Samedh had his second therapy session with Ms. Jenni today. She assessed his cheek muscles and lip strength and then had Samedh practice biting on his new chewy letters. He chose the Q today, and bit down well on both the right and left side. For snack, he brought his own alphabet cookies and Ms. Jenni provided a strawberry yogurt drink. Samedh ate on a "rotation" of one cookie followed by one sip of yogurt drink through a straw. He really liked the yogurt drink, so we'll be buying some for home. Jenni said Samedh chewed well on both the left and right, and would often use his tongue to shift the food from one side to the other. She encouraged us to keep offering foods on a rotation at home, often with a "reward" food at the end. Next week, she suggested we bring in chicken corn chowder, broccoli, etc. for Samedh to eat during his session. Practicing a rotation of foods in therapy will help encourage the same rotation at home.
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Jenni also mentioned that she forwarded her initial report to Samedh's pediatrician, along with a recommendation for a referral to the Developmental Pediatrician team at Devos Children's Hospital. Samedh is below the 3rd percentile in height and weight, and Jenni said in that case her next step would be to have him evaluated by the pediatric team in Grand Rapids. A typical assessment involves evaluating fine and gross motor skills, just to see what the child is capable of doing. Samedh obviously has no issues in those areas, but a dietitian may be able to offer ways for us to add calories to his meals. And then there's the social worker who offers feedback as well. Now we've had plenty of social worker experience with Samedh's adoption, but bringing a social worker into the mix now would be my biggest worry. I can just imagine an "outsider" evaluating Samedh on height and weight alone and making assumptions about his care and welfare without knowing any details about his background or genetic history. That's not likely to happen, but the thought is always at the back of my mind.
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Samedh's doctor is not concerned about his weight and growth, so he has not authorized the referral to Devos Children's Hospital at this time. Jenni suggested that Pankaj and I talk it over and contact Samedh's doctor if we want to pursue the evaluation. For now, I think we'll simply take Jenni's advice on adding extra calories to Samedh's meals. We'll be adding Carnation Instant Breakfast powder to his whole milk and give him Pediasure to drink at mealtime at least once a day. Adding extra butter to foods is something we've always done, but I'll now find ways to add sour cream or cream cheese too (now wouldn't that make a tasty mac & cheese!). Samedh did gain weight in the last two weeks, going from 23lb 13oz to 24lb 4oz. Jenni will continue to monitor his weight every week and submit periodic reports to Samedh's pediatrician. If we don't see an improvement in weight from week-to-week, we can always take the next step under the direction of both Jenni and Samedh's doctor.
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Jenni asked if there has been an improvement in drooling, and I was happy to report that there has. In just the last couple weeks or so, Samedh just hasn't been drooling as much. Maybe he's just more aware of it and is swallowing more instead. He doesn't seem to need his wristbands to wipe his chin as much lately...rather, he uses them simply for chewing.
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Finally, I want to report a very successful lunch time today! We tried a "rotation" as Jenni recommended, and Samedh took turns eating bites of mac & cheese, corn, and goldfish crackers, followed by a sip of milk. Since the goldfish crackers are his favorite, they served as his "reward" for eating the other foods first. He repeated the pattern until his plate was empty, and he enjoyed every minute of it. It was a very systematic process, and Samedh is fond of "systems" and organization. He was proud of himself for completing lunch, and I further rewarded him with chocolate pudding. I reminded him that if he continues to eat complete and healthy meals, more extra treats like pudding will follow.
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