Friday, December 16, 2011

Building Emotional Muscle

Kerry Kelly Novick and Jack Novick are psychoanalysts in Ann Arbor, MI who write a blog for parents called Build Emotional Muscle. Here is the link to a post about a six year old boy who is refusing to go to school. I love it!

Sunday, December 4, 2011

"I'm Not Hungry"

At my book club last night, someone related the story of a friend whose child doesn't eat and so throughout the day, the mother chases the child through the house with food on a spoon saying, "Here, eat this! Eat this!". What a sad story. I've heard it before - a number of times, actually, from the different parents I speak with.

There are any number of reasons that a child will limit food intake. Today I'll focus on sense of hunger. In future blog entries, I'll discuss sensory and motor issues, gag reflex, as well as emotional and social causes.

Why would a child not feel hungry?
         1. We'll start with the obvious - he or she is snacking between meals and so does not get hungry. This is theoretically easy to fix. Limit the size and number of snacks. Space snacks carefully so that they are midway between meals and not too close to dinner.
         2.  She doesn't experience hunger, in other words, a medical issue and so a trip to the doctor is in order. An older child might be taught to eat certain portion sizes on a schedule. The portions sizes will have to be estimated for her age and body size and adjusted as necessary.
         3. He is on ADHD or other meds that cause decreased hunger. This is again reason to visit a doctor. It may be that using supplemental nutritional drinks such as PediaSure creates a workable solution. (But keep reading...)

         4. She is so consumed with her world (possibly due to autism) that she is not in touch with her body. Giving the child alerting activities (proprioception is always useful!) may help her to break free of that state. Once alert, she should show interest in food.

         5. He is so consumed with emotional issues that he is out of touch with himself. Have him take a second to check in with his stomach may solve the problem.

One such child I see in school missed lunch - he wasn't hungry. I saw him outside of his classroom in tears. His teacher, who had no clue about what was wrong was trying to keep him from meltdown. I noticed that the cafeteria workers had put all the food away and now the opportunity for eating had passed. I took a good guess at what had happened to him and brought him to my room.
Me: "Did you eat your lunch?

Jacob: "No, I'm not hungry."
Me: "Are you sure? I want you to feel the sensation in your stomach."
Within seconds, he asked if he could get his lunchtime meds from the office. We went there and passed the cafeteria. A worker found 2 boxes of Rice Crispies and a fruit cup. Jacob took his meds, and then wolfed down the food in record time.

The last three cases are really just this: the child needs to learn to check in with his/her body. This may involve some heavy work (play) -- especially with another person to help with attention -- to get grounded. Once done, the child may finally feel the need for food.

Screening SPD Modulation

There is now a way to actually measure sensory over-sensitivity (sensory over-responsivity) by measuring sweat on the palm (with electro-dermal equipment) and increased heartbeat. I'm hoping that this technique becomes standard practice and finally allows us to get a diagnosis for affected children - which it may once the next DSM is published.

In the meantime, I continue to rely on the Sensory Profile as a screening tool. I make heavy use of its modulation scoring which identifies over- and under-sensitivity, seeking (craving), and aversion/avoidance of sensory input. The test is published by Pearson.  It is available for home or school and for several age groups. Scoring is standardized. A weakness is that being a questionnaire, it is only as reliable as the caregiver/teacher who fills it out. Nonetheless, I see good results. Sometimes I give copies to multiple caregivers or teachers if I am concerned about reliability.

A second tool is the SPM - Sensory Processing Measure, by WPS Publishing which solves that problem. The SPM can be passed out to both parent and teacher, plus the bus driver, the cafeteria lady and other important people in the child's life. The results are added together then scored. The drawback for SPM is that the modulation scores are not as rich as the Sensory Profile's.