The tube

Day 7, Story 7: The Hunger

Posted on by amberhj

A short memoir in 3 parts.

My wonderful daughter, Stella. (Taken during her first Christmas season.)

This story is dedicated to Erin, Sylvia, Rocio, and Hatice.

Introduction

At 31, I was the neurodivergent mother of a neurodivergent baby. But I didn’t know that. Not about my daughter and not about me.

She nursed just as the books say a baby should, for about a week. Then she battled. The breast, the bottle, me. 

My sanity frayed because I knew there was a problem that no one else could see.

I craved empathy like a drug addict in withdrawal. I searched day and night and found it nowhere. Not even for sale. Therapists, several lactation consultants, a postpartum doula for Seattle rockstars—we couldn’t have afforded her anyway—seemed to serve only judgment. So that’s all I ate.

We both starved. 

Sick with anxiety, I lost 30 pounds in the first two months of my daughter’s life. I tried drinking olive oil. Straight up. Part calorie loading, part penance. I gagged and spit it up. Just like my baby when I tried to feed her. 

It felt as though a lifetime of not-quite-rightness manifested in an inability to feed my own baby. In the early days, when not alone, I faced doubting doctors, and well-meaning but dismissive or outright annoyed others.

I became a mom not when I gave birth to my daughter, but when I pushed through to the other side of despair, for her.

*

Part 1: The Tube

Stella was born in August. Four months later, baby’s first Christmas was different than I expected. 

Stella’s cheeks were red and raw due to frequent attaching and removal of various medical tapes. I tried different types, hoping to secure her nasogastric feeding tube to her face while inflicting the least possible amount of dermatological and psychological damage.

Meals were not bonding moments. They were medicalized ordeals. Picture, if you will, a portable pump. Like an old school gaming system with a few buttons and a digital read out–but you only win if you can stop playing. 

Along with the pump there were large syringes for gravity feeds, plastic IV-style bags that connected to the pump and smelled like new shower curtains, and hypoallergenic formula that soured quickly. 

The nasogastric tube went down Stella’s throat and into her stomach. When I tube-fed her, I felt more like a surgeon than a mother. Before each tube feeding began, I used a stethoscope to listen as I sent a puff of air, from an empty syringe, down the tube. A telltale popping sound would indicate that the tube was in her stomach. Rather than a lung. 

Then it was time to hook up the tube and run the pump. I’d monitor Stella carefully for any gagging or gurgling. 

Mishaps were common. Sources of trauma. Stomach contents would come up and out of the tube. Blood would surround the tube in Stella’s little nostril. The pump would malfunction and feedings would need to be started all over again. 

The worst of the worst parts was that the tube would come out regularly. It’s astonishing to me, in hindsight, that the emergency room was the only available source of help. Not only were these constant hospital visits expensive, they were time-consuming, exhausting, and traumatizing for my daughter.

After all the waiting, tiny Stella would lay on a hard bed in the harsh light of an exam room. With masked strangers hovering over and holding her down, the tube would be replaced while she screamed. The kind of scream that alerts a mother’s brain to a threat to life and limb. 

The tube would then come out again the next day, maybe the day after. 

So I learned how to put the tube in myself. This process requires planning and calm. First, you lubricate the tube, then you force it down the throat, somehow hold it in place with one hand while making sure baby doesn’t grab or pull the tube and also taping the end of the tube to baby’s face with the other. Finally, you check the tube’s placement with the stethoscope and puff of air and popping sound.

During one replacement effort, my nerves and her screams caused the tube to go in her nose and out her mouth. A little jolt of horror. I tried to insert the tube while she slept. It half-worked once.

To get enough nutrition from a tube, a baby becomes a machine. Stella needed to be fed every three hours, and feeding could take up to an hour. I worried that my extreme tiredness would lead to mistakes. What if the tube wound up in her lung? 

I lived with the fact that this whole disaster unfolded because my milk caused my baby pain. Every time she nursed, she wound up in agony. She would cry and turn away. In hindsight I realize she was fighting for her life. We both were. 

Instead of feeding, she would gnaw her fingers, which smelled of stomach acid.

I worked around the clock to get enough calories into her. I used a spoon, a tiny cup, a small syringe, causing it to simply run down her throat. This wasn’t “feeding.”

Thanks to this continuous labor, she “ate” just enough to get by, before the tube. She didn’t lose much weight, and she did grow longer, but she didn’t gain any weight either. 

I just needed to try harder. ‘You have to hold her like this,’ said one lactation consultant. ‘You haven’t established a proper latch,’ said another. ‘You don’t seem comfortable. Let her come to you instead of leaning toward her,’ said yet another.

Later I would realize that one of them was at least partially right. Being neurodivergent, I was so used to following the lead of others, so used to being wrong, I couldn’t relax and let someone come to me. Not even my own baby. I felt I had to bend over backward, or forward in the case of nursing, to keep an interaction from falling apart.

At first, no one believed me. But then she started to look pale, even a bit gaunt, with a grayish cast. Her resistance to nursing or bottle-feeding turned into an all-out aversion. By then, the problem was so severe that a feeding tube was necessary. It wasn’t inevitable. 

With the benefit of hindsight, I sometimes wonder how it all would have played out if I was neurotypical and communicated neurotypically? What if I was more reasonable, less brutally honest? More clear, less direct?

“We just have to get her through this,” I would think constantly. After all, she was a healthy baby. She just hated to “eat.” That’s all.

Meanwhile, my daughter and I were alone for up to 12 hours a day, five days a week. Compared to my pre-pregnancy self, I was skin and bones. I couldn’t take care of myself. I really couldn’t.

We didn’t have access to a car most days. Freedom came from taking walks, between tube feeds, through the park and by the shops along the strip near our rented house. Stella and I would stop in just about every day at my favorite coffee joint and paper goods boutique, and the grocery store. 

Here and there, as usual in an area of Seattle so close to downtown, I’d see syringes on the ground during our long walks. They were wedged into the cracks of sidewalks or nestled in the mulch of garden beds. Part of the infrastructure. 

These syringes were functionally different from those I used to feed my baby, but syringes all the same. I noticed that my reaction to seeing discarded needles on the ground was no longer involuntary disgust or general frustration with a system that doesn’t care for people. Concern became visceral rather than abstract. I thought, “That’s someone’s child.” 

Stella and I venture out for one of our walks.

*

Part 2: The Choice

In the thick of the tube feeding haze, Christmas season in full swing, I watched television while Stella napped. A holiday-themed diaper commercial showed angelic infants dreaming in their bassinets with a carol-turned-lullaby as soundtrack. Their smooth, round cheeks were unmarred. Their peacefulness complete. Against my will, bitter tears burned my eyes. I found my entire self twisted with envy, boiling with rage.

Until one week before Stella’s birth, I worked as a copywriter at an ad agency. I’d written prose about large cinnamon rolls and slightly larger ski resorts. I could imagine the creative brief, concept, pitch–the entire process that resulted in that carefully targeted manipulation. But the nerve hit was so deep, beyond the reach of rationality. In the part of me that knew I was defective.

Since then, there have been so many revelations and reversed courses in my path through motherhood, far from any well-worn route. But I now look back to this low, just me sitting alone in the artificial glow of an overwrought diaper commercial, as a catalyst.

During that moment, I knew I couldn’t stay there, in that dark place. Jealousy doesn’t sustain you. It drains you. Anger isn’t nourishing. It eats you. 

I sat in my fury and envy. Confronting the ugliness, I made a choice to not feed it with self pity. It was not going to be easy. I didn’t know how. I just knew something had to change. If not for my sake, then for Stella’s. It was a start, or a promise to start.

That decision soon led me to write. I’d started a blog, half-heartedly. Perhaps I could use it to keep my feelings, unlike the formula, from turning rancid. 

I shared updates with the family on how Stella was faring and how we were managing. Her latest milestone, most recent medical appointment, and how much she was taking in by tube–each milliliter accounted for in a spreadsheet I referenced in reports to Stella’s doctors. Increasingly, I also shared my experience in the struggle.

In the weeks that followed, the blog became a beacon. I began hearing from mothers, across my city and around the globe, who’d found our story. Their babies, too, refused to eat and were given feeding tubes with no plan for weaning from the tubes. No end in sight.

I got to know several of these women, sharing phone calls and emails, desperation and encouragement. We did the same anxious things and thought the same anxious thoughts. Our feelings, stories, and longings were not just similar, but practically identical, despite our differences in cultures and backgrounds.

There was Erin with her grace, sense of humor, and a baby boy who seemed a lot like Stella and was born within days of her. Hatice was passionate, honest, and generous, and even sent Stella presents from Singapore. With Sylvia, originally from Costa Rica, her soul was so torn apart that it made her courage all the more moving. Rocio showed such depth of devotion and commitment to her premature son, helping him overcome his feeding aversion after months in the NICU.

I still marvel at how we were all able to connect on a little virtual island in the middle of the internet ocean. Alone, together.

Thanks to them, I began to realize that I wasn’t a failure or problematic or a pain in the ass for complaining to doctors constantly. I was a mom, doing her best in a challenging, isolating situation. 

We had empathy for each other. And soon I started to develop empathy for myself. When perceiving an absence of empathy from others, I no longer experienced a free fall into anger, allowing me to be more present. I now had a foundation to stand on.

By the time Christmas came around, I had developed a bit more confidence. I found moments of peace even in the face of the same tube-centered reality. I started to tune into Stella and trust my instincts, rather than look to “experts.” That’s when things started to change.

*

Vintage “Happy New Year” card

Part 3: The Leap

After months of tube feeding, Stella hit a plateau. She never took more than about half of what she needed calorically for the day by mouth, the other half by tube. And aside from some anomalies, that’s where she stayed.

I knew that the tube had to come out. The pain that caused Stella’s feeding aversion was gone. Also eliminated was the pressure from me in trying so hard to get her to nurse, which worsened the aversion. She’d had time to learn that eating was not a threat, not a precursor to pain.

The tube had become more of a hindrance than a help. Making swallowing difficult and allowing a gateway for reflux. Overfeeding was easy, since there was no hunger gauge and only a prescribed amount of formula per day, so vomiting was common. Yet most of her doctors seemed to believe that one day, Stella would miraculously take all calories orally, and only then would the tube be removed. I disagreed. I found research to support my gut.

This situation has become more common. Tube feeding of babies, and resulting tube dependency, has exploded. This is partly due to an increase in premature births, with babies needing more time to gain the strength and oral motor skills that typically develop during a full-term pregnancy.

Also, it’s now easier for hospitals to send parents home with tube-fed babies. The digital pumps are small and portable. But technology advances so much faster than our understanding of its human impact. 

Many babies similar to Stella, following resolution of reflux, milk protein intolerance, or whatever caused eating refusal, remain on tubes. Sometimes for years and years. I knew we had to give her a chance. We had to remove the tube, and see if she would reconnect with hunger and eat enough to thrive all on her own. 

Just after New Year’s, we took the leap. I remember Stella’s smiling, tube-free face that day. How nervous I was, but also hopeful. There was only one thing for me to do–offer the bottle when she showed hunger cues. The rest was in Stella’s hands. No more battles. 

In those first days, she did take more from the bottle. But not what a baby needs to grow and stay healthy. 

After two weeks without the tube, she hadn’t gained weight and Stella’s pediatrician leaned toward putting the tube back in. Panic coursed through my veins and, heart pounding, I told him that she needed more time. He agreed to support one more week without the tube.

Right around the three-week mark, it happened. Seemingly all at once. 

Whereas previously Stella would scream, cry, and panic at the sight of a bottle, she started to lunge and grab at the bottle. She’d even cry when it was taken away empty. Stella drank more than double the amount of formula in one day than she ever had before.

Her occupational therapist declared, “Stella has internalized the joy of eating.”

Trauma leaves a mark, but so does the experience of pushing through. After Stella’s dramatic turnaround, on those days when she ate less, I’d still worry despite knowing all babies are in fact not machines but humans whose hunger varies from day to day. Yet I also fundamentally trusted myself to handle challenges and fulfill the needs of my child. That may have been the biggest miracle of all.

The change was thanks to a baby who knew what she needed, an overwrought Christmas diaper commercial, a largely unknown blog, and fellow mothers who gifted me with understanding. 

The tube was gone. Stella wasn’t hungry anymore, and neither was I.

Not the end (just the beginning)

(Note: Remaining holiday stories can be found here as they are released each day through 12/24, and ever after.)

Knowing when to worry, and when not to

Posted on by amberhj

When I was an infant, I had to wear booties attached by a bar. The goal was to straighten out my legs. It worked, but my legs are a bit S-shaped to this day. They curve oddly at the knee, a quirk noticed by various coaches in middle and high school. But you know what? It’s subtle, and hasn’t been an issue. At all.

It just occurred to me that if Stella had needed a bit of leg straightening, even in this simple, relatively painless manner, I’d have been worried sick. Stomach tied in knots. All for nothing.

Stella’s foray with the feeding tube, and her eyeglasses and eye patch should be no different, really. I don’t mean to dismiss them, just to put them in perspective. I’ve let go of a lot of the anxiety surrounding them, but perhaps too much remains at times. It’s pointless, anyway. Counterproductive, even. She’s doing wonderfully.

There’s a huge lesson there. Hopefully it will sink in. This realization could help make 2011 a fabulous year.

P.S. Happy new year!

Meet the brave and amazing Ava.

Posted on by amberhj

Clearly, Ava's pretty fabulous. (And she just so happens to be the #1 fan of Yo Gabba Gabba in all the world.)

I’d like to introduce you to Ava. For Ava and her family, tube feeding is a precious gift. I wanted to share her story with you all to show the other, positive side of tube feeding, and to try to help send more supporters her way. She and her mother deserve the biggest and most raucous cheering section possible.

I’ll let Ava’s mother handle the introduction. From Ava’s CaringBridge.org journal, updated regularly by her mom:

“Ava is a smiling, laughing, dancing 5 year old diagnosed with a mitochondrial disease.  She loves school and dogs, the computer, and her family, who love HER more than anything in the world.  She’s dealt with so much more than she should know, but takes it mostly in stride with an amazing attitude.”

Ava’s diagnosis came after four years of dealing with a host of serious issues and symptoms, from severe GERD to dysmotility to cardiac arrhythmia to hypotonia and on and on and on… a string of conditions that for so long had no concrete explanation. By then she’d experienced an incredible number of  invasive, life-saving procedures including placement of a G-tube in 2006, followed by a GJ the next year. Finally, a very specialized type of biopsy revealed her true diagnosis. Mitochondrial disease comes with a sweeping range of challenges. To hear the description of the condition is to be haunted by it. From umdf.org, the website of The United Mitochondrial Disease Foundation:

“Mitochondrial diseases result from failures of the mitochondria, specialized compartments present in every cell of the body except red blood cells. Mitochondria are responsible for creating more than 90% of the energy needed by the body to sustain life and support growth. When they fail, less and less energy is generated within the cell. Cell injury and even cell death follow. If this process is repeated throughout the body, whole systems begin to fail, and the life of the person in whom this is happening is severely compromised. The disease primarily affects children, but adult onset is becoming more and more common.”

Clearly, mitochondrial disease takes a vast toll, poses daunting and often heartbreaking questions, and total vigilance is required on the part of caretakers in a non-stop effort to maximize quality of life and encourage and prolong vitality and well-being. Tube feeding is one of many types of ongoing support that kids and adults with mitochondrial disease often require for survival. The type of strength and dedication and refusal to settle that Ava’s mother has demonstrated is impossible to capture in words. Ava enjoys the best possible quality of life given her condition, and tube feeding is essential to this. Look at the photos on her site and you’ll see a vibrant, adorable, happy child. And that smile! Oh my goodness. I imagine that to her mother, Ava’s wide-as-can-be grin is the sweetest reward, the best confirmation of her good efforts, the fuel that feeds her soul. Ava’s mother has continuously and tirelessly pushed for the very best options available, proactively searching out any and all treatments and therapies and support for her sweet child, and diving headfirst into the crusade for a cure through her involvement and leadership within The United Mitochondrial Disease Foundation.

This woman and her daughter are the kind of people that should be celebrated in our society. Why is it that with all the soundbites constantly buzzing at our ears and eyes, we never hear about the Avas of the world, nor their heroic mothers? Love this strong deserves a spotlight. I’m shining a little one on it, and I hope you’ll join me. Post a message of support in Ava’s guestbook–I dare you to resist that smile.

In closing, a well-chosen quote I found on Ava’s site, which seems to sum up her mother’s philosophy:

“Listen to the mustn’ts, child.  Listen to the don’ts.  Listen to the shouldn’ts, the impossibles, the won’ts.  Listen to the never haves, then listen close to me… Anything can happen, child.  Anything can be.”
— Shel Silverstein

More on the risks of NG tubes

Posted on by amberhj

A couple of things to share for now: A message I sent in an effort to get support for Stella’s wean, and an AAP study.

Below is the actual text of an email, including excerpts from research that I paid for, that I sent to Stella’s pediatrician and OT on January 4, 2009. The next day, they called to say that a two-week “trial” without the tube would be low risk and to go ahead with it. She never looked back and began eating large amounts at about the three-week mark. She would even have days in which she consumed 1,000 mls of 24-calorie-per-ounce formula. She was about four months old at the time, and before weaning had progressed to taking in 40-50% of her formula orally. But it was stuck there, and feeding her was still quite difficult. I simply don’t know how long tube feeding would’ve persisted otherwise. I’m thankful I was truly heard and that Stella was supported in learning to eat completely on her own.

***

Dear Tom and Robin,

Stella’s eating is regressing. The core issues seem to be reflux and difficulty swallowing. I strongly believe that the tube is worsening both of these, and that much longer use of the tube will cause more damage than benefit. Stella did not have this type of difficulty swallowing before the tube, I know that for sure. Her swallowing has gotten progressively worse over the last couple of months, during which time the tube has gone in and out many times. Her reflux is also still a problem and I strongly suspect that the tube is part of that. I found research which supports my intuition. See below. The cited papers are also attached.

*

From paper entitled, “Infants with swallowing problems” by Helen Cockerill, from Pediatrics and Child Health 18:12 (2008):

“The presence of a nasogastric tube may provide negative stimulation and impact on respiratory support for oral feeding. Long-term use has been associated with the development of later feeding aversion.”

From paper entitled, “Effects of Nasogastric Tubes on the Young, Normal Swallowing Mechanism” by Phillipa Sarah Huggins, MSc, Seppo Kalervo Tuomi, PhD and Christopher Young, MBBS, FRCS, FFRad(D)(SA), from Dysphagia 14:157–161 (1999):

“However, there are several disadvantages to nasogastric feeding, including nasal ulceration, laryngeal injury, and pharyngeal discomfort [5]. Nasogastric tubes may also precipitate gastroesophageal reflux, which can lead to aspiration [6]. Nasogastric tubes are frequently self-extubated, especially in elderly or restless patients. Reintubation is labor intensive and distressing for the patient [4].”

“Nasogastric tubes slow swallowing in young normal adults.” (My own thought on this: It seems logical that if it affects adults this way, babies would be as affected if not more so. Slowing of swallowing seems to be exactly what is happening to Stella–she is clearly uncomfortable swallowing now in many of her feeds.)

“Sensory accommodation to the tube may counteract the earlier pharyngeal response triggering seen in this study, whereas prolonged accommodation of the tube may delay triggering of the pharyngeal swallow. This may hinder recovery of normal swallowing patterns in people with swallowing impairments and increase the likelihood of aspiration.”

*

We are doing all we can to put weight on Stella to put us in a better position to go without the tube to see how she does. Are there any alternatives to the tube? Can we try cup feeding? Can we explore any other avenues (not including a G-tube which is not a route we are willing to go)? I believe that we treated her initial problems but that new problems may have arisen DUE in large part to the tube. Thank you for hearing me out and helping us resolve Stella’s feeding issue. You both have been so helpful.

I would like your honest thoughts on Stella’s progress (or lack thereof) and prognosis. We are very scared and want to know what we are up against. It’s starting to feel hopeless. We are doing out best to keep hope alive, but are desperate to seek out other ways of treating her.

Thank you,
Amber

***

This NG tube study, published in PEDIATRICS (The Official Journal of the American Academy of Pediatrics), is very telling, regarding of the distress caused by NG tubes. Some of the wording and terms used in assessing the pain are haunting: “Does Nebulized Lidocaine Reduce the Pain and Distress of Nasogastric Tube Insertion in Young Children? A Randomized, Double-Blind, Placebo-Controlled Trial.”

Taking a stand against tube-feeding crimes and negligence

Posted on by amberhj

Someone needs to say it: tube-fed children and their families are being neglected and often outright abused by a dehumanizing, misguided health “care” system.

If you don’t believe me, read on. Or at the very least, get a glimpse of a far superior alternative by viewing this tube weaning lecture delivered at Seattle Children’s Hospital by weaning expert Markus Wilken, during his visit from Germany. This video is an invaluable resource, which I highly endorse, as you’ll see at the closing of this overdue rant.

Our tube feeding days are far behind us, yet memories haunt us. Like the time I inserted Stella’s nasogatric (NG) tube into her nose, only to have it come out her mouth, instead of going down to the base of her esophagus as planned. Of waking up every two hours to feed her at night, fumbling in the dark with a stethoscope and large plastic syringe in order to confirm correct placement of the tube before setting up the pump to run for 45 minutes–desperately trying to stay awake while it ran, so as to be able to respond in the event of a pump malfunction or choking incident. The blood that, after the first month of tube feeding, consistently encrusted the tube in her tiny nostril. And, in soul-crushing fashion, the bottles of outrageously expensive Elecare, not covered by insurance, that Stella triumphantly downed on occasion, only to re-emerge in projectile fashion thanks to tube-triggered gagging.

Crazily enough, none of these incidents were the turning point for me. None of them woke me up to the immediate need for the tube’s removal. Though I did often wonder how long this would go on, as there was no plan for weaning. I was doing what I was told because it was supposedly medically and therapeutically necessary. I have another mother to thank for my awakening–a mother who didn’t see such a need and whose child paid a huge price.

Back when Stella’s little baby face was accessorized by medical tape securing a thin but lengthy yellow NG tube, we made one of many trips to Seattle Children’s Hospital. This time for an abdominal ultrasound. In the waiting room, two women struck up conversations with me about, what else, Stella’s tube. “She looks so healthy,” said one, whose child also had feeding issues and was headed toward a tube. Then she asked the inevitable question: “Why does she have a tube?” I explained, and we commiserated about the misery of trying to feed a child who simply does not want to eat. The other, with empty eyes and a tired smile for Stella, commented along the lines of, “My son had an NG tube until he was five. Good luck. She looks great. I hope you get her off of it.” Suddenly, my stomach felt as though it were full of rocks. In that moment, I sank to a very dark place. But while down there, I resolved to never, ever let that happen to Stella. I decided to fight.

So, just to make this astounding fact clear, I’ll repeat it: I met a woman whose son lived with a nasogastric feeding tube until he was five years old. Five years of a thick tube through his nose (no doubt causing nasal ulceration), his esophagus irritated, the sphincters held open (encouraging reflux), food administered on some dietian’s strict schedule and chart regardless of what he thought or felt. It’s a perfect illustration of why I’m so angry. Really, really angry. I have been for a while.

I’m outraged at the treatment that many tube-fed children and babies are receiving from doctors and therapists. G tubes, the next step after NG tubes (if eating does not progress) and a much kinder solution in cases of long-term feeding, are not without problems. They require surgery, which when not done properly can cause extreme suffering and even when correctly inserted can contribute to excessive vomiting. I believe that there are many children with G tubes that do not actually need them, and that if physically able but still unwilling to eat, they should be given a chance to wean before surgery is considered. At the very least,  thoughtful, individualized approach should be taken by an interdisciplinary team of doctors, as opposed to the reckless, disorganized decision-making that is now widespread.

Based on my experience with Stella, I’m particularly concerned about those with long-term NG tubes, tubes meant only for short-term use. It’s not okay. Scientific evidence (which I will present in a later post) and common sense tell us that NG tubes cause extreme discomfort and difficulty (slowing of) swallowing. The frequent removal and reinsertion of this tube is traumatic and damaging for child and parent. No matter what kind of tube is used, a complete disconnect with hunger and extinguishing of the desire to eat is practically inevitable. The tube itself fuels eating refusal and aversion, long after the initial issues prompting the tube’s insertion have been addressed. (This is very different from children for whom tube weaning is not an option at all and long-term tube feeding a clear life-saver.) Families are plunged into despair, their lives shrunk down by the oppression of tube feeding (though, sadly, this comes to feel normal for many families), the incessant vomiting, the stunted growth that the tube was supposed to prevent, and the hopelessness that arises due an absence of a weaning plan. Or any plan for that matter. For most of these children, there is no way out. This is, with no exaggeration, a crime.

And then there is the so-called “therapy” provided to these children. When I hear stories of children being force fed, and there are a lot of them, I literally become sick to my stomach. It’s wrong. It’s a disgrace. Yet it’s happening at leading clinics and children’s hospitals across the country. One of the barbaric techniques used: Puree is shoved aggressively into toddlers’ unwilling mouths, which are then held shut for as long as it takes. As long as it takes for them to swallow–and it can take a very long time to swallow when you are terrified of food. What horror! Stella’s occupational therapist noted that some “graduates” of such programs later have to be desensitized after enduring such trauma, the process of learning to enjoy rather than fear food begins again but on even shakier ground. How can a brute-force approach possibly help a scared child discover the joy of eating? It can’t. If the child does eat, it’s not because they want to. It’s because they have no choice and no other way to make the torment stop. The children are sometimes called “obstinate” by therapists and parents who buy into the crazy, unbelievably misguided belief that kids are refusing to eat because they are, essentially, being manipulative little jerks. The children are blamed, their trauma and autonomy completely disregarded. Parents are pitted against children, forced to play coercive games. This is absolute insanity.

There are far better ways to wean children from tubes, to awaken their appetites, hearts, and minds. These methods are infinitely more effective and humane. They are based on respect and compassion, which every child needs and deserves! Beyond that, every child for whom it is safe (mainly, the many tube-fed kids whose initial issues are resolved) deserves to be given a chance to eat. For many families, weaning is never even discussed! Because the child is not eating orally. But why would they? Why would they suddenly enjoy eating when every three hours, formula is pumped directly into their stomach, sometimes only to come back up again due to nausea and rampant overfeeding? When Stella had her tube, our pediatrician said she’d just “turn it around.” As if by magic. That was never, ever going to happen.

I’ve been perusing blogs and boards of parents with tube-fed children and my goal has been to offer support whenever I think my experience with Stella could be relevant. It feels good to provide support and resources, to help bring about positive change based on such a negative experience. But I’m not sure I can do it anymore. There are too many heartbreaking stories of renowned hospitals directing parents to disregard their instincts and squash the dignity of their child. It’s overwhelming. I’ll start to type a reply to certain posts, ones that reveal that a child is being forced to eat in some fashion, only to delete it, because my thoughts are all over the place. My words too angry.  I wonder where to begin. How can I convince someone that the entire medical establishment is harming their child on a root level, rather than helping? There is too much ground to cover, too much fundamental education and changing of minds to do–more than can be conveyed in a comment box. I’m at a loss.

I have such compassion for the parents, yet feel such angst when I see the failure to question the clearly ineffective and detrimental status quo. You have to stand up for your child. No one else will. You have to call bullshit on doctors’ cavalier attitudes toward tube feeding, not to mention their lack of actual knowledge on the subject. You have to challenge therapists whose tactics perpetuate the feeding battle, rather than bringing it to a peaceful end.

But I know. I know these parents are ground down by the stress, loneliness, and sorrow that comes with not being able to nourish your own child—the nightmare that is tube feeding. I know from my own experience that some parents become so desperate that they no longer trust themselves and find themselves willing to follow whatever directions they’re given, perpetuating their own hell, despite the nagging voice inside that tells them it’s all wrong. Or who are tossed back and forth from one expert “opinion” to another, with no one ever offering a real plan for moving towards normalcy and health. Parents are victims of unnecessarily extended tube feeding as well, and the failure to recognize the deep trauma of both parent and child, and how it contributes to disordered feeding, is another gaping hole in the “care” received.

I have by now heard about, and even helped in some small way through this blog to bring about, dozens of successful tube weans. I know some children require tubes for survival. But many others are simply trapped with no visible exit. In particular, I am intimately familiar with three tube weaning success stories: that of my daughter Stella, and those of Zander and Heath, the children of women who have become dear friends. These amazing triumphs were achieved thanks to parental intuition, constant and fearless questioning, and plain old ignoring of bad medical advice, plus exhaustive research and the shaken but intact inner belief that if given a chance, “my child can eat.” These weans required a lot of belief and trust in the child, not the doctors. They required a process of “letting go.” This is hard to do, not only for parents, but for a broken health care system that insists on monitoring and controlling every milliliter pumped through the tube, in order to cover its ass, all while ignoring the impact on quality of life.

Thankfully, there is an alternative, explored in the video below. Upon viewing it, I cried. They weren’t happy tears in response to the wonderful, validating, rare, evidence-based wisdom on tube weaning that the video unveils. I bawled because the speaker, a child psychologist and tube weaning expert from Germany, describes a higher, enlightened quality of care given to children in his country—a standard and mentality that simply does not exist here. Unexpectedly, I was overwhelmed with grief. By and large, Stella did not receive the respectful, mindful, effective and individual care that she deserved. And thousands of children are needlessly suffering right now.

If you’re angry too, looking for a way out of tube feeding, or want to follow your desire to treat your child with more compassion during their feeding journey, please grab a cup of coffee and watch this eye-opening, heartening lecture given by child psychologist Markus Wilken. He has past, direct experience with the Graz method, which he’s incorporated into ongoing weaning and tube management work in hospitals and clinics in Germany. Astoundingly, Markus has successfully weaned a diverse set of over 400 children. Perhaps, within his presentation, you’ll find the encouragement you need to believe in yourself and your child. To live a tube-free life! You can do it. Your child can do it. It’s time to fight.

********************

Here’s the link (some find that removing the “mms” prefix is necessary for successful viewing):

mms://seattlechildrens.wm.internapcdn.net/seattlechildrens_vitalstream_com/Rehab_5-27-10.wmv

Hooray for Heath, his mom, and inspiring tube weaning success!

Posted on by amberhj

Mighty Heath

Meet Heath. Ain't he sweet?

Remember Zander? Well he’s got company. (The tube-free ranks are growing.)

Sadly, I kept putting off this post because the hugeness of the triumph deserves a truly well written, heartfelt description. Which takes time and energy that I’ve been lacking, though I’ve so wanted to muster it! But then I realized that I can’t tell the story any better than Jenny, Heath’s mom, an incredible writer and an amazingly intelligent and unstoppable mother. So I’m just going to give you the highlights and point you toward the blog that documents Heath’s journey: The Crunchy and the Smooth.

Heath is 15 months old and was 100% tube fed until a couple weeks ago. The need for his g-tube (gastrostomy button) was prompted by his difficult birth and the immediate, medically intense aftermath. The fly-by overview, in Jenny’s words: “cord wrapped tight around his neck, Apgars of 0, ambulance transport from a country mouse hospital to a city mouse NICU, diagnosis: hypoxic brain injury.” As the result of many necessary and lifesaving but overwhelming and traumatizing medical procedures that took place in the area of his nose and mouth (mainly intubation and suctioning), Heath developed Posttraumatic Feeding Syndrome. Until recently, to defend himself from further invasions, he batted away any food presented to him. He was scared, and who could blame him? The answer, his parents realized, was to build trust, apply no pressure, and to let him feel hunger and interact with food on his own terms (play picnics, for example).

I want to pause here and clarify, because “brain injury” is vague and doesn’t paint an accurate picture of Heath. While motor areas of Heath’s brain suffered injury during his birth, Jenny explained to me that his brain is repairing itself thanks to the amazing processes enabled by infant neuroplasticity. The ongoing repairs are evident, as I’ve noticed leaps in his development in the short time I’ve known Heath.  Anyone who lays eyes on him can see that he is thriving in every way. He  is one of the happiest, sweetest, most engaged and engaging babies I’ve ever met. He’s got a sense of humor. He communicates and makes friends easily. His weight is great. He’s meeting developmental milestones a little later than most, but he’s getting there–at his own happy pace (just like all babies, really). Of course, his mother has sought out various ways to support him in his physical development, including occupational therapy, movement sessions and even yoga–and he’s way better than me, seriously.

After much research, various forms of therapy, eye-opening revelations, and inspiration from the Graz model, an intensive wean was planned. The journey began on May 9th, with hands-on support from Dr. Markus Wilken, a psychologist with specialized expertise on feeding adversity. He came to the U.S. to help wean Heath as well as two other tube-fed children, who began eating faster than anyone expected! (You can read about Kai and Rosie’s simultaneous weaning successes at The Crunchy and the Smooth, as well.) Over his career, Wilken has helped wean more than 400 children from their feeding tubes.  He leads the tube weaning program at Princess Margaret Hospital in Darmstadt, Germany and together with Martina Jotzo runs The Institute for Psychology and Psychosomatics of Early Childhood.

Jenny’s blog has all the weaning specifics, but I’ll say that it’s been quite a ride (as in nauseating ups and downs) for Heath and his parents, as most weans are. But, with no doubt, the weaning effort has been successful. The progress Heath has made is staggering. In short, and I am in complete awe though I never doubted he could do it, Heath has become an EATER. He is enjoying a diverse array of foods, with more and more being added to the menu each day. I’m smiling because Heath’s life is forever changed. And because any parent of a tube-fed child who reads this will experience the sensation of their heart doing a back flip within their chest. Brave Heath is going to help so many babies and kids escape from the limitations, pain and decreased quality of life (for the whole family) that comes from extended tube feeding–not just the physical and psychological effects of the tube itself but from the anxiety and helplessness of tube feeding with no end in sight, when your child has (often after much hard work, therapy, recovery) the ability but not the willingness to eat. The parents who stare into a proverbial black hole whenever they ask doctors or wonder to themselves about whether their child will ever be able to eat–they will discover hope in Heath.

To say that Heath’s mom deserves credit is such a vast understatement. The roller coaster ride she (and her wonderful husband) have been on since his birth, when Heath literally had to be brought back to life and the 35 terrifying days in the NICU that followed, is a testament to not only her strength, but her inestimable love and grace. I know why Heath smiles so much.

Practically speaking, this very smart woman is an accomplished journalist. You can tell by the quality of her writing–and the research and outreach to experts across the globe that she executed in her quest to empower Heath with the gift of autonomy and the joy of eating. So, parents of tube-fed children, please check out her Resources Page to hit the jackpot in terms of insights and data and all kinds of valuable, rare informational gems on the topics of tube weaning, tube feeding and associated trauma.

To everyone reading this… I hope you’ll go to The Crunchy and the Smooth and post a few cheerful and supportive words in the comments section. Heath has come a long, long way, but there is still patience and perseverance required by this family as they follow Heath’s lead and adjust to a whole new paradigm.

To Heath, Jenny and the man known as “Peanut”…  big love, loud applause and quiet, awestruck respect from me, Stella and Cody. Enjoy every lick, bite and gulp! (We know you will.)

Three cheers for Zander! Oh yeah, AND HIS MOM.

Posted on by amberhj

Today isn’t just another Tuesday. It’s a very important day. Today, February 9, 2010, is the day Alexander (Zander or Zandy to those who love him) left his G tube behind. For good! I can’t tell you how huge this is.

Due to one of the most severe cases of frank aspiration ever seen at Seattle Children’s Hospital, Zander required a feeding tube for a year and a half (very close to his entire life). Early on, it was discovered that most of the milk he swallowed ended up in his lungs. He started off with an ND tube (like an NG tube that goes further down, indicated only for short-term tube feeding), but it soon became clear that a longer-term J-G tube was needed. At that point, he couldn’t handle a G tube, inserted into the stomach, because food that high up in his system could be regurgitated and cause aspiration. The food had to go directly into his intestines, via G-J tube, to avoid the threat to his lungs. (Much later, though, he transitioned to a G tube.)

Any type of swallowing put sweet Zander in danger. When he got a mere cold, respiratory distress was pretty much inevitable. It was a terrifying journey for the whole family, with a most uncertain destination. They didn’t know where it would lead. They were stuck, in so many ways. Tube feeding has a way of cramping one’s mobility and social life and sanity.

Then it happened. Late last summer, Zander passed a swallow test. Finally. It was his fifth one. He’d failed the four prior, because he was still aspirating. Amazingly, he at last demonstrated the ability to swallow. But could he really EAT? Did he have the willingness? Not at first. He needed to build oral motor skills. He needed to learn to not be afraid of food. He needed to feel hunger, which tube feeding obscures or annihilates. He still had a road ahead of him. So they forged ahead. Unbelievably, there were just two occupational therapy sessions. The work was done at home. They made food “sexy,” conscious of being happy when they ate and letting Zander see them happily eating. They allowed him to touch, and — until he got teeth — gum at flavorful food. They dipped his pacifier into gravy, sauces and juice. Still uncertain, they were hopeful and proactive, even after all they’d been through.

Slowly but surely, Zander began to eat. At first, just a sip from a straw or a bite of a cracker. Breakthroughs seemed to happen when they were behind schedule, when hours had passed since his last tube-fed meal and he was overdue for his next one. On such an occasion, he grabbed his mother’s Jamba Juice and guzzled three ounces in what seemed like mere seconds. Confidence and ability grew in tandem. The percentage of his diet enjoyed orally grew ever so slightly over time, until it hovered at 50%. (That’s as far as Stella ever got, by the way.) That’s when Alexander’s mother, based on research and gut feelings and a few supportive voices, took an incredibly brave but wise leap of faith. She just stopped. She stopped using the tube, and let Zander take flight.

Thirty days later, that would be today, Zander had a check-up with his wonderfully thoughtful, appropriately cautious, yet totally reasonable pediatrician. She saw that since commencement of weaning, he’d gained a bit of weight, and grown taller. She looked at him and saw a happy, healthy, NORMAL boy. And she said that the tube could go. Zander’s mom removed it this afternoon. She still feels a bit dizzy. Makes sense, though. Her world is  spinning, in the best possible way.

Yes, I’ve met Zander’s mom and I liked her instantly. She’s got wisdom and laughter in her eyes. Yep. A killer sense of humor, and a shrewdness that could put any seasoned lawyer to shame. So, as big a day as this is for Zander, I find myself just as happy, if not more so, for her. She got him here. Her strength. Her determination. Her unwillingness to settle. Her ability to take a hit and get back up, in the face of anxiety. Oh, the anxiety. She didn’t let it stop her, and that’s something a lot of parents could learn from these days.

She’s been to hell and back, probably saved her kid’s life more times than she can count, yet she’s got enough energy left to fight for other little ones like Zander. She’s become their much-needed advocate. She’s already inspiring others, and pushing for change. Better care is needed for kids on tubes, a technology that is outpacing our understanding of its impact on children and their development. And, as she and I both learned, there is no end in sight. Kids and babies whose core issues are resolved remain tube-fed for years, because no one knows how to wean them. So few in the medical community are brave enough to at least give them a chance to eat on their own. Well, she’s stepping up to the plate.  But that’s just business as usual for her. I’m going to support her however I can.

Zander now has two “belly buttons”, the last evidence of his medical journey. It’s a new, tube-free world for this family. A time of joy and nervous transition to an alien concept called “normality.”

The next time your child savors mac and cheese, or any favorite food, take a minute to appreciate it. And raise your glass–hold it extra high–for Zander and his mom!

(Much respect.)

Three is a magic number

Posted on by amberhj

Three years ago today, Cody was very, very brave.

Three years ago today, Cody did something that was very, very brave.

Today is our 3rd anniversary. Cody and I have been married for three years, but together for seven and a half. Though, the last year alone feels more like a decade in some ways. Cody gave me the most thoughtful card with several sentences written inside that made my eyes well up (!), and, from Nordstrom, a pretty necklace with black crystal beads. He thought about getting the clear crystal version, but figured black would be better for the fall and winter. He is right. I’m impressed.

We three celebrated three years tonight at a low-end but decent pizza joint. That may not seem very romantic. But in a way, it was.  We were happy and content, just being together. Until Cody derailed my plan to get ice cream at Molly Moon’s afterward! Big mistake, Cody. Huge. But we recovered quickly.

At dinner, Stella ate more food in one sitting than we’ve ever seen: beans, pasta, cottage cheese, olives, shredded mozzarella, grapes, three giant wedges of watermelon, bread. Oh. My. God. It was AWESOME. What a fabulous anniversary gift. I think we both got a little teary eyed. We were in awe, reminded of how lucky we are to have the tube so very far behind us. Our union has created this beautiful, vibrant girl who is thriving. It’s beyond words, really.

This weekend, Cody and I will venture out together for a fancy-ish meal and hopefully a movie. And ice cream will be eaten. And old memories will be rehashed. And I’ll wear my new necklace. And we’ll get to be Amber and Cody for a while, not Mama and Dada.

Cody, I feel so fortunate to have found you. Whenever I miss my family and start cursing about being here in Seattle, so far away, I have to catch myself. Seattle is a magical place! I came here ten years ago basically on my own, with all my possessions packed into my 1990 Jetta, and stepped into the unknown. I was adrift. Throughout my life but especially after moving here, I experienced terrible loneliness and I wasn’t sure why I’d come here or what I was doing or if I’d ever find “my place.” It’s all clear now. I was growing and learning on my own, yes, but more than that–the move to Seattle, all my mistakes and fears and, heh, therapy–it all led me to you, a Minnesota boy sweet and strong enough to put up with me. Truly. (I mean, you just came in here as I was writing this and I snapped at you because I was annoyed and wanted to finish this post and didn’t want you to see it yet.)

You are as smart as they come, but humble, yet, I love that when you don’t know something, well, you’ll somehow form a super-authoritative, convincing and detailed opinion on the spot based on what little information is available. You don’t have a greedy or selfish bone in your body. You are one hell of a point guard (really amazing actually), and a self-made player like me (you may be the only person who knows what I mean when I say that), and this is huge, not only because we got to know each other on the court but because I just couldn’t be with someone who sucks at basketball. You’re incredibly cute, though I’m still trying to convince you of that. Oh boy are you an amazing dad–you nurture Stella and shower her with love and pay very, very close attention to her and appreciate all the little big things she does. Every girl on this planet should be so lucky. What I know for sure is that this world be an above-and-beyond better place if all fathers were like you. I’m lucky to have you as my best friend, and my husband. Honestly, without you, I’d still be lost. I love you very much.

Stella Enters Single Digits

Posted on by amberhj

Stella turned one on Monday. I should probably say something really profound and eloquent and heartfelt but all I keep thinking to myself is “HOLY SHITBALLS!” Over and over and over.

The birthday girl.

The birthday girl.

Okay, I’ll say that after 12 mind-blowing months, it feels like heaven to see her thriving, running, throwing, walking, laughing, smiling, waving, chowing, bye-bye-ing and doing everything she is “supposed to” and more, especially after all we went through with her feeding issues and the entity referred to as The Tube. Perhaps I appreciate this milestone more–who knows, maybe a lot more–than I otherwise would have. There were days when I didn’t know if she’d grow again. I couldn’t see a way out for us–no light at the end of the tunnel. In fact, it wasn’t a tunnel. It was a deep hole and we were stuck in what seemed like mud but it was too dark to really know. There were nights when terror had me by the throat and I literally had trouble breathing because I loved her so much and that feeding tube was hell and totally unacceptable and the tyrannical, suffocating thought, “WHY WON’T SHE JUST EAT?” robbed me of my own appetite and mental stability (what little I had to begin with). The really sad part, I suppose, is that I know there were stretches of time during which worry over her unwillingness to eat, and knowledge of the pain she was in initially, and the resulting lack of weight gain robbed me of much of the enjoyment of some her early little triumphs–the ones that are actually incredibly huge–and anxiety sometimes prevented me from savoring that fleeting, precious time in her life. That’s what gets to me as I look back.

But now, here we are at one year old. We made it! We kicked some ass. Holy crap. We moved MOUNTAINS, we hit the three-pointer at the buzzer, we saved the world! (Our little corner of it, anyway.) I could not be more proud of her. And you know what? I’m proud of me too. I love where we are now. She is such a happy and active child and so strong and vibrant and resilient. She glows! Everyone sees it. I am tempted to quote Jack Nicholsen here, which seems inappropriate and perfect: “You make me want to be a better man.” Because she has inspired me to let go of what doesn’t matter and to cherish what does. Heck, if she is this awesome (and she really, really is–like when she spots her Cookie Monster doll across the room and lowers her voice several octaves and talks in scruffy baby talk all the way over to him), I must be pretty great. So, to be better, I don’t really have to do much at all, except be kinder and gentler toward myself. That’s the example I want to set for Stella.

Just after proving that guacamole has a calming effect.

Just after proving that guacamole has a calming effect.

We threw a very small, delightful and heartfelt party on Sunday (yes, it’s true, a party can be heartfelt). My parents were visiting from Boston, which made it all the more fun. I think we were all shocked when Stella refused to eat her cupcake. Wouldn’t even touch it. We got her to lick the candle, an attempt to help her enjoy some of the Trophy Cupcake frosting magic, but it must’ve been too sweet for her, because she reacted as if she’d been force-fed a heaping dollop of Vegemite. (I reacted the same way, when, during a soiree I attended amid my study abroad experience in Melbourne, I loaded up a cracker with what I thought was Nutella. Let’s just say that I’ve never been more wrong about anything in my life.) Total disgust. However, she eagerly ate my mom’s super fantastic guacamole, and had some flaky crust from one of the three types of quiche (crab, broccoli, and bacon-loaded Lorraine–all were superb).

She looked as adorable as ever, but, not at all used to wearing a floofy dress, she tried to undress herself constantly. Also not accustomed to so many people (and all were adults save for one toddler) crammed into our small abode, she got a bit clingy. I have to say I enjoyed that, because she’s usually far too busy sprinting around or doing headstands on the coffee table (trying to, anyway) to be held. Oh my, she WAILED when we sang “Happy Birthday.” It was funny, and got a big laugh (which probably didn’t help matters!) but I really felt for her. Actually, I set her up. I know full well that when you sing to her on your own, she’ll not only be mesmerized, but she’ll often sing along, or more likely try to one up you with her angelic singing voice when you’re done. But don’t you DARE sing with anyone else! Not even one other person! It is absolutely *terrifying* to this otherwise fearless girl. Cody and I learned this a few months ago. I was singing some old Cookie Monster song (that Cody taught me) while feeding Stella, when Cody chimed in. She looked at me with an expression of total horror, then looked at Cody, and back at me. And then, the tears and hysterics began. Sometimes we forget about this and absentmindedly join in if the other is singing and holy cow does our self esteem take a hit when she gives us the biggest and most terrified thumbs down you can imagine.

Cody made a bound hardcover photo album recapping Stella’s first year of life, as a surprise for me. It arrived yesterday, and it’s fabulous. I just love it. (Thank you very much, Cody!) Somewhere toward the middle, there’s a photograph from Christmas day. She’s on her tummy, wearing her green candy cane (striped) PJ’s, with her fists restly cutely under her chin. Her expression is priceless. She is clearly thrilled and her grin could not be any wider, but there is an undeniably devilish glint to her smile. She’s up to something. The tube is there with its horrible, all-too-temporary tape job, but at first, I didn’t even see it. All I saw was her beautiful face. And as I realized this, I was struck with how far we’ve come.

Stella, happy, happy birthday! You are a wonder to behold. We feel so lucky, so incredibly thankful to have you in our lives. I love you so much I would stand on my head all day long just to prove it to you, or even eat a whole tub of Vegemite. May your second year be as triumphant as your first, and even more joyful! We can’t wait to see what you do next.

Support and community for parents of tube-fed children

Posted on by amberhj

Trying to wean your child off of a tube? Bravo! You’ll find comfort, resources, and encouragement in this online support group:

Tube Fed Children Deserve to Eat

It’s a social network powered by Ning Grouply, with the purpose of “Connecting Parents of Children with Tube Feeding Issues.”  There you will find a wealth of information and wonderful people who are all going through (or have been through) your stressful situation!

Best of luck to you!