Saturday, September 19, 2015

Caleb struggles

If you know Caleb very well, you know that saying he is a picky eater is putting it lightly.  Caleb is a horrid eater.  He wasn't always as bad of an eater as he is now.  Sure, there were a few things he wouldn't eat, and he was never as great of an eater as the two older kids, but he still ate.  The last year though, we've had a serious struggle.  What Caleb will and will not eat has gotten narrower and narrower.  For the last nine months Travis and I have talked to him about what happens to calves when they don't suck (figure relate it to something he's going to understand) - they get a tube up their nose and their milk goes up their nose to their stomache so they get the nutrition that they need.  I've talked to my pediatrician about these concerns multiple times over the last few years.  He's always assured me that Caleb will eat when he gets hungry and I have kept that as my mantra.

The first ADD medicine that we had Caleb on (Vyvanse) was a stimulant which means it could also act as an appetite suppresant.  Nash had this problem but after some discussuion he realized it was improtant for him to still eat something even if he wasn't hungry.  Nash also didn't want to be taken off his meds if he didn't gain weight which is what would have happened.  This summer we switched Caleb to a non stimulant ADD medication (Metadate).  This medication should not affect his appetite at all.

Knowing how picky Caleb is about his food, I hate having him eat school lunch because I can't keep tabs on how much he's eating.  So, since the beginning of the school year I've been sending him a home lunch.  This is not an easy task.  Caleb will not eat peanut butter sandwhiches.  He will not eat ham sandwhiches.  He will not eat spaghetti-o's or lunchables.  In fact, he will not eat meat...period.  He does not like sauce of any kind.  He will not eat the majority of fruits and generally won't eat any veggies.  He will eat: Pancakes, waffles, french toast, bacon, eggs, cheese quesadillas and go gurt.  Tell me how to pack that into a lunch.  He can't open the go gurts without help and won't ask anyone in the lunch room for help opening it.  If I put any kind of chips or cheetos in there he'll eat those but nothing else.  If I put a drink in he will drink a it and if there are fruit snacks, he'll eat those.  The first week of school I packed him a half of a ham sandwhich, cheetos, a fruit snack and a drink.  He would eat the fruit snacks and the drink and maybe one or two cheetos.

Mind you, the whole lunch thing doesn't sound too awful, right?  I mean, they do eat lunch early at school.  However, take into consideration the following:  Caleb will take 45 minutes after he gets out of bed to get his pants and shirt on.  This leaves him time to eat what he can in the car on the way to school.  That means he either eats a piece of toast or some dry cereal (he refuses to have milk on cereal anyway) or a go gurt.  Not exactly the most nurishing of what should be the best breakfast of the day.  Combine this breakfast with the lunch he just ate.

Now, dinner, well, that's a whole nother problem.  It use to be that I would dish a little bit of everything onto Caleb's plate and I would tell him "You have to eat all of something.  At the very least half of two somethings."  He would fight it for awhile but eventually (when he got tired of sitting there and watching everyone else get up and go) he would eat something.  If he complained I would tell him that I am not a restuarant.  He could either eat what was there or wait until breakfast.  This too, would convince him to eat something.  Now, remember how my pediatrician said he'd start eating when he was hungry.  Well, as of late when I give him his plate he will start complaining about everything on said plate.  When I tell him his options are to eat what's in front of him or wait until breakfast 9 times out of 10, he will choose to wait for breakfast!  Even though he has just said not 5 minutes prior that he was hungry.  Now don't get me wrong, if I make a big breakfast for dinner, he's all over that.  But really, how much nutrition is there in pancakes or waffles or french toast?  He can't eat eggs for every single meal!  If I feed him bacon all the time he's going to have a heart attack at 15!

And that brings us to today.

Last night I went to bed at 11 pm and he was in bed asleep by then as well.  This was early for him - he generally stays awake reading until midnight.  I woke him up at 8 am so he had had 9 hours of sleep.  Should have been plenty, right?  He told me his stomach hurt so I told him to use the bathroom and then get dressed so he would have time to eat some food (he literally only ate 1/2 of a serving spoon of rice for dinner last night).  Caleb proceeded to sit on the bathroom floor for the next 35 minutes.  I walked back into the bathroom for about the 15th time and repeated what I'd already been saying "If you don't get dressed you aren't going to have time to eat before school so your stomach is going to keep hurting.  Hurry and get dressed so you can have plenty of time to eat!"  He just sort of started at me.  At this point I knew we weren't going to get anywhere.  We have to leave home by 8:40 to get to school on time so Nash doesn't end up with all his morning work as homework.  I just looked at him and said, "Caleb.  I don't know how to help you any more.  You won't get dressed so you can eat.  You don't eat and you don't feel well.  You don't feel well and you won't eat.  Just go lay on my bed.  I'm taking you to the dr. today to talk to him about how you eat."  Normally this would elicit a blood curdling scream and a quick response to action.  He sort of looked at me and shrugged like whatever.  I felt defeated at this point.  I got Nash to school and came home so I could teach preschool.  I had moved all my pm kids to the am class so I could haul him into the dr. this afternoon and still make it to work at the grocery store on time.  By the time I was done teaching and could go check on Caleb it was 1:00 pm.  The kid was STILL sound asleep.  He had fallen back to sleep after I went to take Nash to school and apparently didn't move.  I woke him up because by this point he had been asleep for 14 hours which is unheard of - even for him & he's my late sleeper.  We got him dressed and he said he was hungry.  I asked what he wanted to eat and he said toast with cinnamon and sugar.  I went and made said toast.  I did not cut the crust off.  I don't always cut the crust off - they've gotten use to that and will just pull it off if they don't want to eat it.  He finally came in and sat up to the counter.  He pulled half the crust off of one side of the toast and then laid his head n the counter in an attempt to go back to sleep!  He never ate his toast.  He did tell me he had thrown up earlier.  It wasn't true throw up - he's got his croup back and I think he was mostly choking on drainage that was stuck in the back of his throat.

We made it to the pediatrican's office at 4:20 and went in.  When the nurse came and got us they weighed him and checked his height (he's actually up to 40 lbs now and he's 3' 9").  The nurse asked what we were there for and I sort of gave her the run down.  She went out and eventually Dr. Clarke came in.  Dr. Clakre checked him over good and then pulled up his chart.  He showed me his growth chart and miracle of miracles the kid is actually gaining weight.  He's in the very lowest percentile on the growth chart but his numbers are slowly going up on the line.  That was a bonus I hadn't expected.  Dr. Clarke said he wanted to run some labs to check his mono status, his thyroid, his iron levels and his liver.  He said that if all the labs come back normal he wants to try an appetite stimulant.  It was at this point that I pointed out that Caleb is not eating when he's hungry.  That really threw the dr. for a loop - I could see the confusion written all over his face.  He sort of debated what to do at that point and then said, "I don't want to be hasty in getting a feeding tube in him.  Let's check to be sure that there's nothing else physical going on and try the appetite stimulant first.  If that will push him forward and get him out of that I'd rather do that than a feeding tube."  I told him that was fine with me.  He said that if the appetite stimulant doesn't work after a few weeks I will need to call him and there's a pediatric GI down at Primary Children's Hospital that runs a failure to thrive clinic.  I explained to Dr. Clarke that the failure to thrive is my biggest concern.  The number of foods Caleb's willing to eat is shrinking by the day.  Not only that, but the condition in which he's willing to eat those few foods is also changing.  There isn't a single food I can say that without a doubt he'll eat every time.  There are numerous other foods I can promise you that my other children will eat every time you put it in front of them.  I cna't say the same thing for Caleb.  My concern is that eventually he's going to start showing symptoms of someone with anorexia and those are things that are not easily fixed.  I am thinking this because he's starting to show some of the coping mechanisims that people with anorexia use - pushing food around their plate and flattening it out to make it look like they ate more - he does this all the time lately.

I love my pediatrician because he really does listen to me when I tell him what I'm concerned about with my kids.  He doesn't just brush me off.  And, I could tell by the look on his face that when I said he's choosing to wait until the next meal even though he said he's hungry concerns him.  But, we are eliminating the simple things first.  We did the blood draw this afternoon and lab results should be back by Monday or Tuesday.  If they come back normal (I'm assuming they will) I would think that he'll be able to start the appetite stimulant by Wednesday next week.  If we try it for two week sand there's no improvement, then I guess we'll head down to Primary Children's to meet the pediatric GI and get his input.  So for now, we wait....and hope Caleb disliked the blood draw enough today that he'll actually start to eat something!