To eat, or not to eat… on Tube Feeding Awareness Week 2015


Food. 

I think about it ALL the time. Not because I’m hungry but because my Little is not.

Don’t get me wrong, 9 times out of 10 he will eat chocolate if given the chance, or sweets. And fairly often he will ask for crisps or chips, or even a crumpet. But half way through that crumpet, he is full. If I were to push (when he was younger), he would continue to try eating and vomit.

We do not know why he does not get hungry, and doctors haven’t even begun to listen to me about that aspect of his feeding difficulty. They are stuck at the gut – is it too slow, is it diseased? (Maybe, and no are the answers to those questions)

My reality is that he is eleven years old and has been utterly reliant on tube feeding since he was 8 months old. I am a tubie mum veteran.

I have ridden the waves of vomit using the various and wondrous concoctions given to him by the pharmaceutical companies (excuse me, the dietitians, who aren’t one little bit biased by those companies – no they’re not!). I have seen him fade away into nothingness and look a ghastly mixture of grey and yellow. I have watched as doctor followed nurse, followed doctor try to stick a cannula into a vein in order to rehydrate him. Knowing that they needed to stop sticking him with needles, knowing that we were creating trauma, and knowing that they could not stop because with every moment that passed, he needed fluid more, and with every moment that passed his dry little body was narrowing his veins.

I have stood against the medics, taken my gut instincts into my hands, learned more than any  mother should ever need know about food, and calories, and fats and proteins and vitamins and minerals and digestion, and I have advocated for that child. I have watched a dietitian write in bold red letters: Mother going against medical advice.

And I have made that Little food, and blended it and sieved it and worked and worked to get enough goodness into the tiniest volume so that his body would not reject it.

I have spent each and every day of the past ten years feeding him every two or three hours, and overnight. We have a magic pump that allows me to sleep, and feeds him drip by drip so that the precious liquid stays inside, and hopefully translates to growth and energy. I have been up more times that I can remember to deal with the various alarms that pump gives off. Now, each time I hear that beep when out and about, my heart starts pumping and my body stands to attention. It takes a few minutes to realise that mine is not the attention being screamed for, that the pump in question is another child’s.

I make Little’s food every day or two. I have a recipe, but I question myself ALL the time. Do I need to rethink it, to recalculate? Have I missed something, should I be doing more, has his growth been enough to justify a change?

I think about food ALL the time.

I am not part of a team. We have doctors and nurses, and wonderful school teachers, and they largely follow my lead. I have no dietitian. Yet. I have no one to work with, to figure out a way forward.

Because this is an odd situation. The general consensus of “they” is that he will one day be tube free. He is mobile and intelligent and there is no physical reason that we can find to explain the need of tube feeding. So no medic will say or write that Little is “tube fed” in a permanent manner. I struggle to get them to acknowledge “for the foreseeable future”. In spite of tube weaning failure on a number of occasions.

Don’t get me wrong, I am not looking for a doom laden approach. But if he is one day to be tube free, we should have a team. It should include me. It should also include professionals who have experience in this area – the psychology of tube weaning is what has me ranting today, so a psychologist; a dietitian; a doctor. And as a team we should make a plan. I know that plan A is very unlikely to work, but as Eldest’s head of care wrote to me this week,

“If Plan A doesn’t work, then we’ll move to Plan B, then C, then D, then E and so on until we find a plan that works”

I have no plan. I do not have the ability, experience or knowledge to make a plan, and as Little’s mother I am the last person able to put any plan into practice. Most people will understand that mother and pre-adolescent coming head to head on such issues is a recipe for disaster.

Little hates his tube food.

Little hates thinking about food.

Little hates the feeling of his stomach filling.

Little fights me whenever food comes up – so breakfast, snack, lunch, snack, dinner. Whining, shouting, screaming.

I can avoid some fights when it comes to oral food. I make it his choice, but then he is miserable because even if his stomach is not hungry, his mouth is and he does not know what he feels like, and cannot find anything to satisfy that feeling. I suspect he feels failure too.

How can I avoid the fights about tube food? That is what keeps him healthy and alive.

He HATES tube food. It’s boring, it takes too long (about 3 minutes), there’s no point, it doesn’t do him any good. And anyway, he’s in hospital “all the time” as it is, so it wouldn’t make any difference if he was ill. He’s tired all the time, so it wouldn’t make any difference if he didn’t eat.

This is the discourse he proclaims. The confusion, misunderstanding, frustration, anxiety and anger are growing as he is getting older.

We should have had a team years ago. Years. Ago. Specifically to avoid This.

I am patient. My children have taught me not to raise my voice. They have taught me to accept their emotions, both bad and good. But I find myself raising that voice when Little screams at me that I am mean and stinky and evil because I want to feed him.

Little Man making Feed!!!!!


Time to sieve the blackberry pips out!
Time to sieve the blackberry pips out!

Amazing first today!!

Little Man cooked his first feed.  He chose the ingredients based on the basic recipe I use…

Beef (he wanted pork because he likes a little pork to eat, but that was yesterday’s meat)

Oats (because he likes flapjacks)

Rice milk and coconut milk (Koko brand) because we ran out of rice milk

Orange and mango juice

Spinach

Forest fruits

Coconut oil

He measured everything out… cooked the oats in the milk and the beef in a frying pan with the coconut oil…

Chose to add in a little turmeric and garam masala (and smelled everything first!!!)…

Put it all into the Vitamix…

Waited…

Then poured it all into a strainer (to be doubly sure to avoid blockages).

I’m so so proud of him!!!  Life skills, emotional development, and knowing that most of taste comes through smell I’m hoping that in time he will be able to taste some of this lovely food he’s making.  The next big test is tomorrow to try and increase volume a little because this particular blend came to 1400mls… he’s never managed more than 1200mls in a day so we’ll see how he goes tomorrow!

Feed, Food and Maths…


Updated picture of Little Man. As of January 2015, all of this information is still accurate.
Updated picture of Little Man. As of January 2015, all of this information is still accurate.

Quick Background: Little Man has Noonan Syndrome.  He has always had severe eating difficulties, never understood, and has been reliant on tube feeding to keep him alive since he was 8 months old.  We tried tube weaning last year, but have now been discharged on the grounds that it was unsuccessful and that there are medical issues that must be resolved before we even think about trying again. When he was three years old, on an elemental feed (a special formula of various chemicals that make up the mythical “complete feed”, with no allergens – even the proteins are broken down to amino acids.  Don’t let the 52% corn syrup in the ingredients put you off – or do, he was very poorly.  Vomiting several times a day, losing weight and all sorts going on.  In desperation I asked the paediatrician if I could try a “blenderized diet” – real, normal food blitzed fine enough to go through his tube.  She agreed. Within four days, he had stopped vomiting.  He had his one and only growth spurt in the weeks following that change, and vomiting is now a pretty rare occurrence. Fast forward to this year.  Because of the failure of the tube weaning, Little Man finally had an endoscopy this summer, and we now have an additional diagnosis to his long list: eosinophilic colitis (I cannot tell you how proud I am that I’m able to pronounce that!!!).  The quick version is that he’s allergic, probably to milk and wheat.  The longer version is that it involves white blood cells not working properly and could be auto-immune.  Added to his history of wonky white blood cells with the leukaemia I’m thinking watch this space. So Little Man is now on a dairy and wheat free diet (did I mention before that all he will eat is potato, pasta, bread, biscuits, yoghurt and cheese??), and more importantly we are now back in the world of dieticians. Dieticians who have been trained following the NICE guidelines on enteral feeding, who are taught the importance of a “complete feed” (one which has ALL the nutrients in the right balance at every meal – just a head’s up – neither you MacDonalds nor your posh restaurant meal will have been “complete”), and who are told time and again that medical feed is the only safe feed for tube fed patients.  The pharmaceutical companies are very much involved in this, after all the only way they sell their feed is through dieticians… And then they meet a maverick mother like me.  I am not alone, but I am a rare enough breed that only one dietician had ever worked with a family doing blended food through a tube before.  For bureaucratic reasons I can’t now work with her… So I need to convince these professionals that while BD is not and should not be standard hospital policy, in this one case, it is not only appropriate, but probably the best thing for Little Man. On the whole she was happy with my blend, but did want to make some tweaks, so I have been doing Food Maths for the last couple of weeks.  I wanted to share in the hope that it might help other families grappling with the same questions. Firstly.  Little Man stands 112cm tall and weighs 21kg.  He is 10 years old. Based on his age, he should be getting approximately 64 calories, per kg, per day:

64 x 21 = 1344 cals per day

The dietician would like him to get 20% of his calories from protein, 30% from fat and 50% from carbohydrates.  This is where the maths becomes a bit of a pain.  Let’s just work it out in calories first:

20% of 1344 = 269 cals of protein

30% of 1344 = 403 cals of fat

50% of 1344 = 672 cals of carbohydrate

All good.  Now the problem is that on food packaging, you do not get given protein, fat or carbs in calorie terms, only in grams.  So now we have to convert those calories to grams.  For protein and carbohydrate the magic number is 4, for fat it is 9.  Exactly why is beyond my scope just now, but I’ve done my homework, and got my maths checked by the dietician, so here it is:

269/4 = 67g protein

403/9 = 45g fat

672/4 = 168g carbohydrate

Yay!!!  Now we are ready to go.  Be careful though.  We often think of meat as protein, as well we should, but 67g fillet steak is not the same as 67g protein…  This is where food packaging, and websites such as http://www.nutritiondata.com come in really handy.

My next job was to compile a data set of foods I use commonly in Little Man’s feed.  Using the websites above, and the packaging, I made a spreadsheet with all the information I needed on it.  You can download it here:

Sheet 2 has all the food ingredients I currently use.  I occasionally insert a new food in there as I find myself using it.  I have not worried about things like herbs and spices, they’re just little bonuses I put in there from time to time.  You’ll see that the top of sheet 1 is a little messy and has a number of recipes at the top.  This is my working table and I haven’t spent hours making it look pretty!!  Those of you who know how to use Excel properly will see I’ve done some fancy grouping and sums – feel free to use and adapt to your needs and find some lovely person like my Darling Man to set up those fancy things that save time in Excel!

Once I’ve got that information, I copy the foods I’m using to a new row, with the amount of each food I’m using.  I’ve taken to cooking the grain in some rice milk as that makes the feed much lower in volume which is a big thing for us.  The totals are made for each column and I record the total volume of the feed in order to calculate the cal/ml ratio.  The following recipe is an example.  Since I’ve been doing this for a few weeks, I’m finding it easier with the help of my trusty Vitamix to get very calorie-dense food prepared, and he’s doing well on it.

Remember those values we worked out?  This recipe has 38g protein (67), 44g fat(45) and 180g carb(168), for a total of 1260 cals (1344).  The low volume of 1100ml gives a lovely 1.15 cals/ml, and amazingly Little Man tolerated this one really well.  I could have tweaked it by adding meat to increase protein (I was working with a bit of mince I had in the fridge), but as I change the recipe each day, he gets a really varied diet and those proportions of protein, fat and carb fluctuate – just like they do in my diet, and yours.

For those of you who noticed the Calcium and Vitamin A columns.  Little Man’s complexion is often very yellow, and a cause for concern.  One of the worries was that he was getting too much vitamin A.  Well – vitamin A ABOUNDS in food!!! It’s absolutely everywhere.  Little Man’s dietician would like him to have ~500mcg a day.  As you can see this recipe is below that.  But a recipe that has a carrot in it jumps to over 1000mcg.  Again, I balance it out over the week, but I’ve found this column very helpful.

Similarly, since Little Man now has to be dairy free, there’s a little concern that he should be getting sufficient calcium in his diet.  And since maverick mum won’t just use a can of formula (corn syrup with added chemicals – I feel quite strongly about this but will leave that rant for another day! ), I had to be sure I was on track for the calcium.  As you can see, he’s getting well over the 500mg daily recommended calcium intake for his age. Anyway, a little note about vitamin A.  Most nutritional labels give the amount of vitamin A in IU (international units)… No use to me!!  Luckily I found a converter that allowed me to input the data into my tables: http://www.robert-forbes.com/resources/vitaminconverter.html This recipe is enough food for one day.  At the moment I’m cooking for him once a day.  I’ve also started reducing his overnight feed by adding two daytime feeds. A little note on overnight feeds.  It causes everyone concern that we should hang a bottle of what is effectively soup overnight.  At room temperature, nasty bugs tend to thrive.  In the past I did wrap Little Man’s feed in ice packs, but for reasons lost in the mists of time I stopped doing that years ago. I blend his food in a high powered blender, my beloved Vitamix, which heats the food up to piping hot – I mean hot enough to kill pretty much anything.  From there it gets decanted into sterile boxes (the ones I would be using if I had to make up powdered formula).  It then gets attached to Little Man’s tubing, so the food is not open to the air at any time.  At all other times, it’s in the fridge, following standard food hygiene. However, the most important thing to realise is day to day living.  I have been feeding Little Man like this for seven years.  Including overnight feeds (good golly do I wish he could do without those overnight feeds!!!).  He has NEVER had a tummy bug, gastro enteritis or anything approaching food poisoning. And at the end of the day, that speaks volumes. I’m hoping to meet a dietician who will work with me as we navigate this brave new world of food allergies, or malfunctioning gut etc…  And I’m hoping that she/he will see that I’m willing to put in the work to do this well. But in the meantime, I know there are dozens of families trying to feed their tubies like this, and I know that recipes are like the holy grail.  I’m not really shouting about my recipes here.  What I hope I’ve done is given you the formulas to work out what your tubie needs, and a little spreadsheet that you can use to make recipes that add up to your tubie’s numbers! Good luck, and enjoy cooking!!  

One question answered, another one takes its place


Short update today…

Little Man Tom, as I’ve mentioned before, is struggling to grow, and keep weight on.  This despite being tube fed with lots of good nutritious, homemade food over and beyond what his height and weight suggest he should need.

A couple of weeks ago we saw the paediatrician who felt his Growth hormone treatment might be the cause of the weight loss.

Since I am the one who administers his nightly injections, I’m sure you can imagine that it has been emotionally very difficult topoke my lad knowing it might be making him ill.

But the one thing I’ve learned to do over the years is wait.  So wait I did.  Until last Friday when I felt that two weeks was quite enough to have checked a fairly simple question with the expert.  The first phone call was fruitless: no paediatrician to be found.  The second phone call led to an answer machine, so I left a message filled with both facts, questions and emotions.

More waiting…

Happily, Tom’s endocrinologist, Prof is a lovely man and quickly realised that this issue needed to be nipped in the bud.  I received a phone call a few hours later from the great man!

Conclusion… Tom’s weight loss is unlikely to be as a result of growth hormone.  Prof feels that we need to look into Little Man’s gut.  This is something I have been questioning for a very long time, so is worth investigation.

More phone calls, to find the quickest way to an appointment.  We have not seen the gastro-enterologist for quite some time, so it may well need a referral from the GP again.  I’m hoping that my phone call to the feeding clinic may provide a short cut!  We will see.

In the meantime, while the growth hormone question has more or less been put to bed, a more fundamental one about Little Man’s body has been raised…

More waiting!

National Health Service N.H.S.


English: NHS logo
English: NHS logo (Photo credit: Wikipedia)

So much moaning usually follows those three little letters..

NHS?  waiting lists

NHS? unequal levels of care and treatment

NHS? old hospitals

etc, etc, etc.

I struggle with this, I really do.  I do not have rose tinted glasses when it comes to the NHS.  There are many problems that desperately nee addressing.  The inequalities are unacceptable, and must be remedied.

But we pay our taxes, and as part of the “payback” we expect in the United Kingdom is that we can visit the doctor, or arrive at hospital, and be treated.  There and then, no questions asked.  FREE.  At the point of care.

That means that when I see a doctor, I do so without insurance papers, without cash or a cheque book in hand.

It’s all too easy to take this for granted, but it is absolutely a national treasure, that should be preserved as long as possible.  If things need to change, they must change, but the fundamental right to medical treatment free at the point of care should always be guaranteed.

I experienced something quite different nine years ago.  We were living in France when Little Man was rushed into hospital.  Three hours later we were told he hard a heart defect and probably leukaemia.  It was 11pm, we were naturally shell shocked but the next sentence is one that will always stay with me in its inhumanity.  “You must be here at 7am tomorrow morning for transfer to the paediatric hospital and you must remember your insurance papers.”

My little boy, 11 weeks old, was seriously ill.  His life was quite literally in the balance.  And they wanted me to find insurance papers… coming from England this struck me as a barbaric thing to ask of parents who have just been given this news.

Anyway…

9 years later, almost to the day…

Last night, after a good but tiring day I set about the nightly business of preparing Little Man’s feed.  He is pump fed through the night because he cannot tolerate enough food during the day.  If we try to feed him even 50mls more a day, he vomits.  The night feed represents about 60% of his daily caloric intake, so it’s a pretty important part of his care.

I followed my usual routine, turned on the pump and prepared to go to bed and blissful sleep!!!

Beeep…

At this point in time, it may be helpful to go read an earlier post, that will take you on my love hate journey with this sound.

Tom has the use of a Nutricia Infinity Pump which has a wonderful array of different error messages, most of which are easily resolved.  Last night was a new one: ER12.  Not good.  After a quick peruse of the manual, I see that the only solution is to phone the company that supplies the pump and plastics.  Luckily, fortunately, thanks to our really rather wonderful NHS, they also provide a 24 hour phone line.

After a short conversation, it was established that a new pump was essential, and that a fast delivery was very important.  I was fully expecting to wait at least until today, and was readying myself for a night of bolus feeds every few hours (these are feeds done by hand using a syringe… not fun in the middle of the night).

I called them at 9.22pm.

The new pump arrived at 11.45pm.

Tom got all of his night feed, more or less as normal.  I got a night’s sleep.

The NHS is a massive organisation, and it is far from perfect.  But I have yet to learn of a healthcare system that provides this kind of care based solely on taxpayers’ contributions.

‘Nuff said!!  Don’t knock our NHS!

Silent sounds, Soundy silence…


I’m writing this tonight, sat rather comfortably in my bed, relishing the sounds of silence.  Darling man who has heroically shifted his working day early in order to be Dad for this last week of the holiday is now fast asleep beside me.  Growing lad Zack is no doubt still awake but drifting off to sleep and absolutely quiet.  Princess Kesia, courtesy of rather more medication than I would like, is deep in peaceful slumber.  Little man Tom is in the land of Nod, all plugged in for the night and life is still. In the background, the very comforting sounds of the Gilmore Girls… It is a fact that my loved ones seem unable to fall asleep in the silence of their own minds and thoughts…  We found fairly early on that Zack found night time much easier if he had a CD on.  Not only this, but music is ineffective while a story, or audio book is a wonderful relaxant and sedative.  When Kesia began to have trouble sleeping, I tried various strategies such as the sleepy book , reading her stories, warm milk etc etc etc…  Eventually, I tried the same as Zack… CD preferably with talking rather than music.  Tom has very different sleeping difficulties largely linked to his chronic pain problems.  Not only does he sometimes struggle to fall asleep, but he often wakes in the night due to pain in his legs, arms or tummy.  At the age of 9 we are trying to teach him some self management techniques, and a CD was one suggestion from the occupational therapist.  One particularly effective CD is the one from Relax Kids.  He especially likes the stories for boys. And my wonderful, kooky, kind, quiet, mysterious, darling man… Since I have known him, he has been unable to fall asleep without some sound… specifically television sound.  Now, this goes against EVERYTHING I was brought to think of as “right”.  It simply can’t be good for you to sleep with noise and or lights on around you.  And in many ways that makes perfect sense.  I remember reading a few years ago that proper sleep was disturbed by light.  Again, sense… And now?  Now, I am in a more pragmatic place.  Some sleep, even if it isn’t as deep or restorative as it could be, is simply better than no sleep…  And my goodness golly, aren’t we lucky to live in a time and a place that allows CD players and night lights and televisions.  Are we spoiled?  Obviously yes!!  Should we deprive ourselves because others are not as fortunate?  Well that’s more nonsense than falling asleep with light and sound on.  So in a spirit of acceptance, I accept that our house is not as quiet as some around bedtime – at least it’s peaceful! For years (and years and years) our bedtime sound was that of Friends.  So much so that the first season’s CDs are worn out, thus bearing out the theory that CDs do not last for ever! So much so that we know the entire series almost word for word! And it has become something of a lullaby…  Only recently was it overtaken by something other.  The something others have not had quite the same hold, the rather comforting mix of giggles, long storyline, and just gentle nothingness. Although for me, The Gilmore Girls is simply perfect!! However, as I sit writing this inordinately long blog post, Friends is on my mind.  Because the writing challenge I came across tonight was about sound.  And the sound that immediately sprang to mind links in to one particular episode.  It’s not a significant sound, and I suspect most people watching the episode would hardly notice it at all.  Me? Every. Single. Time. I watch or hear this episode, I leap out of bed and into Tom’s bedroom – no matter the time.  And I KNOW that it is the same episode that provokes this reaction!  But that sound is so visceral, so ingrained in my brain that my body acts before my mind can take over.  It is a sound that I listen for even while deeply asleep.  And a sound that I cannot imagine ever forgetting. Meet the Infinity Enteral Feeding Pump, courtesy of Nutricia Homeward:  (If this works and I’ve understood how to do it, clicking on the picture should send you to a you tube video showing you how to program the pump, and allow you to hear that singularly piercing sound, that I will henceforth refer to as “the beep”.  Here’s hoping!)

Little man Tom has been tube fed since he was 8 months old, and has been reliant on a pump feed overnight since then.  He’s now 9 years old, so that 8 years and 4 months of “the beep” ruling my nights.  Because this thing is full of alarm settings:  OCC IN, OCC OUT, BATT, END DOSE, AIR etc etc.  The favourite seem to be OCC IN and OCC OUT (occlusion into the pump or out from it… the theory is that depending on the alarm you will be able to find an obstruction or a kink in the tube in a different section of the whole system…  if only it was that simple!!).

The pump has a variety of different tones, but “the beep” refers to OCC IN and OCC OUT.

If little man Tom moves in his sleep and kinks his tube?  OCC OUT (someone really clever would somehow find an audio file of “the beep” and link it to those words… I’m neither that clever nor that patient – for which you should profusely thank me, as it offers you the true joy of one less painful aural experience).

If his feed is a little too thick and the pump gets confused?  OCC IN (or if a tiny lump gets stuck between the bottle of feed and the pump).

If the tube twists?  OCC IN or OCC OUT

If the feed is the wrong colour for the sensor?  OCC IN

If the feed runs out or blocks in the bottle stopper?  AIR IN

If by some miracle all has gone well and the whole amount of feed has been pumped into little man?  END OF DOSE (a slightly different beep)

If little man has so twisted and turned in his sleep that he has become unplugged and the pump is kindly feeding the bed or the floor?  SILENCE… NO. BEEP!

Now.  I’ve been doing this, it’s been established, for some 8 years now.  That’s not far off a decade!!  So on the whole, we are past the teething problems.  We hit a tough patch when Tom was about three years old because I moved from formula to a blenderized diet of “real” food… so lumps, consistency, viscosity, colour became a whole new world of “pump whispering” but again, it’s been a while! Despite this, the pump usually finds something to beep about at least every other night.  Some nights the bloomin’ thing just never stops!!  And 8 years of broken nights do mean that I tend to give up and turn the blasted thing off… compensating for the lack of calories can be an uphill struggle for the next few days. So… It’s taken me this long to reach the starting point of this post!  The writing challenge on WordPress this week was to write about a sound.  “The beep” is my sound.

That sound permeates my entire being.  I am so attuned to it that I often wake milliseconds BEFORE it beeps.  It is a sound that I live and breathe, one that I both love and depend on and also one that I resent with remarkable passion.

I have utterly ambiguous feelings towards this little beep.  It symbolizes life, the conquest of modern science and medicine over mysterious, complicated and long term illness.  Without that beep, I have no doubt that my little man Tom would quite possibly not be alive.  And so, it is a sound that I treasure and that I would feel quite bereft without.

And yet it is also a sound that I hate with more energy than I can express.  Every time I hear the beep, I hear another reminder that my little boy is a little bit broken.  That despite everything I could have done as his mother, I could not teach him to eat.  And before the choirs start with the usual chorus of “but you didn’t do anything wrong”, I’m well aware of that.  My genes, my maternal instinct and my creative spirit all sing differently.  Fortunately, my mind, my thoughts, my ability to see the world through different eyes keep me on a much more even keel.  Whatever the logic, the “right” thinking, the beep reawakens the deep (yet quiet) grief that my son must live a life that few would choose.

On a far more practical and selfish level, I HATE being woken up several times a night by a strident electronic beep which means anything from a few seconds out of bed, to half an hour or more.  Unblocking tubes, changing to new tubes if necessary – the yuck factor of having to clean a bed, floor, mattress (not to mention little boy half asleep and cold covered in feed) all in the dead of night on nearly a decade of broken nights.  As a little aside, for those of you new to me and my funny little ways, Tom’s feed is essentially blended dinner – milk, fruit juice, oil, protein of some kind, vegetables… a delightful concoction which fills me with glee when I see it go into his little tummy because it keeps him healthy.  But really quite disgusting when stuck to sheets, dripping on the floor over any toys that have been left out, or worse still papers and books.  Icky, ick!

Back to Friends, and the small matter of “Coma Guy”.  Much as I enjoy this episode – it makes me giggle and smile – I cannot train my body to realise that the beeps in the background of the hospital scene are not MY beep!!! By the time my brain has informed my nervous system, I’m already in Tom’s room, checking the pump!!

Sounds are mysterious things.  They fill our lives from morning to night, and even through our sleep.  One sound links to another and some sounds trigger deep emotional and physical reactions.

My sound is a little, life saving electronic beep.  One that I love, one that I hate.

What is your sound?

Intensive feeding therapy… with a long term view to tube weaning…


Long term is the right word.
After a break of nearly a month, we are back at Great Ormond Street to visit the lovely Mr E for Tom’s feeding clinic.  We started this process in March, and I think it’s fair to say that the progress so far has been firmly lodged in the “getting to know us” category.  Tom gave a good impression of a little boy who wanted to be rid of the tube for a while before finally being honest and becoming quite angry with Mr E, saying that he did not want the tube to go away.  So Mr E has a rather tricky job on his hands, and I for one am hugely relieved not to be on my own handling what is a significant difficulty in our lives with Tom.

Trouble is that each visit tends to start with, “how have things been?”.

Because we are a family and not merely a set of distinct problem and issues that need resolving, Kesia’s difficulties impact on Tom and vice versa.  The uncertainty of the summer have had a huge impact on me despite my best efforts to stay calm and happy – that then creates tensions which the children feel without understanding.  Zack has been home, changing the family dynamics once again.  All of these things need to be at least touched upon when answering “how have things been?”.

And Mr E, so lovely, often looks as though I have taken his head, put it in a blender on the highest setting and replaced it on his shoulders.  How do you unravel such a tangle to find a way forward for little man Tom in the specific area of food?  On the surface, this feels like simply another hospital department to help deal with one of Tom’s medical problems.  Dig a little deeper, and it’s food…

Food.  Such a simple word, such a simple, basic, necessary part of life.  And yet, Tom was born without that impetus to eat.  He never had a rooting reflex, and only drank milk at first because I had the experience of breastfeeding two other children who were still very young.  Once “positioned” properly, the sucking and swallowing were fairly normal.  But he hated it.  And as the weeks went on, he hated it more and more, and never showed the slightest interest in being fed.

The whys and wherefores are a mystery.  There are many possible reasons for this, from the neurological and developmental (the lack of rooting reflex may suggest that he simply hadn’t developed the ability to eat yet) to the physical (he probably had reflux which causes pain, and slow motility which gives tummy ache).  I dispute behavioural reasons at the time, he was simply far too young, although at the age of 9 years there is now a huge behavioural element to his difficulties.  The fact was and is, however, that food, eating and feeling full are not things that come to Tom the way they do to most of us.

Just to tangle things a little more, we cannot ignore the fact that Kesia finds food challenging.  In completely different ways.  She enjoys good cooking and experimental flavours and can become quite obsessive about cookery books.  She loves cooking and baking, though would much rather someone else did the eating.  Clearly, however, food is a source of stress, and when outside stress becomes too much, she simply stops eating.

Two very different problems.  Two very emotional problems.  As a little aside, I might add that for a long time now, I have felt deeply that my primary role as mother is to nourish my children.  Emotionally, socially, physically.  It is an ongoing battle with my inner self to keep the dark voice of “failure!” at bay.  When Tom was very little, a therapist told me that my job was to provide food, Tom’s job was to eat it.  An astute comment, and one that frequently keeps me sane.  Years later it is still a mantra I use to remind myself that I am not a failure…

So.  Having had the “how have things been?” chat, and weighed and measured Tom ( he’s lost a little more weight but still within acceptable limits), Mr E has gone to work with him on some project which aims to motivate him and hopefully give him something a little more concrete to work with.  I think that this may be the beginning of the work… the more concrete the better I think!!! I would almost love to be given a menu for the next fortnight – give him this amount of this on this day!… but as we are learning every visit, tube weaning is far closer to art than science.  Mr E has authoritatively told me to stay in the office (don’t look at any confidential files lol!) to have a bit of alone time.  Kesia is in the playroom with a lovely lady and Tom should be working.  The time and space are good, but a little worrying – they allow baggage and tangles to come to the fore in my mind.

Luckily as I was typing that last sentence, Tom came to tell me I was needed!  Sweet boy worked really hard with Mr E to draw up a “Journey to tube weaning”.  The first goal is to reduce his feed by 120mls.. slowly!  Mostly we are working on his motivation, so no rigid concrete plans (poor me!!, but I do understand that it would set him up for failure) but we are simply looking for Tom to try and eat more “by his mouth” in the next few months.  A little weight gain would be rather nice too!

There’s a lot crammed in my head at the moment, and I crave the time and energy to release it here.  I plan to put links to past posts and link to my old blog too, not to mention pictures etc… But for now I shall make a cup of tea and enjoy watching my sweet two weed the garden!