Pica, Rumination, and Other “Behaviors” 2

I learned about Robert’s rumination during a meeting with Robert’s teacher and her clinical supervisor at  ABA school. Before that meeting I had never noticed that Robert tended to bring  the food back from his stomach, “play” with it in his mouth, and return it to the stomach.   I knew neither what ruminating was nor that Robert was doing it.   I assumed that it was a different name for pica. It took me a while to realize that the teacher and I were talking about different things. I credit the teacher for stating that the causes and treatments of rumination could be behavioral and/or medical. Robert’s school took upon itself to deal with behavioral aspect of rumination.

It was my responsibility to deal with medical side of rumination.  Yet I didn’t do anything about it until Robert was almost 18 years old.  The reasons/excuses why I didn’t take any radical steps to address this syndrome immediately are as follows:

1. The rumination seemed to (almost) disappear during Robert’s stay at ABA school. The way the school dealt with it worked so well, that I didn’t observe it at home. I forgot about it.

2.Rumination flared up during periods of Robert’s increased anxiety, specifically his second year in Collaborative program and the fourth year in Public School. Unfortunately, during those times I encountered  severe problems with both educational settings and needed to address the serious consequences of those problems. The rumination seemed less important.

3. During more visible periods of rumination I gave Robert 1-2 calcium tablets a day following the advice I received on Me-List.  Calcium (Tums) seemed to reduce the problems slightly. I had a feeling that I was “treating” it.

4.The gastroenterologist, who had seen Robert a few times for painful gases, constipation, pica, food intolerance (beside food allergies), and rumination, suggested endoscopy and colonoscopy to clarify medical picture.  I thought Robert couldn’t do it.

Well, I couldn’t .

Then I felt we had to.  The tests pointed, among other things, to acid reflux. Robert was put on omeprezole.  At first he received a stronger dose to  break the habit of “playing” with the food and to heal his esophagus.  Later the dose was reduced.  This treatment helped a lot.

Although I am not sure if we were able to do the tests sooner I regret not even trying.

The earlier diagnosis could bring Robert very needed relief.  It would also allow Robert’s teachers and me  to separate those “behaviors” that were reactions to discomforts of various degrees from those which had different causes.

If a teacher/parent  knows that a child is screaming and hitting his own face because he/she is in pain the response is empathy and understanding.   When the child does the same things because she/he wants to escape demands or  doesn’t accept changes to the environment the reaction is different and depends on a previously chosen strategy. (It might be based on Functional Analysis of Behavior.)

When I suspected that Robert might be  in pain but wasn’t sure of it, my reactions were chaotic and ambivalent and as such didn’t address Robert’s behaviors in any case.