Hangry

This little infographic shows the typical process we experience when we’re hungry:

Hungry

And this little infographic shows how hunger turns to hanger and how easily the state of hungriness can lead to escalation in our house (and I suspect we’re not alone):

Hanger

I love hangryness, its a real joy.

I’ve previously written about Interoception  and Adopted Children & Eating Issues and Demand Avoidance if you’d like more info than the little bits here that you will no doubt need to squint at (it does look pretty though).

I’m assuming that time and working on interoception are going to help with this. I also need to remember to leave Little Bear a tray of healthy snacks outside of his bedroom door for when he wakes up at the crack of sparrows and none of us are ready to leap out of bed and make him some breakfast. On the occasions when I’ve remembered, it seems to have worked well in terms of pre-empting some of the issues above. Anticipating hunger and regular snacking and routine mealtimes do seem to keep things as calm and even as possible (though don’t actually take away the underlying issues). If anybody else has any clever tricks, I’d love to hear them.

Hangry

Adopted Children & Eating Issues

A really interesting chat broke out on Twitter earlier this week between several adopters. It was one of those chats where you realise that all your children do something that hitherto you didn’t really identify as being an ‘adoption thing’ but actually, now everyone is doing it, it must be. The thing we were talking about was eating. We have quite a few behavioural issues around food here but this chat was more about the mechanical side of things: disruptions to the process of taking a bite of food, chewing it and swallowing it. The chat really began around children holding food in their mouths for much longer than average, something which seems to be common in many adoptive households. We also noticed that many of our children overstuff their mouths and choke more often than you’d expect.

The big question was why? We had a healthy debate and several of us stuck our oar in. As with most complex issues my first reaction was to blog it out so here is my summary of the main factors:

The reason for holding food in their mouth could be a sensory one. It could be that a child is under-sensitive to sensory information in their mouth and can’t ‘feel’ the food there very easily. If this is the case it is likely they would be better at eating/chewing/swallowing food which has a more extreme taste or texture or temperature. Spicy foods or those with a lot of crunch or those which are sharp or bitter will provide the mouth with more sensory information than bland foods, helping a child to ‘know’ it’s in their mouth. The difficulty here of course, is that you child will have their own taste preferences and these will influence the range of food they will eat. I think this category could apply to Little Bear but he really doesn’t like spicy foods. He does like a good crunch though, especially from a crisp, but won’t tolerate it from a raw carrot. He has no difficulty dispensing with cold ice cream!

The converse of this point could also be true: some children are over-sensitive to sensory information in their mouth. These children are often sensitive to different textures finding some pretty disgusting. It’s possible that these children hold food in their mouths because it is preferable to them than swallowing it. Other signs of this could be spitting food out or an active gag reflex.

Often children need to get used to a bigger range of textures before being asked to eat the consistencies of food that bother them. Because of how the sensory system is wired, the next best place after the mouth to explore texture is with the hands (and if they can’t manage this, then with the feet). In typical development, young infants naturally put their hands in their food and explore it. This is an essential developmental step and some older children need support to revisit it to help with eating issues. Sometimes the foods they struggle to tolerate can be played with and explored manually before them being brought close to the lips then perhaps just touching them with their tongue tip. This should be a gradual process (weeks not hours) and needs to be managed sensitively. It should be done with a child, not to them. You can also lessen sensitivity through general tactile work – exploring different materials etc. It doesn’t necessarily have to be done with food though that does work well.

I suspect there is a third sensory category when it comes to eating which would be ‘sensory seeking’. I don’t think you would see food being held in the mouth with this aetiology but you might see over-stuffing as a child tries to get the most sensory input they can. I think you would see a constant need to eat and perhaps wanting to eat stronger flavours/ more extreme textures/ more extreme temperatures. It wouldn’t be a huge leap to think that children who seek oral sensory input would also chew/suck non-food items, though I think it is possible to seek oral stimulation without the food side of things.

However, there are other possible issues at play. What about experience? As most of our children were not with us when they were babies, we have very little information about their weaning. We don’t know if they were allowed to experience the getting messy-putting-their-hands-in-their-food stage. We don’t know what range of tastes they were given or even if the types of food they were weaned on were appropriate for an infant. We don’t know whether that may have led to sensitivities and a greater likelihood of gagging. We don’t know whether they went hungry or whether they were force-fed. All these options could cause potential eating issues now.

We do know though that tastes develop based on experience – the more times you try a food, the more likely you are to like it. We also know that there are ‘windows of opportunity’ within the weaning phase and if children are not exposed to tastes at these points, the window can close.

I strongly suspect that Little Bear hadn’t tried a wide range of foods before he came home. He certainly wasn’t too familiar with vegetables. If children haven’t been exposed to many different tastes and textures, they won’t eat a wide range. Things that are new to them will seem alien and it is likely their first reaction will be of dislike. They are likely to pass these foods around their mouth/ spit them out etc.

Research suggests that rather than assuming they definitely don’t like that food, we should keep offering it to them. Obviously you have to be extremely careful with making children eat foods they don’t want so this is pretty tricky. We used to do a lot of hiding vegetables – in sauces or soups and Little Bear happily took them that way. I also used a bit of good old bribery (some of you won’t like this) e.g. you can have pudding when you’ve tried one bite of x/y/z vegetable. We’ve had good success with this and I’m really proud of the range of vegetables Little Bear will choose to eat now.

The other aspect of experience that is important is that our muscles develop alongside the foods we eat. If we just eat sloppy or dissolvable textures all the time, our chewing muscles won’t develop. Many children who have experienced neglect have low muscle tone in general. Some have such low tone that their face can appear droopy and they need specific stimulation of those muscles to improve the tone, often completely altering their appearance.

I suspect that Little Bear was mainly given a mushy diet in foster care and didn’t experience a range of textures like fish or meat. I have noticed that he is more likely to hold chewier items in his mouth and this could be because his muscles are underdeveloped and chewing is actually really hard work for him. I chatted this through with a friend who is experienced in children’s eating and drinking difficulties a while ago and she suggested building texture up gradually. You can’t expect a child to go from eating Weetabix one week to steak the next. There needs to be a gradual build-up of chewiness. I think this has led to an improvement here. Little Bear will now happily polish off a range of fish, sausages, bacon or chicken (if it’s soft enough). He will eat beef but it is still noticeably effortful for him, it stays in his mouth a long time and can result in it being spat out.

My friend also pointed out that if you aren’t experienced in chewing (or sometimes this just happens randomly) you don’t develop the side to side movements of your tongue that you need to push food from one side to the other as part of the chewing process. She said you can develop this outside of eating by playing games that involve trying to touch a specific item in a specific place with your tongue or just the teeth on one side. I used to add a little game onto the end of tooth-brushing involving Little Bear playing ‘tag’ with his tongue and the brush.

Although I don’t want to get into the behavioural side of things too much, it is also pertinent to consider a child’s general presentation. Do they have difficulties with attention control and concentration in general? Little Bear does. Could it be that he gets distracted mid-chew and forgets he has food in his mouth? I do tend to give him frequent prompts and reminders to keep chewing. I also need to remind him that his mouth is full so he shouldn’t put the next mouthful in yet.

So far, that is quite a lot of possible factors that could be affecting our children’s eating. However, I haven’t really mentioned swallowing/choking and the factors above don’t really explain why some children who were removed from neglectful situations very early or even at birth still go on to have these types of difficulties. Could something be going on in utero?

It’s certainly possible because the bit of the brain that is most developed when a baby is born is the brainstem. This is also the bit that controls basic functions such as eating and drinking. The cortex and higher brain regions mostly develop after birth and are consequently very susceptible to environmental damage such as lack of stimulation. Because the brainstem develops during pregnancy, one assumes it is more susceptible to damage from things that happen in utero than any other bit of the brain. We know that recreational drugs, including nicotine and caffeine, as well as alcohol and stress hormones such as cortisol cross the placenta and impact an un-born baby. I have struggled to find specific research about particular pollutants affecting the eating and drinking areas of the brain but it isn’t a huge leap to imagine it’s possible. Is there something different about the structure or connections in our children’s brains that lead to the types of mechanical eating difficulties we are seeing? Perhaps.

At these points I like to reassure myself with the concept of brain plasticity – the ability the brain has to build new connections and new pathways; to learn to do things it couldn’t do before. I read that the brainstem is less plastic than the cortex but it is still capable of plasticity. Maybe change in the areas it controls is more difficult to achieve and may take longer but I like to think it’s possible.

It seems our random Twitter chat has led us unwittingly into a fairly complex area. My feeling is that this little corner of behaviour is under-researched and I suspect I have raised more questions than answers. If anybody knows of any articles that could tell us more, please send them my way. In the meantime this one was sent to me and I think it’s well worth a read: Article about the impact of trauma on the developing brain

 

 

 

*I probably need to point out that all children are different and will all have been impacted in different ways and to greater or lesser extents by their experiences to date. The reasons given here are just some of the possible reasons and may or may not apply to your child. They are also my personal thoughts and based on my reading only.

 

 

Adopted Children & Eating Issues

Dinner Winner

I have decided while I Am Writing to post some shorter blog posts for a few weeks about some products we have bought recently.

This week’s product is the Dinner Winner plate made by Fred.

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 Meal times have always been a bit tricky here, ever since we first met Little Bear. I suspect his development was disrupted around the weaning stage and when he first arrived I probably should have gone back to basics with introducing solids and different textures. He was over three at that point though and I was pretty distracted by many a pressing behaviour challenge. I did do purees for him and I have fed him on and off since.

Little Bear is six now and at mealtimes, especially tea time when he’s tired, he tends to mess with anything and everything but doesn’t focus his energy on eating. He will clamber over the bench, fiddle with his cutlery etc. but not touch his food. It has always driven us a bit mad but we have tried to be patient and to feed him if that’s what he needs.

I wasn’t looking for another solution but a few weeks ago I was flicking through a therapy magazine and came across these Dinner Winner plates. I immediately felt it would be worth a try because it is essentially a visual support for eating your meal. It evidently struck a chord with the speech therapist in me: it’s such a clever and practical idea and I couldn’t believe I hadn’t seen one before. We found you could buy them on Amazon and one was with us the next day.

There are lots of designs but I chose the superhero one as I felt Little Bear would like that one and it was a bit more grown up.

On the first day, the plate worked like a miracle. Little Bear LOVED it, especially the fact that there is a compartment with a lid for you to open at the end of your meal and hopefully find a treat. I explained to him that you start at the beginning and eat one compartment at a time. There was a risk Little Bear wouldn’t care about the order but he took that aspect very seriously and finished his dinner in record time. I don’t want him to rush but tea it is usually a very lengthy affair so this was a clear improvement.

The second day was similarly wonderful. After that, the novelty wore off a bit. However, I can honestly say that though the plate hasn’t delivered a miracle it has certainly improved things significantly. I think Little Bear is much less prompt-dependent now. Previously I had to prompt every mouthful or load his fork for him but now he does often feed himself the whole meal, without prompts, just with a bit of dithering between compartments. I now wonder whether seeing a whole plate of food was overwhelming for Little Bear and he was having difficulty breaking the task of eating into parts. The plate has done that for him and one compartment at a time is not overwhelming. Also, when one has gone, counting the remaining compartments gives a natural countdown to being finished which seems to help Little Bear with seeing an end to the task. Sometimes we are winning at dinner.

I don’t think the treat at the end would be appropriate for all children, depending on their issues with eating but it does work for Little Bear. One chocolate button seems to be motivation enough.

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On a practical level the plate requires a bit more preparation from me. I tend to serve his food onto a normal plate to check I’m giving him the right quantity and then I need to chop it up and divide it between the compartments. It is a bit more faffy but I feel as though it is worth it. The first meal he had on it was baked potato which obviously had to be modified a bit more than usual!

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Overall I think it’s a fabulous piece of design and a really clever use of visual support. I would definitely recommend it and this is not one of those blog posts someone has paid me to write!

As an added bonus, Little Bear practises his reading on the words written in the compartments. It’s a big thumbs up from me and my little dude.

 

Dinner Winner

Regression

“Get off me” he says, shrugging away from my touch, his body becoming stiff and unyielding. I’m struggling to engage with him in any meaningful way. He’s either zoned out on the IPad or running around slightly manically outside. His concentration span is pretty much zero and despite trying, I can’t get him to sit down and play with anything. He is wetting several times per day. Meal times are equally as challenging. He is struggling to stay seated for more than a minute or two and unless the food is spooned into his mouth he won’t eat. There is little to no conversation; my attempts are met with noises or just ignored. It is hard to find the bond between us. Last night, at bedtime, he looked into my eyes and pinched my face as hard as he could. This evening, before tea, he refused to follow any instructions and when we insisted, there was a punch. He would not sit at the table and when physically stopped from climbing on the back of the bench and pulling on the radio, he said we had hurt him. An angry face, a tense body, a fist raised in threat. A darkness; a distance.

 

“I love you forever” he says, snuggling closer, pulling my arm tighter round him. We sit for a long time, watching the film. Occasionally he leans his cheek against mine or shifts his position a bit so we can cuddle more comfortably. He jumps up. “Pause it Mum” he says, “I need a wee”. We chat about the film and what we might do later. We joke and he laughs a lot. His laugh makes me laugh. At teatime he feeds himself. The next day we go for a bike ride. He rides on the road for some of it and listens to every single instruction given, including ‘turn left’ or ‘turn right’. When we say ‘stop’, he stops. It’s a fairly high risk activity and we trust him to do it sensibly. We have a lovely time. When we get back, he changes his clothes as he’s asked and we sit down to play a building game. We imagine, we build, we chat. We have fun. As I’m getting tea ready, he plays with Grizzly. They play a game with challenges in it – he writes words down, he does simple number puzzles – in between throwing a ball about. There is a lot of laughter. Relaxed body, happy face, relaxed atmosphere. A warmth; a closeness; an enjoyment in being together.

 

It sounds like a description of two different children, but it isn’t. They are both Little Bear. You’d be forgiven for thinking they were two different people though, even in the flesh, the contrast being as stark as it is. The first paragraph is a presentation of Little Bear during a regression, the second how he presents normally. I would say the child I’m describing in the second paragraph is with us the majority of the time, upwards of 80% of the time. But the child in the first paragraph does appear sometimes, usually quite out of the blue. It can be a bit shocking when that happens because we are so accustomed to the second presentation that we almost forget that the first one is a possibility. On the other side of the coin, when we are in a regression, it can be hard to imagine how we will get back to the second paragraph. Is that even possible? Have we imagined that life is usually like that? Where has the close bond with our lovely little boy gone? And most concerning, how is it possible to feel this distant from your own child? What does it mean for the future? As well as several other concerns that can easily spiral from there.

I know from experience that there is no need to be quite that dramatic because we have consistently passed through regressions and back to paragraph two on countless occasions. However, when you are in it and it’s happening, it can be pretty wearing. It can be easy to doubt what you are doing and your ability to navigate the challenges in the best possible way. At those points I generally have to remind myself that although we no longer know the child in the first paragraph very well, we did used to. It was the child in paragraph one who moved in two and a bit years ago and he was the child we lived with day in day out for months and months while he slowly flourished into the child in paragraph two. We do know what to do. We can reach him, despite him seeming unreachable at points.

The regression I’ve described above is quite a severe one by current standards. Usually we can hover about somewhere in a grey area between the two descriptions. It could just be that Little Bear really struggles with toileting for a while or we have a phase of needing to feed him or he loses the ability to sit and read to us. Sometimes it is several of those things and before Christmas it was all of the things, exactly as I have described.

We are versed enough in Little Bear’s behaviour that we can identify a regression pretty quickly now. We also know that something will have triggered it but as I wrote about in Adoptive Parent: Behaviour Detective it can be extremely difficult to figure out what the cause is. The behaviour described above was present for three or four days, getting progressively worse, after we returned from Lapland. I had blogged last week about our trip to Lapland in A Magical Adventure? and was starting to feel stupid that I had been so positive about it when actually the fallout was just happening afterwards. I remembered about when we had A Mini Crisis and Little Bear had seemed completely fine at the time but had spent the rest of the weekend at melting point. Come to think of it, he is pretty good at adapting to situations when they happen but can become discombobulated afterwards. Had Lapland been too much?

Grizzly and I had a chat, as we always do when things seem to be going awry. Could it be Lapland? Could it be the change to routine of the holidays? Could he still be feeling unwell? What could it be and what would we do?

The problem was solved surprisingly quickly for us on the very next morning by Little Bear himself. It was Christmas Day and of course Santa had been and left full stockings. Little Bear wandered into our bedroom, stocking in hand, with a massive grin on his face and none of the darkness of the previous evening. “I didn’t think Santa would come to me but he did” he beamed and just like that, the gorgeous little man from paragraph two was back (and has stayed).

Whilst I was obviously relieved, my heart did break a little. What had made him think Santa wouldn’t come to him? I know it’s obvious. I know all about how difficult Christmas is for children who have had adverse life experiences; for children who fear they are too bad to warrant gifts. I just hadn’t anticipated it for Little Bear because we have had two previous Christmases with him, which he has coped exceptionally well with. It sounds a little ridiculous now, but he hadn’t said anything. He hadn’t given any indication that he was worried about Santa. He had shown us, through his behaviour and we did know there was something amiss but my detective skills had let me down somewhat.

We don’t do any of the Elf on the Shelf malarkey or in any way push the whole you only get presents if you are good thing but I suppose now that he’s at school and his comprehension skills are much improved, Little Bear is more affected by outside influences. Thinking about it, the big guy himself in Lapland had asked the boys if they had been good and I had cringed at the time (but drawn the line at correcting Actual Santa!).

Little Bear has such a complex tangle in his brain and evidently he still struggles to express his thoughts and fears with words. It is at these times that a regression tends to happen, or when he is poorly, and I guess for now, we will need to continue to ride them out, firm in the belief that we will return to paragraph two sooner or later. We have to remind ourselves to be patient, consistent and as nurturing as possible when the regression is happening. It is essential that we wonder and try to see the world through Little Bear’s eyes in order to possibly figure out what might be behind it. Realistically we need to accept that we won’t always be able to detect the trigger. We might never figure it out. It might not be something that can be consciously identified anyway. But we must ask the questions, and endeavour to stay in paragraph two, because regressions aren’t fun for anybody, least of all Little Bear.

 

 

 

 

 

 

 

Regression