Treating feeding disorders in a multidisciplinary child unit

פנינה הרץ
ד"ר פנינה הרץ
פסיכולוגית התפתחותית מומחית. הוכשרה כתרפיסטית במוסיקה ועוסקת בתחום זה לאורך שנים עם ילדים עם אוטיזם / PDD מרכזת את המרפאה הרב תחומית הקרויה: מרפאה להאכלה, תזונה, קשר והתנהגות אכילה". בית חולים הדסה הר הצופים

Hope a cuddly, sweet, affable 14-month old came with her parents, Dan and Lee, to our clinic for feeding disorders (FD). Her birth weight was 4.5 pounds and Apgar scores: 7 (1 min); 9 (5 min.). Hope was released from the premature-baby unit at the age of two months. She was diagnosed with Pierre Robbin syndrome, a suspected milk allergy, IUGR, anal fissure resolved and FTT. After being operated for Cleft Palate, Hope started gaining weight and height. As medical issues became less and less relevant, difficulties with behavioral and parent coping abilities arouse. Hope was developing slowly in terms of motor, speech and language, but communicative in a non-verbal manner. Her parents described her as an active toddler with an easy temperament.
A quiet and young couple arrived with an alert and sweet toddler. The parents seemed puzzled and uncomfortable with the situation. It seemed that Hope was progressing spontaneously, with two young parents learning how to function as parents. I kept in mind the fact that the grand mother was an active part of this story, pushing the carriage. I had the impression that Hope took an active part in the family setting and she was rushing her parents to take a quick course in parenting, so that they can take better care of her, and provide her various needs.
The immediate goals were to help Hope gain weight, height and weight/height ratio according to her medical record and build a relationship based on trust with Hope's parents. The Intermediate span goals included: preparing Hope's parents towards Hope's entrance to a pre-school program (which would expose to positive modes of eating and relationships), getting to learn about the specific family's mode of life and perception about parenting and meeting individually with Lee who seemed more confused and missing strategies, strengths and a positive view of life.
Hope's family came to all the Psychological appointments recommended. The appointments are scheduled for every two weeks or closer together in accordance with the needs of the medical situation and in order to create an ongoing process that will yield a therapeutic relationship. Many parents find the Psychologist as a unit that threatens there abilities as parents, and might prefer to access other professionals and avoid meeting with parts that can arouse guilt feelings. There for, I found myself out reaching and using my abilities as a suitor. A visit at Hope's home was a critical point of information gaining, paving a way for me to Lee's heart and learning about her inner world, childhood and adolescent experiences, and their influence on her parenting style and abilities. Themes of emotional neglect, rejection and loneliness arose. It was clear that Strengthening Lee as a person can strengthen Hope and provide her varied needs by mom.
At now I am meeting individually with Lee or with Lee and Hope as a dyadic unit. Lee is busy with two major issues: searching a professional orientation and accessing insights about her parenting abilities. It seems that Lee is concerned with the theme of normality due to her personality, inter-personal relationship and motherhood. The more she is noticed by the other parent figure she will be able to notice Hope's existence and needs and provide them.

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