Drink Formula, Eat Banana

We had a very happy little guy at dinner tonight. Nathaniel ate orally. And he loved it.

I had one overriding thought when the team in Cincinnati told me we could start oral feeds - "I want this to be simple." Advocating for someone's safety is hard work. Watchful waiting for three years is stressful. As we find a new routine to life post surgery, we are just beginning to see how much strain our whole family has lived with for a long time. Intense feeding therapy is the last thing I want to start right now.

When Nathaniel discontinued oral feeds, we decided to keep him at the family dinner table. He prayed with us. He listened and participated in our conversations. He received his g-tube feed while we ate. Almost nightly, he would reach for our silverware, plates, and glasses. It broke my heart. Often he ended the meal with someone's fork or spoon in his mouth. We kept his oral stimulation toys and other quiet activities available, but I think holding and pretending to use a utensil, even without food, gave him pleasure and helped him feel like he belonged.

For the last few weeks I have thought a lot about how to introduce oral feeds as natural and simple as possible. How can I build on what Nathaniel is already doing at meal times? How can I respect the fact that while we have to start with purees like an infant, Nathaniel is three? How can I offer him control of this process and help him feel like a preschooler rather than a baby? I asked young moms about transiting their toddlers to self feeding and tools they found useful. I consulted briefly with our therapy team about whether we should jump into feeding therapy or try on our own first. I read online. I shopped. I selected an ez pz bowl, OXO Tot Training Fork and Spoon Set, and IKEA POKAL Snaps Glasses, and infant wash clothes as napkins.

Last Thursday, I started offering Nathaniel very small sips of his g-tube formula from his little glass. This felt like a very safe place to start as I know his digestive system is used to the product, and I could just help him focus on the fine motor and oral skills of drinking. He did very well. The small IKEA glass is perfect size for him to hold. I decided to jump over using a sippy cup and offer Nathaniel a real glass to respect that he is older and would want to be like the rest of the family. It also allows for slower swallowing rather than the chain swallowing kids often do with toddler cups. Nathaniel struggled to develop a suck swallow pattern in feeding therapy in the past. Drinking from a glass just seemed like an easier place to begin. It was for many reasons, one is that the clear glass allowed me to see what he was doing with his lips and tongue and how fast the liquid was going into his mouth. After a couple times of me sort of pouring the formula into his mouth, he took control. After four days, he is trying it one handed. Yes, a glass has been thrown to the ground once. It did not break. I am sure one will at some point. It will be a teaching moment. 

As we introduce foods, we need to avoid the six common food allergens. I will be making Nathaniel's purees and food so that I have a lot of control over the ingredients and the textures.  We had a super busy weekend and I did not get to store to buy the sweet potatoes that I planned to have prepared for dinner. At four o'clock, I considered skipping the idea of starting today. But then I realized we had a lot of bananas. "I want this to be simple," I reminded myself. I mashed half a banana. 

Nathaniel was delighted with the whole idea of eating from the moment I set his bowl down. By the way - the ez pz bowl was amazing! Many thanks to Nathaniel's big sister for telling us about the product. Nathaniel has a lot of skills to learn quickly - fine motor and oral. The last thing we need to worry about in this process is a suction bowl that flies off the table when he pushes slightly too hard against it. The ez pz silicone bowl/mat combination was worth the small financial splurge. The photos below show his progression of self feeding through the first few bites. Very quickly, he learned to pivot his wrist and insert the spoon straight. 

I was very hands off the eating process tonight. I poured sips of formula for him when he pointed to his cup and signed more. I offered his napkin and demonstrated how he could wipe his hands. I am pretty sure letting him experiment and have a lot of control will be the best approach for Nathaniel. From a medical stand point, it was smooth sailing. No gagging. No difficulty swallowing. He drank about an ounce of formula and ate half a banana. He did cough a couple times, but I think it was due to a respiratory virus he's been dealing with for a few days; Nathaniel's brothers each had a minor cold in the last week. We had to wipe clear snot from his nose before it dripped into his bananas a couple of times.

Starting to eat orally gives us a lot of new words to add to the talker. I added BANANA to his EAT page and used it often while he was eating in hopes that he will quickly learn labels for favorites items. Did I mention he has a lot of new skills to learn? My sweet three year old did not know what a banana was until tonight. So much fun to see these changes for him. I opened DRINK and many words under the DRINK main screen: DRINK, FORMULA, FILL, FULL, EMPTY, SWALLOW, POUR, and SPILL.

I am really looking forward to all the spills. It means Nathaniel has food.