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Obese and Undernourished
At the time of this writing, Zach has been with us for over three years, although he’s technically only been “ours” for less than one. We began foster care in late 2008 and, as our first foster child began her transition home, Zach toddled through our door. At two years old, Zach was barely walking and he was grossly obese. His eyes were sunken into his head and he had virtually no expression except for one of vague concern. Speaking years later to a friend of mine who had served in Iraq, I now know this is what they call “The Thousand Yard Stare” and is a symptom of PTSD. At the time we didn’t know anything about the psychological impacts of severe neglect, but we knew there was something very wrong.
Days passed and he would not eat. The only nutrition we could get into him were what we called “yogurt smoothies,” milk and yogurt mixed together in a sippy cup. Even more disturbing, whenever we could get him to drink the smoothies, he would vomit. He wouldn’t vomit a lot, it was almost like a baby spitting up too much food. We took him to the doctor but got no answers, so we had to keep searching. We were also very concerned because his teeth were very yellow and seemed small. We took him to an emergency dentist who confirmed he had bottle rot and gave him fluoride treatment. But, still no answers on how to get him to eat. Because Zach was non-verbal, he couldn’t tell us why, or what foods he liked or didn’t, in fact he didn’t tell anyone anything. He would not speak or look anyone in the eye. He would not play. He would not smile, or show any emotion. It was like he wasn’t there.
We tried every “toddler” food we could think of, mac and cheese, hot dogs, chicken bites, peanut butter jelly, even cookies…nothing. He refused to touch any of it. Zach was a mystery on many levels. Why wouldn’t he eat? Why was he throwing up? Even more confusing was his obesity…if he wasn’t getting food, how could he be so chubby? One day, I was running late taking our oldest son to school and forgot to make him breakfast so I ran to Starbucks and grabbed a bagel for everyone, even though I knew Zach wouldn’t eat it. As soon as I started passing back the bags to the kids, Zach started to grunt…I looked back and he had his hand out! He was interacting and wanted food! I handed back a bag with a bagel and he pulled it out of the bag and began eating with more gusto than I had ever seen anyone eat! After he finished his bagel, he put his hand out again and grunted, so I gave him mine…he ate that one too!
I dropped my older son off and returned to the house, trying to figure out what had just happened…was it Starbucks? Was it the bagel? Why had he responded so strongly? I called my husband, perplexed as to what exactly had happened. After I told him the story he said “what…what if it was the bag? What if he was only getting fast food and doesn’t know that food comes from the refrigerator?” I hung up the phone and ran to the kitchen, pulling out a paper lunch bag and poured some goldfish crackers into it. I walked over to Zach and he again grunted and held out his hand…through my tears I watched him eat the goldfish crackers. I had cracked his code…we were talking, and he was eating.
Many people assume malnourished children are underweight, but a child who has been malnourished can also be overweight. With Zach, an untreated case of acid reflux (which is now under control and treated with daily medication) had caused vomiting every day, preventing Zach from keeping much protein in his system. This, along with being fed only the high fat, low protein fast foods he received for the first two years of his life made him both obese and malnourished. After we figured out how Zach needed to receive food, we were able to introduce healthy foods and over the next several months, Zach not only lost almost 10 pounds, but he started to pull out of his mental fog and began interacting with us more and more. When he was 2 years old, he functioned essentially as infant, but today Zach is a social butterfly in his pre-school and preparing to attend mainstream kindergarten next year, and has only minor cognitive delays.
Fostering and adopting children can be very frustrating, especially when there seem to be no answers, but in our case, thinking outside the box (inside the bag?) made all the difference in helping Zach receive the nutrition he needed in a way that he could accept.
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