Appointment with the nutritionist

Mariella and I met with the nutritionist today.  She isn’t bad, she’s personable enough.  She started out with a weight and height.  She’s still up a little bit, so the weight she picked up on the prednisone has stuck, likely due to the pediasure…that’s fine, we’ll take it.  It brings her to the 3rd percentile for weight.  Her height has not changed, which drops her to the 1st percentile for height.  Her BMI is average for her height and weight, though…though, for her age, she’s very low.

We talked about what Mariella eats, how much, etc.  I’m well aware I sound like “Negative Nancy” when I’m discussing her diet with people.  They offer ideas, and I end up nixing it…not because I’m trying to be difficult, but because I know what’s going to make her sick.  I’m sure it’s as frustrating for the medical professionals as it is for me.   I’m willing to try just about anything, unless we’ve already tried it, and it hasn’t worked.

The only thing I DIDN’T like was that if really felt like she was BLAMING Mariella for not growing.  She would say “you have to eat what mommy gives you” when, in reality, she does eat what I give her.  She just isn’t able to eat a lot…and she’s scared to eat, and sometimes, she just plain doesn’t feel well enough to eat.

We worked out how many servings of each food group she needs (3-4 dairy, 2 protein, 5 fruit and veggie, 5-6 grain) and she gave me a reward chart to fill out.  When she consumes something, she gets a sticker in the box for that item.  So, for supper tonight, we had pork medallions, apples, mixed veggies and a biscuit…she ate everything but the apples, but had a second serving on veggies…so she got a sticker for the pork, 2 for the veggies and 1 for the biscuit.  She isn’t to have anything to drink until AFTER she’s finished eating.  Solid food first, then drink…so she also had a serving of milk, so that got a sticker too.  Her portion sizes are those of a toddler…so very small amounts.

For each week that she fills most of her chart with stickers, she gets a little reward…probably a “sleep over” with Abby.  They love to have sleep overs in each others room.  When we go back, we’ll show the nutritionist the charts, and she will determine if Mariella has done well enough with eating things that she can get a big prize…Mariella has chosen a pedicure, probably.  The nutritionist wanted to have the big reward be based on whether or not she grew/gained but I nixed that.  I don’t think she should be rewarded or penalized on something she has no control over.  Reward her for eating the things she should be, but not for growing.

The only exception was if she was having a really rough time breathing, and doesn’t want to eat, I’m allowed to give her a full bottle of pediasure…rather than trying to force her to eat.  I’m not to do that if her belly is bothering her, though.  She should try to eat first, and supplement with the shake if we need to.

All in all, it wasn’t bad.  I get the feeling that she hasn’t been exposed to the challenges of Gastroparesis (though, why would she be, since the GI docs out here don’t diagnose it, or treat it)  That she mostly deals with kids who are diabetic, or are not gaining weight for other reasons.  I was turned off by the rewarding growth idea, and the way she addressed Mariella about eating.  However, sometimes, Mariella DOESN’T do her job of eating, because it’s easier to drink a shake, so maybe the nutritionist isn’t all that far off.  We’ll see what happens.  At least with a chart, it will keep ME on track of presenting balanced meals in appropriate portions…Mariella is the only one who can actually eat.

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3 Responses to “Appointment with the nutritionist”


  1. 1 kerri May 26, 2011 at 12:10 am

    While I don’t fully agree with the whole rewards thing [or agree at ALL. If it were simply that she didn’t WANT TO eat that would be one thing, but if she FEELS yucky that’s another!], I hope that this person figures SOMETHING out that helps Miss Mariella.

    I DO wonder, though, [while I don’t think this whole rewarding eating in general thing will work, I do like the balance-y food group-ness] if a similar system may help to re-integrate foods that she is scared to eat now because they’ve made her sick in the past? For example, she TRIES the food, even in small amounts and builds up stickers just for trying it again?

    I mean, I’m no expert or anything and I don’t know Mariella, but even if THIS dietician’s plan doesn’t work, there are other things to try, you know?

    Hang in there and keep us posted ❤

    • 2 mommato2beauties May 26, 2011 at 9:13 am

      she’s super psyched about the whole sticker thing…I’m not noticing her eating any more, but we’ll see what happens. I am going to let her earn extra stickers for trying new things too, or maybe start a new chart for that…the only issue with that is that I don’t serve new things all the time…but a chart would help me keep track when I do.

  2. 3 Melissa May 30, 2011 at 6:48 pm

    I think you are doing a great job! I like that you didn’t reward only if Mariella gains weight/height. She has much more control over eating healthy things, and trying to eat even if it isn’t her day. I just think that there are so many messages about food that can create problems in the long run, that it’s really important to focus on positive things…like affecting your health by doing something that feels right. If for some reason the eating part doesn’t help with the growth so much, it is the doctors jobs to find something that does work. Because after all there are other reasons than just food that Mariella is small for her age, right?

    Melissa


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