Posts Tagged ‘appetite’

Making Up Lost Time and Lost Weight, by Richard Kahn, M.S., Registered Dietitian

Monday, February 6th, 2012

Feeding developmentally delayed or premature infants and children can be complicated. Some reasons for complications can be the gap that arises from the bonding time lost to the NICU, or communication challenges related to delays that confound even the best parents. The emotional and physical bonding is often more challenging.

Premature birth or delays intertwined with concerns about feeding and weight gain can mark the life of child and parent. Daily feeding problems disrupt family life. The idea that children will not starve themselves is hardly consoling. In extreme cases, this comment is not even true. In most cases, the most bedeviling feature is the busy child engaged with everything except food.

The mother of one my current patients missed that time as she watched her busy son have trouble eating and gaining weight. She called it “lost time.” It that made her feel distant from her child when it came to feeding. Her son was born about 1 month early and, one year later, mom still missed that time. Little children often experience the same disconnect as the parent, and this disconnect further decreases their interest in food. More bonding was needed to interest her son in more calories.

The child’s development also presented challenges. By this child’s sixth and seventh adjusted months, he did not meet the developmental milestones of cup use and finger feeding associated with that age, despite the absence of any fine motor problems. The speech therapist and I made some progress with the feeding and offered nutritional information and developmental guidance. The guidance consisted of ways to help mom, dad, and baby connect with games and modeling, to helping their son eat in an age appropriate way. Mom began to feel more connected, more food went in, and the rate of weight gain increased.

A crisis arose when an old ulcer acted up. Stomach pain dulled the child’s appetite. Medications quickly resolved the ulcer but two mild illnesses occurred, one right after the other. As expected, the illnesses kept his appetite depressed and months of gain vanished in 4 weeks. Mom knew she could not force feed but her sense of failure as a mother made her very sad and increased her sense of disconnection. Her grief was exacerbated by the advice of the pediatrician, speech therapist and me that she wait out the illness. At this point, mom verbalized her sense of alienation, which she dated to that “lost time.” We therapists were worried, because as parents become distressed, children often respond with a depressed appetite. They feel the loss of connection when the parent’s feelings turn inward instead of outward towards them. Meanwhile, her son was on the mend and began to return to bottle feeding, but it was unclear about mom’s response to the recuperation.

I suggested she place him on her lap against her belly while humming as he was bottle fed. She had already moved from using television to recorded music as a distraction. I felt that now, with humming, she and her son could begin to reconnect and gain back some of that lost time. The physical connection soothed mom and baby. Perhaps, redressing some of that lost time by helping him grow while enveloped in her lap, returned him to the muffled sounds heard inside the amniotic ocean. With that, the session ended. A few weeks later, mom was happy. Her son’s weight was up and I am looking forward to the next steps.

Richard is a Registered Dietitian offering nutritional services for children between 6 months and 5 years of age. His interests are feeding problems in typical and atypically developing children experiencing pickiness, refusals, failure to thrive or other weight gain concerns. His work is based using developmental, play and family strategies to address eating problems in families with young children and children with developmental delays. He is currently researching a method to help parents wean their children off the bottle. He can be reached at: [email protected] and by phone at 917-232-5373. www.brooklynlearning.com

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