Saturday, January 30, 2010

Things I Need To Know

How do I transition from, "I know your sensory disorder sometimes makes trying new things harder for you than for other people, but remember, new foods are not going to actually hurt you. If something tastes bad you can just spit it out. It won't kill you. Please try new foods. Try everything!" to "Always ask an adult before you take a bite out of anything you haven't had before. Read labels on food packages. Don't eat or even touch anything that says PEANUTS or PEANUT BUTTER or PEANUT FLAVOR or MAY CONTAIN NUTS or MAY CONTAIN TRACES OF NUTS. Don't allow other kids to share food with you. Don't eat at a restaurant, ever, unless I am there with you and I've brought your Epi-Pen."?

How do I do this? How do I tell a child who once spent an entire year of his life starving himself nearly to the point of mandatory feeding tube insertion because he was afraid of eating food that certain foods he could eat without trouble a week ago can now, suddenly, KILL HIM, without sending four years' worth of constant effort to get him to eat well careening back to square one?

How do I convince a child for whom certain shirt tags feel like little knives constantly stabbing his back, a child who can feel a tiny crease in his sock as though it were a rock in his shoe, a child who is terrified of needles, that he must now carry an Epi-Pen with him at all times, and practice repeatedly with a dummy pen to learn how to inject himself with it, and that if he feels a severe reaction coming on and there is no one around to help, he must use it, he must stab himself with a needle, and he must hold it there on his leg, and he must hold still and let the medicine flow, no matter how much it hurts him, no matter how scared he is?

How do I protect a child who was already quirky, skinny, short, bookish, nerdy, dreamy, uncoordinated, red-haired, and dangerously smart from getting teased by children or excluded by adults even more than he already was before, because he now has an allergy that many people seem to find so inconvenient to deal with that they'd like to isolate the children who have it entirely from other kids at school?

How do I convince not-so-medically-savvy family friends and relatives who have seen my kid eat peanuts before without trouble that no, he can't have just a little, and yes, in fact, three bites of a peanut butter cookie could actually, now, kill my son?

How do I make myself really believe the words of our brand new allergist, that my child probably won't die from this, that he may even outgrow it, that there are treatments down the line that could help him overcome this entirely in five years, or ten, that this won't change his life to terribly, that really, truly, everything will be okay?

Thursday, January 28, 2010

The Reaction

When Isaac was eight months old, he had emergency surgery to remove a periorbital dermoid cyst — a sort of benign tumor on his skull, next to his eye — after a CT scan had determined it was less than a millimeter away from infiltrating his brain.

After the surgery, my son, who had already proven himself quite a finicky eater in my early attempts at introducing table foods, became extremely orally defensive, and began to refuse solid food almost entirely. I did not know, at the time, that he had sensory processing disorder, and had no idea what was causing him to refuse food, or what sort of therapy might help him.

In the months that followed, his weight dropped lower and lower on the growth chart, and his growth slowed, until he finally met the criteria of failure to thrive. We took him to see several pediatric medical specialists without a successful diagnosis. During our months-long search for answers and help, we had him tested for common food allergies with a simple blood test, but the test came back negative.

We were advised at one point by a pediatric dietician to introduce peanut butter into his diet, because of its high nutrient and calorie content. (It is, after all, what doctors feed starving children.)

I was skeptical of this advice. Back then, the American Academy of Pediatrics recommended that parents delay introduction of peanut products until age 3 to reduce the chance of allergy (this advice has since been shown to be not only totally scientifically inaccurate but in fact detrimental — think the "All those doctors who have been telling parents for decades to put babies to sleep on their stomachs to prevent SIDS have just been scientifically proven to be totally talking out of their posteriors! Because they've been actually CAUSING SIDS with that unscientific, unproven advice! Who knew?"sort of wrong and detrimental — but of course I did not know that in 2005).

Plus, having seen his strong gag reaction to other really sticky foods, I wasn't optimistic that he would appreciate the finer points of peanut butter. But at this point I was desperate. And we had already had him tested for allergies once, hadn't we? So I took the dietician's advice. And at the age of 14 months, I fed my son a spoonful of peanut butter for the first time.

He promptly spit it out. And gagged. And made a face. And cried. And refused to eat or even touch anything else on his plate, apparently on the grounds that it might have been tainted with the Horror That Was Peanut Butter.

Fifteen minutes later, his eyelids puffed, and his cheeks swelled to twice their normal size.

And. I. freaked. out.

I was home alone with him, without a car. My husband was at work several minutes away. I called 911. Two burly EMTs from the fire department down the street showed up with the fire ambulance.

And they laughed at me.

"I don't see anything wrong with that baby," one said. "You're overreacting, I'm sure he's fine," said the other. "I don't see this swelling you're talking about."

I realized with horror that because my son was so thin for a toddler — he was in the third percentile for weight — the EMTs could not tell his face was swollen at all. They thought he looked like a normal baby. He did look like a normal baby. But not my baby.

They took my child's temperature and then left, refusing to take me to the hospital. I gave my son a dose of liquid Benadryl, scooped him up, and ran to our family doctor's office, which, thankfully, only was a mile and a half down the street. As soon as I walked in the door the receptionist, who had seen my son before, could tell there was a problem.

By that time, the swelling was already going down, and my annoyed and itchy toddler was returning to his normal cheerful self. But our doctor ordered a series of allergy tests at Children's Hospital just to confirm that peanuts, which seemed the obvious culprit, had truly been the cause.

For days, waiting for the testing appointment, I worried, convinced my child had a peanut allergy. I rounded up all the food in our house that was not clearly labeled peanut-free — including several of my son's few accepted foods — and despaired at the thought of throwing it all away. I already had an underweight child who was afraid of food for no apparent good reason. How many orders of magnitude more difficult would it be to try to help that child overcome his fear of food if he now had a legitimate reason to be afraid?

In those few days I lived the afflicted life of a parent who has just discovered her child has a food allergy. And then came the tests.

And they all came back negative. Every single one. Including the one for peanuts.

"He's not allergic," the allergist said. "There is no way he would have a total lack of reaction to peanut protein in a skin test if he had just had serious a reaction a couple of days before. It's something else in your house. Maybe he put his hands on a counter right after you cleaned it and then rubbed his eyes and got cleaner in his eyes, right before lunch? Kids this age have sensitive skin. We see mysterious reactions like this fairly often. You might never know what it was. Just hope it doesn't happen again."

So I threw out all my synthetic household cleaners. And a few weeks later, I tried peanut butter again. He still didn't like it. But his face didn't swell up.

In the four years since then, he has never taken a liking to peanut butter sandwiches. But he's certainly had the occasional Reese's Peanut Butter cup, and Peanut M&Ms. He's had trail mix with peanuts, and chocolate sundaes with peanuts, and peanuts in granola. He's eaten french fries cooked in peanut oil more times than I can count (Before you judge that junk food list, Judgy McJudger parents: remember — picky eater! Who needs to gain weight).

He certainly doesn't eat peanut products daily, or even weekly. But he has had them at least a couple of times a month for years.

Two days ago, at a school assembly, he tried a peanut butter cookie. And he made a face. And he spit it out.

And he broke out in hives.

And flushed bright red. And developed a blister on his upper lip. And he started itching all over, and complaining that his stomach hurt.

And then he started coughing and he couldn't stop even after a Benadryl Fastmelt and we had to take him to the emergency room. Where a doctor with a bedside manner about as warm and friendly as an avalanche falling on you gave him a double dose of Benadryl, prescribed us an Epi-Pen, terrified my five-year-old by jabbing a dummy demonstration pen into his thigh just to show us how it worked, without explaining to my son what it was first or warning him (and without telling him it had no needle in it) and then charged us $200 for ten minutes of his time.

And now I'm waiting. Waiting for an appointment at the allergist's office. To find out whether my son is allergic to peanuts.

Sunday, January 24, 2010

A St. Louis Charity Helping Out in Haiti

In December of 2008, during a time when food price inflation and natural disaster damage to crops in Haiti had caused a months-long food crisis so severe people were eating cakes made out of mud to avoid feeling hungry, as part of a series of post on global hunger I was writing for, I interviewed Dr. Patricia Wolff, the founder of Meds and Food for Kids.

Founded in 2004, Meds and Food for Kids makes an inexpensive, easy-to-store nutritional supplement for children called Medika Mamba. Made from peanuts, which can be grown locally in Haiti, the vitamin-fortified supplement is specially designed to help young malnourished children return to health, and does not require cooking or refrigeration (a key benefit in a country with poor infrastructure and highly unreliable electricity).

Before the earthquake, Meds and Food for Kids was already working to save literally thousands of impoverished Haitian children from illness and death. The organization has also provided a livelihood to many Haitians — though the administrative offices of Meds and Food for Kids are located right here in my hometown of St. Louis, Missouri, the factory where they produce Medika Mamba is in Haiti, and they purchase Haitian-grown ingredients from Haitian farmers at fair trade prices.

After the Haitian earthquake, I contacted Dr. Wolff to find out how the Meds and Food for Kids facilities in Haiti had fared, and what the organization might need to continue delivering vital food supplies, not only to the hungry kids they were already serving before the earthquake, but also to the thousands of newly homeless and hungry families who will now need food aid.

According to Dr. Wolff, the MFK factory, located in Cap Haitien, about 80 miles away from the devastated capital of Port au Prince, survived the earthquake intact, and can begin increasing production of nutritional supplements right away — if the organization can get enough supplies. And therein lies the problem — the MFK warehouse in Port au Prince was destroyed; a shipment of six months worth of ingredients has gone missing; many of MFK's local suppliers have sustained damage to their own infrastructure, and the transportation bottleneck in the capital has made getting imported ingredients to replace the lost food expensive and difficult.

So, today I am putting a button in my sidebar that links to the Meds and Food for Kids donation page. There are many wonderful aid organizations working to help save lives in Haiti, but I encourage my readers who would like to give to the Haiti relief effort but are unsure about where to give to consider donating to MFK.

They were helping in Haiti before the earthquake, and they will continue to help in Haiti long after the news cameras leave.

Tuesday, January 19, 2010

Questions My Five-Year-Old Asked Me Today

My son is home sick from school today with a cold, an ear infection, and suspected bronchitis. It's his fifth day being sick, and now that the antibiotic our doctor prescribed him is starting to kick in, his energy is returning and he is bored out of his skull. He's tired of TV, he's tired of books and yet he's still not quite well enough to play. So, desperate for conversation, he has been pelting me with questions without cease since his eyes opened this morning (My need to actually get some work done after five solid days of attempting to entertain him notwithstanding). And these aren't questions like "Where is my Slinky?" or "Can you play racecar rescue with me?" or "Do you think vanilla or chocolate ice cream is better?" Oh no. My kid doesn't let me off that easy.

Since I can't actually seem to manage to get the blog post I planned to write today written in between answering my kids' questions, here, in its place is an abridged list of the questions he has asked me so far today:

What are some things that bad bacteria do to hurt your body when you have an infection?

How do antibiotics help your immune system destroy bacteria?

Why is there momentum?

What do you mean "an outside force"?

What are the forces that make things stop moving?

What makes friction?

Why do light things fly through the air more easily than heavy things do?

How did Isaac Newton discover gravity again?

What is soy milk made of?

Where does chocolate come from?

Is the word cocoa related to the word cacao? Why are they different? Who named the chocolate tree?

Is spinach related to lettuce?

What number comes after a googol?

What is the last number anyone has ever come up with before infinity?

Why is there infinity?

How did people discover the idea of infinity?

What is at the end of forever and forever?

Why did people think the earth was flat thousands of years ago?

Why do people make up constellations?

If stars are moving and orbiting other stars and stuff all the time, why don't we notice the stars moving when we look up at them at night?

Did the Greek and Roman gods really exist?

Why do people make up stories about why things happen?

Why did people used to not use science to explain things?

What does geography mean?

What does geometry mean?

How is geometry related to geography?

And my favorite the question of the day:

What is a virgin?

(He was reading a book on astronomy. With constellations. Including Virgo the Virgin. THANKS SO MUCH, ancient astronomers, ancient religion-makers, and modern writers of children's astronomy books for providing me with the most interesting conversation of my day.)

Thursday, January 14, 2010

Guilt and Gratitude

I was in a relationship once that turned abusive. My fiance at the time, in the midst of a deep depression, started drinking heavily, calling me constantly when I was away from home, jealously interrogating me about friendships with other people, punching walls and throwing dishes when we argued, etc. He shoved me once "by accident" and dislocated my shoulder. I could see where this was going. I had no plans to become a statistic. I got out.

But to get out, I left everything. Everything I owned that wouldn't fit in a helpful friend's car. My books, my clothes, my dishes. My CDs. My TV. An apartment lease that was in my name. My home. My cat. (MY cat. Not his.)

I was in my early twenties. I had just graduated from college. I had no savings. I had no car.

I did have massive student loan debt, crushing medical debt from a near-death experience that my insurance company had decided was not enough of an emergency to warrant emergency surgery, and an underpaying job. And, a few weeks after my well-timed exit, I had a bona fide death threat from the ex, convincing me, firstly, that I'd absolutely done the right thing by leaving, and secondly, that I'd likely never see my material possessions again.

With no family in town in a position to help me, it took me a while to get back on my feet. I stayed with friends for a while, until I overstayed my welcome. I found one temporary sublease, then another. I bummed rides and took buses and sometimes walked several miles to work. One night, unable to get back to a temporary home before my next shift at work, I slept in a friend's car. Or rather, I didn't sleep, but spent the night having seriously uncomfortable flashbacks to a few weeks I once spent homeless as a child.

A few months later, I found myself in a sparsely furnished room, lying on a frameless mattress I had purchased myself, in an apartment that was actually paid for and mine. (With my cat back, and at my feet.) And as I lay on that mattress on the floor in that spartan little room, I felt a flood of gratitude. Overwhelming, profound gratitude of a strength that I had never felt before. Gratitude that I was alive, gratitude that I had a bed to sleep on, gratitude that I had a roof over my head, that next week, that same roof would still be there. And for days, when I would come home from work and find myself in that room in that bed, I felt the same gratitude wash over me in a healing wave. I no longer missed the material things I had left behind. I had what I needed. And that was enough. So much enough that it filled all my empty spaces almost to bursting. I was happier than I could remember, living in gratitude.

But it didn't last. It wore off, that beautiful sense of being grateful for having everything I needed to get by in the world. Before long I was wishing for things I didn't have again. Wanting nicer clothes, wanting nicer food, wanting nicer things again, wanting, wanting. Worrying about money again, complaining about my job again, getting wrapped up again in the petty details of typical American life.

In the years since I have tried often to force myself to recall how I felt, during that brief time of living in gratitude, with limited success. I often get angry at myself for being so seemingly unable to step back and appreciate my own luck at just being alive on Earth, let alone alive and with ample access to food and shelter and medicine and kind companionship and high speed internet and cable television and caffeine. I am painfully aware that there are far too many people in the world who do not have one tenth of what I have. There are people in my own country who do not have a tenth of what I have. But I still so often can't seem to find contentment, let alone gratitude.

I fret over my rusting fence, while in the past year, three houses on my street have gone into foreclosure. I worry about how to pay for my son's medical care and private school, while there are parents on the other side of the globe selling their children into slavery to save their lives because they can't afford to feed them.

What has happened to my gratitude?

Last night, climbing into bed after a day of watching television coverage of the post-earthquake crisis in Haiti, I felt it return. Surrounded in clean sheets, on a soft bed, in a strong house, in a neighborhood that's still standing, with my neighbors alive and well in their homes, I suddenly felt as grateful as I've ever felt for all of it. For my home and my full belly and my slaked thirst and my child sleeping safely in the next room with all his limbs intact. I wanted to kiss my home's standing walls.

And then I found myself trying to reject it. Wanting to feel guilt instead of gratitude. Because this disaster is too, too terrible for me to want to make any sort of selfish, self-centered silver lining out of it. I mean, what a typical privileged American way to react to a crisis, right? A city the size of my own town was completely flattened, and children are dying in the streets, but, hey! I am finally grateful for my own life and home!

I didn't want to feel gratitude in response to someone else's tragedy. To so many someones' tragedies. I had just spent a day seeing terrible pictures, seeing mothers crying next to the bodies of children crushed in their own homes. I didn't want to feel my luck in comparison to them. I wanted to feel some part their pain. As if by feeling some tiny part of it, I could somehow take some of it away.

But as I lay there, fighting unsuccessfully to push away that all-encompassing gratitude I have so often tried to force myself to feel without success, I suddenly realized that our gratitude, the gratitude of the fortunate, the gratitude of the spared, may be exactly what people in Haiti need.

Because we do have what we need here. We do have enough. We do. We in the United States have just spent a year in the worst economic recession in 80 years, and many of us have lost money or jobs or homes. We don't all have what we want right now. We don't even, in many cases, have what we need.

But when we look at what our neighbors in Haiti have just lost -- have lost when they already had so little -- how can we possibly say we are not wealthy?

We have enough, more than enough, and we can share it. And I am grateful that we can share it. I am grateful. And I believe most of my countrypeople are also grateful. Grateful enough to tune out, to drown out, the few selfish, cynical voices telling us not to give.

Wednesday, January 06, 2010

Food Karma

A few days ago, I found myself sitting at my dinner table, silently rejoicing because, for the first time ever in his life of five and a half years, my son ate a whole hot dog, complete with bun, without my prompting, wheedling, or bargaining with him to get him to finish it.

A hot dog. And not one of those fancy organic locally processed free range all-natural nitrate-free hot dogs, either. Just a hot dog. From Oscar Meyer. I bought it in a bright plastic package at the grocery store, on sale, plucked from a whole refrigerator case full of processed meat.

All right, it was a turkey-based highly processed, highly packaged, nitrite-filled factory farmed meat hot dog. But still.

I am a vegetarian. I am an environmentalist. I am a gardener. I am a from-scratch baker. I read every book Michael Pollan writes. I am concerned about the health and environmental consequences of our heavily industrialized food system. I feel morally troubled, not so much over human consumption of meat in principle (hunting animals for food is, after all, a thing we apex predators evolved to do), but over the particular treatment of domestic animals in the factory farm system.

When I can afford it, I try to buy locally grown and/or organic food. In the summer, I grow my most of my own vegetables and buy my much of my fruit at the farmer's market. I sneakily swap free-range chicken and beef into my carnivorous husband's diet.

And yet I take my son to Burger King and let him choose a hamburger that has probably been processed with a mechanically rendered beef fat slurry treated with ammonia. I let him eat cheap chicken nuggets sometimes from Tyson (which once plead guilty to 20 violations of the federal Clean Water Act in a town just three hours away from mine, was investigated by the Justice Department for illegally smuggling Mexican undocumented workers into the country to work for little pay in dangerous conditions, and was investigated by the U.S. Department of Agriculture for animal cruelty after a shocking video released by PETA).

And I rejoice when he eats a hot dog.

Before my son was born, I, like so many people who do not have children but plan to, held a vision of my future as a parent that was thoroughly colored by idealistic naivete.

Certainly, I had encountered children who were picky eaters before I myself became a parent. I had gone to school with children who would only eat cheese pizza, plain hamburgers, and french fries; I had been a babysitter to a girl who would not eat anything that was green; my own (much) younger brother once went through a month-long phase during which all he would eat willingly was white rice seasoned with butter, salt, and pepper.

Outwardly I sympathized with the parents of these children (including my own beleaguered mother), and would never have breathed a word of criticism to their faces, but, secretly, I judged them. By and large, I thought, parents of picky eaters who subsisted on junk food simply hadn't tried hard enough to get their children to eat more wholesome things.

Wasn't my own mother much more lax with my little brother, her youngest child, in every regard than she had been with me, the oldest? Didn't she allow him liberal access, as a toddler, to nutritionally questionable foods like white bread and soda, both of which had been largely forbidden to me in my early years in favor of wheat bread and juice?

Not that I blamed her, exactly, for going a little soft with my kid brother — she was much busier as a mother of three than she had been as a mother of one, after all — but, well.

I was sure I that, whenever I got around to having my own child, I would be capable of preventing any junk food addictions and overcoming any picky tendencies with proper planning and diligence.

My child would learn to prefer fresh fruit to cakes or cookies, because I would limit sweets and provide a wide variety of the tastiest fresh organic produce at all times.

But, at the same time, my child would not develop a secret, deprivation-driven obsession with desserts and confections, because I would not deny them to him altogether; he would have candy at Halloween, and cake at his birthdays; I would be reasonable.

My child would learn to love broccoli and spinach, because I would introduce vegetables at an early age, and eat them at every meal myself in front of him.

My child, if he ate meat, would learn to be ethical in his choices. I would do my best to serve him organic, hormone-free milk, and eggs from free-range chickens. I would offer him sausage from locally hunted wild deer, or hamburgers from ethically raised grass-fed beef. We would not eat at fast food chain restaurants except under serious duress. (Not that I always followed this rule myself, of course. But I would when I was a parent.) When he was old enough to understand, I would tell him why I, as his mother, made these choices about our food.

My child would never develop a taste for highly processed, environmentally hazardous junk foods, like Oscar Meyer hot dogs, because I simply would not have them in my house.

My child would never go on a month-long rice-only jag.


I had no idea, before my son was born — in fact, I had no idea before I started trying to feed my son solid food — that I would one day find myself praying desperately to a variety of divine beings I don't even necessarily believe in that my son would eat even just one bite of white rice.

That despite my best intentions, despite my most diligent efforts, despite my careful consultation of all the most respected child-rearing manuals (from Sears to Spock), despite advice from family members and friends and pediatricians and dieticians and nutritionists and, later, as the situation grew more obviously dire, a whole host of medical specialists with much longer titles, the goal posts for getting my child to "eat healthily" would move from "Teach him to eat organic vegetables and whole grains!" to "Teach him to eat, um, anything besides breastmilk and three flavors of baby food?" to "Dear God, please get my child to eat ANYTHING AT ALL."

Yet that is where I found myself, just a few years ago: at the table, in a house with a pantry and fridge filled top to bottom with healthy, tasty, natural food, facing an underweight, slowly wasting toddler with failure to thrive, desperately trying to feed a clearly desperately hungry child who would eat almost nothing I offered him.

At his thinnest during this period of self-imposed starvation — at around 12-18 months,when his weight was no longer even present on the growth chart for a child his height and age — Isaac was so thin he looked sick to me. Though he was an energetic, intelligent little boy with bright eyes and a quick smile, when his clothes were off, you could count every rib and see every knob of his spine. He lacked the characteristic pillowy paunch of a toddler. His belly, instead, curved inward. I could not bear to look at his terrible thinness, and yet I could not look away. He looked like a public service poster of a starving child. But he was a real child, in front of me. He was MY child.

These were, without a doubt, the most frustrating, depressing, terrifying few months of my entire life. When I think back on it now, I still shudder. I've been attacked on the street for the last ten dollars in my purse; I've spent nights sleeping hungry and cold in car too young to understand why I'd lost my home and not knowing if I'd see a home again; I've had my heart so utterly broken by a lover's betrayal that I felt it might never beat again. And I would take any of those days over my worst days of fear and helplessness worrying over the health of my son.

I spent thousands of dollars I did not actually have at this time taking my son to expensive medical specialists. An endocrinologist. A pediatric gastroenterologist. A pediatric food allergist. A child psychologist. He was tested for every genetic disease, every bacterial or viral infection, every hormonal imbalance or food intolerance or oral-motor developmental delay or structural intestinal defect these experts could think of that might cause an otherwise healthy and normally developing child to simply refuse to eat. I held my screaming toddler down while phlebotomists with impossibly large needles withdrew vial after vial of his blood from his tiny arms. I strapped him to a table while specialists taped bizarre plastic devices to his private parts to collect urine samples. I restrained him while an allergist pricked his naked back with 40 simultaneous needles. I watched him wheel away, sedated and anesthetized, to a room where a doctor would shove a camera snake down his throat to examine his intestines. Every time I held my child and allowed someone to hurt him in the name of helping him, I wished desperately that they were hurting me instead.

And for months of this, no one could give me an answer.

I was constantly worried that my son might stop eating altogether require surgery to install a feeding tube. I was terrified — cold sweats, nightmares terrified —that someone among this team of experts who could not solve the problem of why my child would not eat would decide that I must be purposefully starving him — that I was abusing him, that I was one of those awful evil Munchausen by proxy parents (which I only even knew existed after watching The Sixth Sense). During my nightly fevered internet searches for things like "failure to thrive" and "post surgical post-traumatic feeding disorder of infancy" and "infantile anorexia" and "Dear Sweet Internet Gods, why the F@#K won't my starving child eat?" I had come across a single message board posting by the friend of a relative of an innocent woman who had supposedly had her failure to thrive child taken away from her by the state under suspicion of abuse, only to have child services discover that the child would not eat in foster care, either, and in fact had a terrible medical condition underlying her self-starving ways, which of course only worsened during the stress of separation from her parents, etc.

Because I hated myself (what mother who can't successfully feed her child doesn't hate herself?), I bookmarked it and reread it from time to time in ritual self-flagellation.

In reality, I spent nearly every waking hour either attempting to get my child to eat, or thinking about how I ought best to attempt to get my child to eat.

I was a terrible bore at playdates and children's birthday parties. "What is going on with you?" the unsuspecting might ask. And I would say, "Oh, my son still isn't eating well at all. I'm very worried. I don't know what to do." And then, compulsively I would relate, in obsessive detail, my latest medically-guided attempt at intervention. A detached part of myself would observe my nervous patter and mentally shout, "Change the subject! Talk about the weather!"

But for me, there was no weather. There were only Days When Isaac Ate Well, and Days When Isaac Did Not Eat.

Friends and family gave me constant well-meaning advice that made me want to punch them in the face. It's not natural, or at least is certainly seems unnatural, for a seemingly healthy, hungry child to refuse all food for months on end, and so naturally most people with casual knowledge of my situation assumed I must be making some simple parenting mistake.

"Don't try so hard to encourage him to eat." "Try harder to encourage him to eat." "Stop breastfeeding him." "Nurse him more often." "Strap him to his high chair and don't let him leave all day until he's finished his whole plate." "Tell him if he doesn't eat one bite of peas you'll make him eat the whole bowl." "Try plainer foods." "Try spicy foods." "Let him see other children eat in front of him." (When he ate with other children, he would, in fact, helpfully give the other children all of his food.) "Get someone else to feed him." (His father, his grandmother, and his aunt had all tried.)

Others assumed I was exaggerating the extent of the problem and advised me he would simply grow out of not eating if I just left him alone.

Every time I spoke in public about my son's eating problems, unintentionally hurtful judgment and well-meaning but uninformed advice surrounded me until I thought I would drown in frustration and self-loathing. And yet I had nothing else to speak about. Because my days were consumed with trying to solve this problem.

When an occupational therapist finally helped my family find a diagnosissensory processing disorder — and I finally, finally found therapies that would slowly but surely help my son overcome the severe tactile sensitivity and texture aversions that were driving his fear of solid food, every bite my son took of every new food seemed like a blessing. It didn't matter, to me, whether that new food was a fresh-picked organic locally grown Winesap apple or a hot dog. It was FOOD, damn it, and my son was eating it. My new motto became "If it has calories, and it's not obviously poison? He can eat it."

I know better, now, than to judge the parents I see feeding their children chicken nuggets and fries and soda at McDonald's. Not until I've walked a mile in their shoes. Not until I've taken the beam from my own eye.

But now, with a solid space of four years between me and the worst trauma and fear over my son's initial failure to eat enough to thrive, I am beginning, once again, to judge myself.

Has my gratitude at his graduation from pathologically picky eater to typical picky eater — his transformation from a child who was thisclose to life on a gastric feeding tube to one of "those" picky children, who only (ONLY?!?) reliably eats plain-tasting sweet breakfast cereals (that must be dry), toast, plain, white flour pancakes with plain syrup, plain scrambled eggs, bacon, chicken nuggets, hamburgers, hot dogs, grilled cheese sandwiches, plain quesadillas, plain macaroni and cheese, Swiss (it must be Swiss!) cheese and crackers, french fries, corn chips, potato chips, ketchup, applesauce, sugar-sweetened cooked carrots, mashed sweet potatoes IF they have marshmallows on top, strawberry-flavored fruit leather, the occasional raisin or dried blueberry, vanilla ice cream, and vanilla or banana-flavored yogurt — has my utter, blessed, soul-healing relief that my child finally eats enough of a variety that we can take him to a fast food restaurant and order something he will actually eat off the menu, given me an unjustified feeling of permission to stop trying in the healthy food department?

Have I given up entirely on that dream of a child who blithely eats homegrown tomatoes, organic green vegetables, Indian lentils, and Thai curried tofu?

How do I feel, really, about my weekly purchase of Tyson chicken and nitrite-laden Oscar Meyer hot dogs?

The truth is, there is a little unhappy voice in the back of my brain that still protests every time when I plop factory-farmed meat and preservative-laden snack foods in my grocery cart. Even when I know we can't really afford this week to try the organic grass-fed beef hot dogs, at the very real risk that my son will reject them because they don't "taste right" like the brand he's accustomed to and they will rot and I will have to throw them away.

I struggle regularly with how hard to push my son about the fact that he eats no green vegetables, at all, ever.

As soon as he was old enough to hold a trowel I started involving him intensively in my work in the family garden, hoping that his enthusiastic affection for the bean and pepper plants he so carefully planted and watered himself might translate into some sort of affection for green peppers or green beans, but that hope was in vain. Oh, he's gamely popped fresh homegrown organic baby peas just picked off the plant into his mouth at my insistence, more than once, and screwed up his face in displeasure, and spit them out again. And I let him.

I've tried ordering beautifully presented, perfectly seasoned vegetables for him at restaurants, and he dutifully tries them and spits them out, and I let him. I've tried hiding vegetables in sauces (which he doesn't much care for anyway) and homemade breads, and he tries them and spits them out, and I let him.

After such a long exhausting battle to get him to eat enough solid food at all, I don't want to make his life, or mine, all about his eating now. But when he's grown, if he still hasn't developed a taste for vegetables or fresh fruit — if his limited diet starts once again to affect his health — if he, ever the sensitive soul, always rescuing stranded earthworms after a rain and asking his father to put spiders outside rather than smash them — realizes the impact of his childhood diet on animals and the environment — will he blame me?

Will he think I didn't try hard enough? Will he think I tried too hard?