Saturday, February 13, 2016

Feeding Tube Awareness Week 2016

Happy Feeding Tube Awareness Week!

Let's jump right to the point of my blog post this year.

"A child won't starve himself."

LIES

You hear it everywhere.  In moms groups.  In parenting magazines.  In viral internet articles.  From your own mother.  And, as I can attest, from your own pediatrician.

I'm telling you, they're wrong!

What they SHOULD be saying is "A healthy child won't starve himself."  Unhealthy children do it more often than you would think, and in those cases, thank heaven for feeding tubes!

I'm not here to tell you what to do about your 75th percentile child who seems to live off of milk and quesadillas.  Sure, I have a lot of tips for picky eaters, but let's save that for another day.  The majority of those picky eaters will be fine.
Today let's talk about the many reasons why a child will legitimately starve, to the point of weight loss, or at least no (or very, very, dangerously slow) weight gain.


  • First, the one that encompasses many, many reasons:  it's less painful to starve than it is to eat.  Let that sink in a little.  My baby would have rather died a slow and painful death than eat.  Eating just hurt too much.  There are many reasons why eating can hurt, and for Caleb and Russell it was because they were reacting to foods that caused tummy aches, nausea, bloating, etc.
  • Then there's the cognitive cause.  Some babies are born unable to swallow, chew, etc. due to anomalies in the brain, such as cerebral palsy.  Some brains literally don't tell the body that it needs food.  
  • Then there's the anatomical cause.  There may be strictures in the esophagus, making it hard to get food down.  A tongue-tie, making it hard to swallow.  An uncoordinated swallow, causing aspiration.  A loose hiatal sphincter, causing painful acid reflux.  A congenital heart defect, causing early fatigue while eating.
  • Then there's the mental side of it all.  Things like tongue ties and reflux and an uncoordinated swallow and intense sensory processing problems can cause oral aversions so severe that children will starve themselves.  Most parents know how hard it can be to get their kid to take medicine, but imagine your kid having so much anxiety over putting medicine in their mouths that they actually throw up at the thought of it.  Now imagine that happening with water, or your baby's bottle, or food that looks or feels a certain way.  It can be pretty intense.
  • Then there's the hundreds of other medical reasons, many of which go undiagnosed for many kids.  I know a kid with kidney disease who requires a huge amount of fluids to keep his kidney happy, and the only way to get the fluid in him was through a feeding tube.  Some kids have such extreme hypoglycemia that they can't go all night without food, so they get a tube for that.  There are so many reasons!  The biggest factor in Caleb needing a feeding tube was his poor GI motility.  His body just doesn't digest food fast enough, so he always has food in his stomach, making him always feel full, even when he's only had one snack all day.  His body was literally starving to death, but he absolutely would not eat because he couldn't fit anything else in his tummy.  When he got a feeding tube, he would throw up half of what we fed him, because he was always full of formula.  Now that we found the medication that works for him, throwing up is a thing of the past.  But he still can't eat enough on his own to grow.  We don't know why, but we do know that his feeding tube still keeps him alive.  And there are so many kids in the same boat as him.



Well, there are just a few reasons off of the top of my head that explain why some people need feeding tubes.  I'm sure there are plenty more.  But rest assured, if a child has a feeding tube, the parents have tried everything imaginable to get them to grow (yes, even putting butter on everything, or serving ice cream at every meal).  Doctors don't go handing out tubes to every kid who doesn't eat his veggies.  So instead of questioning the parents' diligence, or knowledge, or parenting skills, think again about the many underlying reasons why a kid really will starve himself.  Then give those parents a pat on the back.  Coming to the decision to tube feed your child isn't an easy thing to do, but at times it is necessary, and then it's an answer to those parents' prayers.  


If you'd like to learn more, you can visit http://www.feedingtubeawareness.org/
To see a video of how we gravity feed Caleb through his feeding tube, go here.
For pictures of many of the feeding tubes Caleb has had, go here.

Monday, February 8, 2016

Soy Trial

After about a 6-month soy trial, Caleb starting to complain of daily stomach aches.  After troubleshooting ("are you hungry" "do you need to poop?"), he would still feel a little pain, so it was time to scope!

Since eosinophilic reactions occur in response to food proteins, and oils and sugars don't have proteins in them because they're so highly refined, Caleb has always been able to have soy oil and soy lecithin.  (Some very sensitive people can't have them, but we discovered that Caleb can.)  So the only things that he eats that have soy proteins in them are a few brands of granola bars (his favorite snack), soy sauce used in Asian food (which we use a lot), and a few odd things here and there.

The biopsy results are in and Caleb IS NOT reacting to soy!  So that's GREAT!  But the pathology report also showed some odd things ("fragments of antral and fundic mucosa with focal foveolar hyperplasia and elongated pits" in his stomach, and " mild basal cell hyperplasia, mild papillary elongation, and mild spongiosis" in his esophagus...don't ask me what any of those words mean!).  So even though the biopsies didn't show yeast, we're going to treat him for a yeast overgrowth, just for good measure, since he's been on daily antibiotics for 3 years.

If that doesn't take care of things, we may have to consider whether or not Caleb has a good, old-fashioned intolerance to soy, and think about removing it from his diet.  I'm hoping it doesn't come to that, but his comfort is a high priority!

It's a little crazy to think that Caleb's diet now is how it likely will be for the rest of his life!  That is:
*eosinophilic reactions to dairy
*eosinophilic reactions to eggs, but without symptoms...he has now passed two scopes while eating limited amounts of eggs
*behavioral reactions to wheat...we had to stop the trial before being able to scope, because his behavior was effected so negatively.  Maybe some day, when he's more mature, he can trial wheat again.

It's amazing how far he's come from the days when we could count his total safe foods on two hands!

There's a new restaurant in town called Chi-Ku and everything on the menu is Caleb-safe!  It's kind of emotional seeing Caleb choose whatever he wants, and then actually eat it.  It never gets old watching him stuff his face!