Thursday, May 24, 2012

Yes, I'm Paying My Kid to Eat


I use money liberally to reward and create incentives for Cooper.

(Go ahead, think what you want about my parenting skills. But please just read this first, and then sit with my child and patiently try to get him to expand his palate, night after frustrating night.)


We used to dole out toys (Thomas the Tank Engine trains and vehicles from "Cars" and "Cars 2" were frequent incentives used during the toileting process) but now that he's into LEGOs, there's only so much in the $4.99 and below price point that a company can manufacture during any given year.

So that leaves cash. Which I favor since delivery requires neither payment of sales tax nor shipping and handling charges.

Marc and I are grateful to Cooper's wonderful team at school for supporting our efforts to expand his diet beyond pizza, chicken nuggets, and Annie's Shells.

Since he responds well to incentives, somehow I managed to promise him $20 if he does good cooperating and participating when someone from his team (usually the occupational therapist) offers him a new food at school between mid-May and the end of the school year in June. This averages out to about $4 per week. I don't know if that's a fair amount. It's hard to get a sense of how much is fair when most people don't have to pay their kids to eat. 

Such is life with Mr. Happy-Go-Lucky, my favorite special needs kid.

We did a lot of this food exploration business last year in kindergarten. He'd eat a food at school (I don't know if that meant he took one bite or 25) and then refuse to eat it again at home. So we had a big gap between what he'd do in one place vs. another (the technical term is carryover, which I think is a neat word).

Or he'd eat 1-3 bites of a new food at home, profess that he liked it, and then refuse to eat it anytime it was subsequently presented to him.

This one step forward, 45 steps backward thing of his makes my life fun.

So I'm trying to encourage carryover by paying him to eat a food multiple times. For example, if he eats a portion of a new food (such as an entire piece of bread), he gets 25 cents the first four times he eats the new food.

We're on Day Three of this program, and I realize now that I forgot to credit him for the bowl of Annie's Shells that he ate tonight ("real aged cheddar" is a different flavor from his standby favorite of white cheddar, so it counts as a new food).

This is a child who will eat only ONE BRAND of ONE TYPE of strawberry yogurt. This particular brand is of course no longer sold at the convenient grocery store down the hill from us. Fortunately he has agreed to allow another brand of strawberry yogurt to cross the threshold of his mouth without protest. This brand is available at the convenient grocery store down the hill. Maybe in a year he'll agree to try regular yogurt (not the kid-branded stuff such as YoKids or Danimals Crushers). A girl can dream.

We have spent hours trying to figure out why he is such a picky eater. There's the autism, sensory issues (foods have texture, smells, temperatures, and of course, tastes), and low muscle tone problems that made it difficult for him to even use his mouth to chew and swallow.

Typically developing children usually imitate others, especially their parents, and therefore have an interest in what is on a parent's plate.

Not in this house.

Instead, we have a delightful person who appears to not want to try anything out of fear that he won't like it and there will be an unpleasant taste in his mouth afterward. At least that's what we've surmised, since he gets upset when we try to ask him about anything involving food and his preferences.

Apparently, it's not unusual for kids with ASD to refuse to try new foods, insist on eating a limited number of foods, have rules about how the food must be presented on the plate (such as not touching), be selective in what textures they'll eat, and cause disturbances during meals.

I'm guessing it's also not unusual for parents of kids with ASD who exhibit some or all of the above behaviors to want to cry in frustration. At least this one does.

The concept of a meal being a fun communal experience with one's child is shattered when said child loses interest in trying new foods at 20 months and protests by coughing, batting away the spoon or fork, or throwing the food onto the floor.

In Cooper's case, we did an oral-motor evaluation when he was 25 months old and learned that he exhibited open mouth posture with drooling and had decreased muscle tone in tongue. He was unable to swallow liquids from a cup with lip closure or do at least three suck-swallows in sequence when drinking without pausing.

He was also oral-defensive, meaning he’d scream bloody murder if you tried to touch his cheek, let alone put a toothbrush inside his mouth.

The evaluation also noted an intermittent diagonal rotary chewing pattern (whatever that is, it must be important). At the time, Cooper didn’t use his tongue to clean food from the upper or lower lip. (Um, gross, but not his fault because the weak muscles in his tongue needed to be taught how to move around his mouth and do a better job of tongueing.)

I've lost track of how much money we've spent buying food for him to try that he just rejects and we then have to throw out. I know we've spent at least $1,500 on oral-motor therapy and special products to help strengthen the muscles in his mouth, which is a lot of money but was absolutely necessary because he deserves to have a chance to have functional muscles in his mouth, even if he despises the process by which he acquires them.

It's hard to get excited about the progress, because we never know if it will continue.

That said, we had a good week: he tried a new cereal (Cascadian Farms Chocolate O's) and gobbled down an entire box of Annie's Shells & Real Aged Cheddar (good stuff, I have to say. I got the stink eye when I had a small bowl myself!).

Maybe one day my kid will eat
- a banana
- an apple
- a sandwich (even a cheese sandwich!)
- a real piece of chicken that isn't a nugget or a tender
- a carrot
- a salad (the flavors!)
- a steak
- an egg (any form, as long as it's cooked)

I'll keep you posted!