up!

Then we jumped straight into "let's try out some things" mode.

We put Camille in a high chair.  Gayle diluted the pureed food with my expressed milk - half and half - and she started feeding it to Camille with a spoon.  She took it okay.  Then Gayle tried feeding her from a flexible soft cup.

"Wait, wait...what are you trying to do?!"

The cup looks something like this:

"Flexi-cut nosy cups"

See? It's flexy!  For easy feeding.

Camille was moderately hungry so she took it very well.  Gayle was amazing at taking all the tiny windows of opportunities when Camille would be open to drinking/eating!  She gave me great pointers on how to look for these opportunities.

"Hmm...not bad."

And then after about 5 minutes and a lot of tactics to keep her interested...

"Um, so, where's the boob?"

And then melt down.

So I nursed her and everything was better.

Before I started nursing her, though, I wiped Camille's face and she expressed that she did not like that.  Gayle asked me if she hates getting her face wiped.  I said yes.  She asked if Camille hates getting water on her face.  I said yes!  She then told me that this was not uncommon in babies, but it isn't typical.  (What?  Is it really?  I thought all kids hate water in their face.)  She recommended a few things to distract Camille and train her to be better at having water run down her face.

Anyhow, at the end of the visit, we established these objectives:

1. Gradually diluted the solids that we are currently feeding Camille with expressed milk.  We will eventually get to the point where it's just expressed milk.  Do this almost immediately after I breastfeed her.  After she's had her fluid, everything is fair game.  She can have her solids in varying consistencies (e.g., thick purees, finger foods, etc.).  This is because Gayle noticed that after she has been given something solid, she is no longer interested in going for fluids.  
2. Adding formula and/or oil and/or butter to Camille's feeds.  This will enrich the expressed milk and fatten up her meals.  She also gave me some handouts of foods that are dense in calories.

Gayle will call me in two weeks to check in.  She gave me a couple of the flexi-cut nosy cups, a couple of spoons, and an Avent Feeding Bottle Set (because I like "free" stuff!).

I felt very good about this visit.  I feel like there is a lot of work to be done.  More pumping, more mess, more stubbornness from Camille.  But hopefully it will all be worth it!

Stay tuned for updates in a couple of weeks...