Sometimes our work brings tears to our eyes.

Today I discharged four year old Gabriel after one week’s intensive treatment for food phobia in Kartini Clinic’s Food Phobia treatment program.

Jill, Gabriel’s mother, had a hard time finding us in the first place.  Following a course of treatment for strep throat, her son had choked on an ice cream cone and thereafter refused to eat.  No amount of talking, cajoling, bribing or insisting could induce him to eat or—eventually—drink.  For a day and a half he literally ate nothing, until Jill discovered she could induce him to eat completely lump-free yogurt.  She kept him alive on yogurt until she could find help. 

Jill found us on the web in the early hours one morning and immediately called her mother to tell her the good news:  “these people know what Gabriel has and have a treatment program for it!”

Despite the fact that Jill endured some skepticism on the part of concerned friends and family members, and hoping that we knew what we were doing, she took a leave of absence from work, bundled her son into the car and drove across the state to Portland.

Once in our program Gabriel required placement of a nasogastric (NG) tube to take control of his calories. As per our food phobia treatment protocol we began him on olanzapine (Zyprexa).  For five days we offered no food and let his anxiety subside. At that point he had refused to let anything come near his mouth, including a toothbrush.  His normally rambunctious, active boy behavior had become mistrustful, and he began hitting his mother as well as other people, screaming for them to go away.

Once the tube was safely in place he ignored it.  No one spoke to him about food or asked him to eat.  Gabriel played with his mother and other kids in the hospital for the better part of a week.  Only then did our staff attempt to introduce solid foods. At first he was able to lick and taste a cookie, but no more.  Over the weekend he asked for chewing gum and Gatorade and was able to tolerate both.  Then his little brother, two years old, came to visit with Dad, and — wouldn’t you know it — accidentally pulled out Gabriel’s feeding tube!

Gabriel cried bitterly as the nurses prepared to replace the tube.  “I’ll try and eat!” he insisted.  We decided to let him try.  He was clearly anxious about the first bite of pizza, and had to chew it many, many times.  When he took that first swallow his eyes got as big as saucers  “I did it!” he cried. “I swallowed!”

In fact this episode neatly sums up our approach to treatment of food phobia in children: “bite, chew, swallow.” For kids with food phobia, anxiety around the act of eating is the primary problem. There is nothing wrong with their ability to swallow, but they are convinced they will choke if they do so. Rather than add to that anxiety, we take measures to lessen the emphasis on the act of eating (at first). The presence of the NG tube (to continue vital brain nutrition) allows us this luxury. Only once the anxiety is under control can re-feeding begin in earnest, step by step: bite, chew, swallow.

And while we don’t usually do so, Gabriel’s mother was so thrilled she asked us to share this treatment result with other families out there who may be looking for a food phobia program to help their child. It is with this hope that we present to you a brief video of a very happy little boy we like to call “Where are my cookies?” I hope you enjoy it as much as we did.