Children grow up in body and mind even when they are affected by some kind of delay or medical conditions. When a medical or developmental problem masks signs of inner maturity, the drive to grow remains. The drive to self feed, for example, exists even when most people miss the child’s cues. In the parents’ mind, the child remains, unconsciously, immured in the NICU, the disease or the technical definition of the delay. Professionals inadvertently contribute to this feeling when they focus in on limitations.
When a growth problem hard to understand, parents and professionals often focus on food instead of the processes related to eating the food. The important adults should the child as a whole person with a desire to grow into increasing mastery. When the child is kept from mastering of self-feeding within their limitations, feeding struggles and refusals can start because the child does not yet recognize the delay. Children, especially infants and young toddlers, only recognize their desires. When we do not recognize others’ desires, emotional disconnects develop. In the case of feeding, mealtimes can be unsuccessful nutritionally and socially. Here is what happened with Pearl, an underweight toddler with a transplanted liver.
A long list of drugs suppressed Pearl’s immune system in order for her new liver could make itself welcome in her body. The same drugs, though, irritated her mouth, throat, intestines and suppressed her appetite. The very lifesaving medications were one reason Pearl was underweight. To make things more challenging, Mary, the mother, and, Tom, the dad, were working through a difficult divorce. Dad was out of the house. Loss of a parent and the stress of a divorce can also a make a child want to eat less. And, no one had told Pearl’s parents that keeping her from self-feeding caused Pearl to fight feedings.
Mom, a nurse, understood that drugs can lower the appetite. It was hard, at first, for her to understand that an underweight with medically-induced reasons to a poor appetite should not be force fed, let alone to self feed. The daily feeding struggles further diminished Pearl’s appetite. Mom was inwardly experiencing the vulnerable baby and not the child strong enough to fight her way back to health and mom during feedings. Mom had to grow past the challenging baby months to become the mother of an increasingly healthy toddler capable of asserting her own desires.
Another area of infantilizing was the little child’s table. Children do better watching grown-ups Infants and young toddlers need adults or at least an older child to model self-feeding in order to eat well. That common piece of furniture had to go.
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The struggles ceased. Pearl began to gain weight. Her need for medicines decreased as her body adapted to the new liver. Sessions decreased from twice a month, to monthly to every other month. I was getting ready to close the case. A call came. Pearl’s weight plummeted. That nice healthy growth curve that took months to achieve sank like the Titanic. What was the iceberg, I wondered? I rushed up as soon as I could.
By chance, I arrived as mom was taking Pearl to the school bus in a stroller. Pearl and her mom lived in a high rise whose set-back entrance felt like a mile to the bus to mom who had to be at work on time. Pearl could do the walk, albeit at toddler pace. At the same time, a working, single mom definitely is busy. Those few extra morning minutes provided by the stroller could make a big difference in terms of getting to work on time. Looking at the stroller, then, looking at Mary, I said, “Are you babying her again?” I saw an abashed face with an acknowledging smile. Mom had backtracked on Pearl’s self-feeding and other parenting strategies we had worked on. We all got back on track. Pearl’s weight climbed back into the healthy range.