The Main Players

Good Morning, Sara.  Your mission, should you choose to accept it, is to raise two nutritionally complicated children...

...Hah! Forget that.  You have no choice.  They are your children.  Of course you are going to accept this mission.  It comes with the territory of being Mom.

Here are the main players in your mission:

GWENDOLYN

CODE NAME: GRENDEL

She may look cute and innocent, but cross her and you awake the monster within.  Her given name is Gwendolyn, but she quickly earned the designation Grendel (on bad days, Grendelyn on good days; for a quick overview of her literary namesake's character analysis, click here) due to her temperament as a baby.  The name applied well as a toddler and continues to hold true as a preschooler.  

Grendel has struggled with GI issues her entire life.  Beginning as an infant, she had severe reflux.  While some kids are referred to as happy spitters, she was an unhappy, or, more accurately, furious, spitter.  She also had chronic diarrhea, bleeding diaper rash, and colic that lasted well beyond the usual 3 to 4 month timeframe for colic.  At the age of 3, when baby sister (Code Name: Hobbit) displayed similar symptoms that were relieved when mom went on a Total Elimination Diet, it was determined that she had undiagnosed allergies as an infant to allergens that were passed through mom's breastmilk.

Grendel's spitting continued through toddlerhood and still occurs as a preschooler.  For the past 1.5 years she has thrown up into the back of her mouth roughly 20-30 times a day.  More recently, during the past 5 months, she has experienced daily tummy aches.  A pediatric GI specialist has given her a presumptive diagnosis of eosinophilic esophagitis.  She takes a proton pump inhibitor once daily to control her GI symptoms and protect her esophagus from acid damage.

Furthermore, Grendel was recently diagnosed with Sensory Processing Disorder (SPD).  She receives Occupational Therapy once a week to help her to manage her senses and to better integrate sensory information (more on this in future posts).

Mom has been drastically changing Grendel's diet in recent months in hopes of relieving both the GI discomfort and the SPD symptoms.  Grendel, who has been a vegetarian since birth, is now gluten-free and dairy-free.  Mom is continuing to modify her diet by cutting out all artificial colors and flavors and by limiting sugar intake to one "sometimes food" a day.

FIONA

CODE NAME: HOBBIT

Hobbit experiencing her first taste of solid food at 6 months

Hobbit earned her code name from her tendency to eat breakfast, second breakfast, eleveses, luncheon, afternoon tea, dinner, supper, and several meals throughout the night.  Born at 36 weeks, and weighing in at a whopping 5 lbs 10 oz, she used her love of mommy milk to triple her birth weight by approximately 7 months.

Like big sister, Grendel, she has had GI problems from the start.  She developed meningitis at birth landing herself in the NICU for two weeks for administration of IV antibiotics.  The combination of illness and Mom's overactive letdown resulted in complete refusal to breastfeed directly from Mom.  Mom pumped exclusively and continued to work with Hobbit.  After 6 weeks, Hobbit had pity on Mom and began breastfeeding directly.

The feeding difficulties with Hobbit did not stop there.  Hobbit developed diarrhea, colic, reflux that was unresponsive to the maximum dose of Zantac, and a bleeding diaper rash.  Mom was able to put together several clues that led her to believe that Hobbit was reacting to allergens in breastmilk.

1. Hobbit was diagnosed with failure to thrive while in the NICU and a soy formula fortifier was added to Mom's breastmilk.  Hobbit's belly bloated, the NICU staff were worried her intestines had stopped moving, and the fortifier was discontinued.  She still struggled to gain weight.  At discharge she was not yet back to her birthweight and the doctors recommended she go home on the same soy formula fortifier.  By the next morning her belly was bloated again.  The pediatrician agreed that the fortifier should, yet again, be discontinued.  
2. Hobbit was spitting up more at home than she had been in the NICU.  The pediatrician recommended adding rice cereal to her bottles of breastmilk to help keep the milk down since she still was not gaining weight.  After adding rice, Hobbit began spitting up even more and drinking less.  Mom discontinued the rice cereal.  Mom read the ingredients on the rice cereal and realized that it also contained soy.
3. Mom thought about changes that had taken place in her own diet since returning home that might result in increased spitting and realized that, due to her vegetarian diet, she had begun eating more soy at home than she had when eating from the hospital cafeteria.  

Step 1: Mom removed soy from her diet.

The pediatrician informed mom that a soy intolerance without a dairy intolerance was uncommon, and within a couple of weeks Hobbit had developed mucous filled stools.

Step 2: Mom removed dairy from her diet.

Hobbit improved drastically and began responding to Zantac.  However, she was still obviously suffering.  Mom could not find any patterns in food consumed that might be causing Hobbit's symptoms, so with the support and encouragement of the pediatrician and pediatric GI specialist chose to go on a Total Elimination Diet (TED).

Step 3: Mom went on a TED diet.

A TED diet works by eliminating all of the common allergens and reduces mom's diet down to some of the least allergenic foods from each food group.  Mom subsisted off of squash, potatoes, pears, rice, and beans (the actual TED diet calls for turkey, but mom has been a vegetarian for the last 5 years) for a couple of months and then was able to add foods back into her diet once every 4-7 days as Hobbit enjoyed each new solid food.  Essentially, mom expanded her diet as if she were a baby.

Hobbit did well for months.  As long as mom stuck to this diet and dosed hobbit with Zantac, Hobbit was relatively happy.  Then, at 9 months, Hobbit had two episodes, separated by 4 days, in which she vomited 15-25 times over the course of 3 hours.  During the second episode she began vomiting bile and was rushed to the hospital.  Doctors suspected a bowel obstruction, but all imaging studies came back negative, so Hobbit was sent home with instructions to bring her back if this happened again. About 4 weeks later it happened again.  She was taken to the ER, the doctors suspected malrotation, an x-ray was performed, but it was once again negative.  An upper GI series was ordered to determine if there was an anatomical abnormality, but it was negative.

It is now believed that Hobbit has Cyclic Vomiting Syndrome (CVS).  CVS is characterized by episodes of vomiting that are unexplained in origin and that recur with the same intensity and length of time. She will be seen by a pediatric GI specialist soon to rule out other possibilities and determine if this is, indeed, the cause of her vomiting episodes.  If she does have CVS, mom and Dr. Dad will have to work to determine Hobbit's triggers to decrease vomiting occurrence.

HUBBY

CODE NAME: DR. DAD

Dr. Dad will be your team member, in this mission, and your greatest support.  He is your husband and your rock.  He goes along with your parenting and nutritional schemes, however crazy they may seem.  He is the Ethel to your Lucy.

Dr. Dad is an anesthesiologist by day and super dad by night.  He is the very best at reading books, giving baths, making obstacle courses, and developing death defying stunts in a game that he and Grendel like to call Cirque Du Bébé.  He also has endless patience and jumps right in to help with the girls as soon as he gets home providing you a much needed break.

You and Dr. Dad will have to combine your medical knowledge and parenting abilities to develop diet plans and parenting strategies that will help you to raise healthy, happy, and confident little girls.



YOU
CODE NAME: MOM

You earned a Master's Degree in Medical Dietetics after marrying Dr. Dad.  You completed the coursework for your degree before Grendel was born and your Master's project after she was born.  You have not officially worked in the field of dietetics (outside of your internship), but you have earned substantial dietetics street smarts during the past 3.5 years of raising two children.  You love staying at home with Grendel and Hobbit, and they are keeping your nutrition skills sharp!  You have not yet taken your Registered Dietitian credentialing exam, but you are planning on completing that soon.  In the meantime, you are learning more about nutrition each and every day, both from your natural gravitation toward nutrition information and your endless pursuit of relieving the symptoms of your two little girls while feeding them healthy diets.


So, yeah, you've accepted this mission.  And you have the greatest team ever.