tag:blogger.com,1999:blog-2743746633913926150.post4868708760738977432..comments2024-03-12T07:00:44.143-04:00Comments on CHILDMYTHS: Child Starvation Death in Qatar: Intentional, Accidental, or Ill-Advised?Jean Mercerhttp://www.blogger.com/profile/14619393019771381980noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-2743746633913926150.post-25507431575475297052013-09-02T15:36:26.472-04:002013-09-02T15:36:26.472-04:00Agreed! Some children will literally not eat if th...Agreed! Some children will literally not eat if there is too much pain/conflict/stress/trauma around meals. (Counter to what many pediatricians still say, "No child will starve himself.") I think it is very dangerous, particularly if the child is already marginally nourished to force and invite more stress/conflict. katjahttps://www.blogger.com/profile/05012393829563895757noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-51798129265539579872013-09-02T11:55:17.980-04:002013-09-02T11:55:17.980-04:00Thanks so much for this comment. In terms of gener...Thanks so much for this comment. In terms of general recommendations, I don't think one can say more than that each family has to work out the best approach to feeding with their unique child, using the general idea that feeding needs to be responsive. Certainly providing the meals and snacks (rather than just putting food where a child can get it) helps eating act as the interactive social event that it can be-- just as feeding a baby or sitting by and socializing as a baby self-feeds make the process a pleasurable communicative event.<br /><br />All these ideas would also argue strongly against the practice (proposed by some "adoption educators") of insisting on bottle-feeding older children, even adolescents.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-19543625950545104912013-09-02T11:22:20.123-04:002013-09-02T11:22:20.123-04:00Jean,
I would not make that a general recommendati...Jean,<br />I would not make that a general recommendation at all. If the child welcomes and is comforted by being fed, that is one thing. If the child resists, and this tactic increases battles and conflict, I believe it can be harmful. Clients with very young children have reported that their adopted children were self-feeding completely at very young ages, which makes sense if they had to fend for themselves. Forcing a child who wants to do it themselves to be spoon or bottle fed doesn't seem like a good strategy to build trust and closeness. I do think that the parents can and should provide regular and safe meals and snack, and that whenever possible, parents should provide the food (vs simply having a drawer in the pantry or food out so the child is still left to fend for herself...) I get into this a little in the beyond the stash article. Responsive feeding is critical, and if it increases stress and battles, it is likely to decrease appetite and make any feeding challenges worse. katjahttps://www.blogger.com/profile/05012393829563895757noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-84199998581413731752013-08-28T16:48:44.040-04:002013-08-28T16:48:44.040-04:00After a dip into the suggested literature on respo...After a dip into the suggested literature on responsive feeding, another issue related to possible belief systems of the parents occurred to me. This has to do with the recommendation of some unconventional therapists that adopted children not be allowed to obtain food or drink on their own, so that they will feel completely dependent on their caregivers, and that young children should not be allowed to hold their own bottles or to feed themselves by hand or spoon, but must receive food from the hand of the caregiver. These actions are claimed to facilitate attachment of the child to the caregiver, but they are clearly at odds with the child's need for developing autonomy and mastery.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-71660476449723997762013-08-28T16:29:18.063-04:002013-08-28T16:29:18.063-04:00Thanks so much for providing these general but det...Thanks so much for providing these general but detailed comments. I have many more questions, but will start by looking at the readings you suggest.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-74259816087416615582013-08-28T14:23:34.680-04:002013-08-28T14:23:34.680-04:00I’m one of the advisers for SPOON. In general, to ...I’m one of the advisers for SPOON. In general, to the spontaneous vs. a reaction to environmental factors question, the answer is of course, both to varying degrees. It can help to think of initial feeding challenges in two somewhat artificial categories, primary (coming from the child) or secondary (coming from the environment) though all is related. http://thefeedingdoctor.com/the-worry-cycle-of-feeding-part-i-for-adoption-month/ <br />Feeding challenges often wax and wane from any number of factors. I usually don't see “normal” eating interspersed with periods of extreme presentation unless other factors are present. Most of the time what I see is gradual improvement— first in anxiety and how the child relates to food, and second in intake and self-regulation. <br />Particularly with our current panic over obesity, one of the biggest problems I see is that food anxious children are restricted or put on portion controls from day one. So, they continue to feel anxious and not trusting they will get enough, and that anxiety can develop into an entrenched food obsession, rather than improving slowly over time as the child is reassured she will get fed. (See my NACAC article on hoarding here…)http://www.nacac.org/adoptalk/beyondthestash.html<br />Aversive feeding disorders or selective eating, are increasingly common, I estimate from various studies that it’s about 10-15% of the general population, and it’s likely higher in foster and adopted children. Up to 80% of children with special needs will struggle with feeding.<br />Children with a history of adversity have a higher chance of struggling with eating and self-regulation. <br />I hope that my “Worry Cycle” series can shed some light on possible factors that can affect intake and behaviors at mealtimes, from challenges the child presents with, to how parents may respond to those challenges (often with little support or misguided advice). <br />For example, one family I worked with had a preschooler adopted internationally. She was not gaining weight, was anxious, gagging and vomiting daily at meals, had normal medical, speech therapy and swallow eval. GI and psych eval were 6 weeks away. The parents were terrified she wouldn’t eat, so there was a lot of pressure on her eating, and pressure backfired. They also had a rule that the child couldn’t spit out food, since it was felt to be rude. That is one relatively simple thing we addressed. If a child has a food aversion, or history of gagging or vomiting, she has to have a way to safely get food out of her mouth other than gagging or vomiting. Within a weekend of no pressure, and more responsive feeding, the vomiting had completely stopped, and within ten weeks she had gained more weight than in a previous year. (This is “Bethany’s” story in my book, Love Me, Feed Me.) <br />Generally, the harder parents and caregivers push and try to make a child comply, the worse things go. (Journal of Nutrition 2011 has a great supplement on the responsive feeding literature.) Hope that helps...<br />Katja Rowellhttp://www.thefeedingdoctor.comnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-38962913358321155072013-08-28T09:06:24.355-04:002013-08-28T09:06:24.355-04:00Thank you very much. I will be most interested in ...Thank you very much. I will be most interested in Dr. Rowell's comments.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-63293798141109604612013-08-27T22:58:57.184-04:002013-08-27T22:58:57.184-04:00Jean, please look forward to a response from one ...Jean, please look forward to a response from one of SPOON's medical advisors, Dr. Katja Rowell, on the above question regarding eating patterns. Thanks again for engaging us in this discussion.Mishelle Rudzinskihttp://www.spoonfoundation.orgnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-83342106786646922202013-08-27T16:53:54.247-04:002013-08-27T16:53:54.247-04:00Dear Mishelle--
Thanks for your response and for ...Dear Mishelle--<br /><br />Thanks for your response and for the information that SPOON makes available.<br /><br />Of course, I did not ask you to comment about this particular family, or in any way to breach professional ethics. What I asked was whether the alternation of normal eating and unusual eating behaviors described in news reports has been thought to occur spontaneously, as opposed to occurring in response to events in the environment. I have not been able to find descriptions of this kind of alternation in the literature.<br /><br />Best regards,<br />Jean MercerJean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-84884482602331133282013-08-27T15:59:40.027-04:002013-08-27T15:59:40.027-04:00Thanks for reaching out to SPOON. SPOON Foundation...Thanks for reaching out to SPOON. SPOON Foundation has a wealth of information on feeding challenges from food aversions to food hoarding behaviors, both of which are described as present in this complex case. However, we do not feel comfortable commenting or speculating on this case without more background information or consent from the family.<br /> <br />Our advisors may be willing to connect with you about general feeding issues. We also recommend our website www.adoptionnutrition.org as well as "Love Me, Feed Me: the Adoptive Parent's Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More"<br />for background and help for families struggling with feeding and weight worries.Mishelle Rudzinskihttp://www.spoonfoundation.orgnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-11314732398977050112013-08-23T13:00:20.207-04:002013-08-23T13:00:20.207-04:00Responsible parents would have, at a minimum. cons...Responsible parents would have, at a minimum. consulted a pediatrician about the child's troubling eating habits. (They apparently did see a physician when the girl was first adopted, because giardia was diagnosed at that time.) Usually there is mention by the defendents if the child had been evaluated any time prior to death; we don't see that here. <br /><br />A pediatrician would have given the parents, if not advice about how to feed the child, then surely when to seek medical attention before the child's condition might get critical. <br /><br />Either the child was severely emaciated and dehydrated at the time of death, or she was not. Is there another option other than concluding that someone is lying here? The family photos do not show an emaciated child. Certainly she seems no thinner than her adoptive mother. <br />Linda Rosahttp://www.scienceinmedicine.org/fellows/Rosa.htmlnoreply@blogger.com