Hi Robynne,

Remember little Miss Allie? We're baaaaaaaaaaaack!

Allie had a very severe bottle aversion until about the age of 1 when we discovered Baby Einstein videos, which worked wonders. We have recently been able to get her to eat without videos, using other forms of distraction, like toys, reading books, etc. Allie still WILL NOT hold her bottle, never asks for food, and does not like to eat, although she no longer screams when she sees the bottle (although she doesn't get excited either). We simply feed her on a schedule, because if left up to her, she would not eat at all. Lately, it's been difficult to get her to eat her bottles as well. I don't think she's in any reflux pain, I think it's the fact that she does not want to sit still. She's 21 months and always on the go. I am at my wits' end trying to think of ways to keep her entertained while feeding her the bottle. She is taking pediasure, and we use all different flavors so as to avoid a taste aversion to one certain flavor.

Allie was formerly averted to all solid foods. In the past few months, we have been able to get her to eat about 3/4 to 1 ounce of pureed food per sitting (which is great, but not what she needs!). She still does not know how to lateralize her tongue. She crunches on crackers, etc., but spits them out. She only knows how to move her tounge in and out and that's it. When she takes a bite of a cracker, it almost look like she wants to eat it, but she ends up spitting it out. She is doing much better w/ the purees, and is starting to like them, although one day may be great, then the next is not so great. It just depends.

Her feeding schedule goes like this:

Wake up - 8:00 a.m - take prevacid
5.5 - 6.0 ounce bottle - 8:30 a.m.
Highchair breakfast - 9:30 a.m.
4.5-5.0 ounce bottle - 10:30 a.m.
Highchair lunch - 12:30 p.m.
6.0 ounce bottle - 1:30 p.m.
(nap)
4.0 - 4.5 ounce bottle - 5:00 p.m.
Highchair dinner - 6:30 p.m.
6.0 ounce bottle - 8:00 p.m.
(bed)

As you can see, we are constantly feeding this kid, and most of her nutrition comes from her bottle . Sometimes, she will not even eat the 6 ounce bottles at all. We struggle to get these calories in her, and it's no fun. After spending three straight days over memorial day weekend with her trying to get her to eat, I'm exhausted (I work full time and our sitter does most of Allie's feeding). I"m ready to wean Allie from the bottle; however, it is clear that her solid intake is not near enough what it needs to be. We have tried putting pediasure in her sippy cup (straw cup) or in an open cup, and she wants nothing to do with it. She will only drink water from her sippy cup. Our current OT and ST say to keep offering the pediasure in the cup and eventually she'll get it. I'm not so sure!

Her weight is only at the 10th percentile, so I'm very scared to try weaning her - like what will happen if she doesn't make up for those lost calories?

Any suggestions on how to get this child off of the bottle? Sometimes, it can take as long as an hour to get the bigger bottles (6 oz) into her and it is getting extremely frustrating. She wants to get down and go play, and we are constantly trying to entertain her while we're trying to feed her.

Thanks Robynne. I appreciate it.

Hi Christyn!!!!

Your Allie is getting so big! My Aly is 9 going on 16 :sad2:

I do have some suggestions. Robynne doesn't like sippy straw cups for all kiddos. If Allie is 21 months and showing no signs of wanting to transition off of the bottle, she is telling you something is not kosher with her sippy. Straws usually send large and fast bolus (liquid) amounts into the mouths of our babes and can scare an already aversive feeder even more so. Large bolus amounts, if a child has an incoordinated swallow, can cause aspiration. My preference would be a free flowing sippy, one with a valve, or a Nuby silicone sippy with slits that control the flow rate. The Nuby sippy is a nice transition from the bottle since it is soft like a bottle nipple.

Another suggestion would be to put away the PediaSure and water for a while; they obviously are not working. Go get something new and sinful...lol! Go get a smaller bottle of bright orange Fanta with a twist top so Allie can help you pour the fizzy pop into her new sippy cup :smt041

Get out the suckers for "taking a taste" out of her new sippy. Primary reinforcers go a long way.Fade them out quickly so they are not expected. Get back to me with progress.

Robynne

Robynne,

About the Nuby cups, the one we currently use is found here:

http://www.babybungalow.com/nubapr.html

We use the one called "Mega Sipper with Fat Flip Straw Top." Allie drinks water with absolutey no problem from her sippy cup. In fact, she loves it, as long as it contains water ONLY. She carries it around, and says "cup," while pointing to it and has no problem taking water from the cup. We also use the honey bear cup recommended by our ST - you can see it here (she loves this also, calling it "bear"):

http://www.talkingchild.com/shop_HoneyBearCupwithStraw.aspx

If we put away the pediasure, what should we give her? It's where her main source of nutrition comes from, and she's at the 10th percentile for weight, so we really don't have a lot of wiggle room. We're even adding duocal to her bottles right now to get extra calories in. I tell you, I'd throw that bottle out the window today if I thought that she could go without it, I'm just so scared of having her eating nothing all day (which is probably what she would love to do!) if we get rid of it.

We've tried giving Allie suckers before, she is just averse. She may taste it with some coaxing, but will not go back to it. I've even tried ice cream this way (when she's not in the high chair). It seems that this kid does not like to eat ANYTHING. She never seems to like something enough to want more of it, KWIM?

Also, with regard to the Fanta, won't carbonated beverages make her reflux worse? I always found that soda bothered me when I was having reflux pain.

Thanks in advance!

Christyn

Does she ever have interest in your cups out of curiosity? To answer your question about carbonated drinks, yes and no. First of all, we know she isn't going to drink 8 oz. Many of my patients who are aversive find the carbonation a novelty...they are intrigued because of the bubbly sensation in their mouths.In other words, it gets them interested. I have started there and made vanilla PediaSure orange with a couple of drops of food coloring...lol. We do what works.

I am very familiar with the Honey Bear and the Fat Flip Straw Top. From my personal experiences with kiddos with feeding aversions/bottle transitions, I rarely have luck with straw utensils (with the exception of one patient who was very low functioning). This is because I see how much liquid they get during swallow studies and how difficult it is for them to control the fast flow rate due to the negative pressure when compared to small sips from an open cup. You do not need to use a carbonated drink. Try an orange or red juice in a Dixie cup. If you need to, put the juice in her Honey Bear or Flip Straw Top first to help with the transition. If she likes it in her favorite cups, perhaps she will try in a Dixie cup or a Nuby with a silicone valve. Allie has more control of the fluid boluses coming into her mouth with an open cup vs. a straw. However, she may have a comfort level with the straw cup now and may not want to go with an open cup yet. I would try to eliminate the Honey Bear since she does not have to use much of her oral-motor skills to drink with that utensil.

I absolutely understand your concern with her weight. Do NOT put away the PediaSure. Simply start introducing Dixie cups, sippy's, and new juices/liquids. The last 2 bottles to eliminate will be morning and evening. Do not worry about throwing her bottles away yet. We just want to spark some new interest.

Robynne

Thanks Robynne, I just now saw your response (I missed it).

Allie does show a great deal of interest in our cups. In fact, we give her an open cup at every meal - one with water in it, and one with milk or pediasure. Allie is doing better with her oral motor control with an open cup, and can even hold her own cup and drink from it (although she does spill).

She would prefer to drink water from an open cup compared to milk/pediasure. When we give her the milk or pediasure in an open cup, she will drink it, but she spits a lot of it back out (she does not do this with water). But, we are doing this at every meal, so I guess she will have to get it eventually, right?

I think I just answered my own question. All in good time, grasshopper! Allie is just on her own little sweet schedule. I'm just tired of feeding my almost 2 year old a bottle. It can take up to an hour or more per bottle, and at 5 bottles per day and 3 high chair feedings per day, it's getting very tiresome.

Thanks,
Christyn