Toddler refusing Enzymes

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sierradavis

New member
My daughter with CF is 1 1/2 years old. She started taking enzymes Day 2 and has never given us any problems until recently. We have always put them in a spoonful of applesauce. She is refusing the applesauce now, along with pears etc... after denying the fruit we tried just giving her the pills and she would take them and swallow them suprisingly. Now she won't take them at all. We have to force(hold her down) her to eat them but it's really a pain and she doesn't get all of them. Does anyone have any tips/ideas that we could try to make the process easier?
Thanks!
 
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jshet

New member
My son has cf and autism. Taking enzymes was a nightmare when he was younger. This worked for us, and still does. I bought sweetish fish and when he would take his enzymes, he gets one fish. He loves these little candies, and this is the only time he would get these. I never, ever give him these except for when he takes his enzymes, or the magic would be lost. You can choose anything that will motivate her to want to get that one little piece of candy.

Hope this helps, jshet
 
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Aboveallislove

Super Moderator
Had the same problem. I worked with a therapist/dietitian. Here are the detailed directions:

http://www.ellynsatter.com/june-201...and-the-division-of-responsibility-i-171.html

One "modification" she helped me with later when he was older and had refused for a full day and hadn't eaten (he was scared because he had vomited on them as oppose to stubborn). Hunger adds to anxiety, so sips of grape juice before enzymes if she truly gets that far. But it sounds like normal 2 year old stubborn. I'd offer them on a plate where she can take or on the spoon so she on her own can pick them up and take if she wants).

Here's another link with more detail:
http://forum.cysticfibrosis.com/threads/25144-Baby-refusing-enzymes-HELP!?highlight=ellyn+satter
 
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sierradavis

New member
That video is great! When Aubrey was taking them like that I would hear her crack them open before she swallowed them ugh, I used to worry about them activating too soon!
I will have to try the candy route, she loves fruit snacks. Or maybe the banana idea. I am hoping this is a quick phase she is going through. She is so good at taking all her meds. I will give her the syringe of her prilosec and she takes it by herself and has done that since about a year old! Thank you all for your help!!
 
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cfmomky

Guest
Try putting them into cottage cheese. Just serve the food without any comment. Later you can try butter on the pills so they slide down easier. You can always switch up foods, applesauce one day, cottage cheese, pudding, and even ice cream. Vary them and see if it helps.
 
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Gammaw

Super Moderator
Sierra, I have to ask. When you were giving them to her in applesauce or baby food, did she see you put the beads in the food? Or did you do it out of her sight? If she saw you do it, did you ever take a bite of them yourself in front of her and did you tell her what they are for? I can't imagine having to hold her down. I would think she would have issues with the enzymes forever after that! I ask because it was about the same age at which my son refused enzymes. The CF psychiatric nurse explained his refusal was because we were sneaking something in his food -from his view - since we did it out of his sight and he didn't trust it. It was the age at which he figured out there was something in the applesauce that he knew was not normally in there. I had to mix them in front of him, explain what I was doing, telling him they would make him big and strong - a big attraction at that age - and even take a bite myself so he knew they were ok. He didn't start swallowing them right away though. He would watch me intently and if he refused them I would ignore it entirely and feed him anyway. After just a few days of the same routine - putting them in his food in front of him, explaining these were his zymies, taking a bite myself, emphasizing they made him big and strong and then offering him some, ignoring any refusal completely - he finally started taking them on his own. He's 9 now, 75% BMI and swallows six in one bite with a swish of milk. Thats after having been born with a meconium ileus at 5 pounds.
 
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Aboveallislove

Super Moderator
That's very similar to the satter approach re not hiding tricking or forcing. but with her approach the the meds stay there until taken...I'd worry that the food would cause an obstruction if several meals without enzymes but so glad that worked out! And boy I wish ds would swallow them now whole!
 
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Gammaw

Super Moderator
So what do you do with the meds if they won't take them after they sit there? Do you let them eat without taking them or is it a standoff until someone gives? Power plays rarely feel right to me. And in my experience, you can create competition and resentment, not compliance. But I'm no pro, so what do I know.
 
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Gammaw

Super Moderator
By the way, we waited until ds wanted to learn to swallow his zymies like a big person, then we had him practice on m&ms. When he was comfortable with those he grabbed the zymies on his own and swallowed whole.
 
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Aboveallislove

Super Moderator
Check out the link with the directions. It isn't a power play but a matter of mastery expectations. I expected him to master it as i expect him to master all his medicines. He must take his medicine and he must figure out what he needs to do it. And yes, I sat there. I didn't get upset or annoyed or rushed or sad or mad at least not that I let him see! I just waited until he was ready. The first time it took an hour, then thirty minutes and then within a week not an issue. The guidance is from both a dietitian and a family therapist. It actually worked even on flagyl for three days but he had such a horribly violent reaction he doesn't get it prescribed anymore. But we had to do it with the flagyl like drug. Anyway, check out the link and see if it makes sense. But obviously your way worked for you guys which is wonderful! And yes I wish he could swallow like a big boy!
 
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Gammaw

Super Moderator
Interesting. I will check it out. I took a quick look before. But I wonder.....if he really thought we were giving him something harmful or just wrong for him, and instead of trying to get him to understand that no one was trying to hurt him.....and instead just sat and psychologically forced him to take them through sheer will - wouldn't I be introducing him to a feeling of powerlessness in the face of ......dare I say it ......abuse? I mean imagine having to choose between starvation and possible poison? I don't want to break a child's will. Just form it. I still think you really need to eliminate all potential barriers before assuming it's just stubborness. I'm glad it was the correct move for you guys!
 
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Helenlight

New member
Our daughter definitely gets more resistant if she senses that she's being forced/coerced/pushed into anything. Thus we always try to make anything related to CF maintenance a positive (or at worst, neutral) experience. With enzymes it could help to start to allow her to try and mix and take them on her own, with a lot of encouragement from mum & dad. Even if she makes mistakes, makes a mess, she may well gain a sense of achievement and independence that she doesn't feel when being 'made' to do things.
Another possibility could be to have her meal visible (or a desired food of some kind), and explain that she can have it as soon as she's had her enzymes. We sometimes zoom the spoon around like an aeroplane with a special delivery for her mouth :) If she's not in the mood, explain (nicely) that the food will go away until she's ready for her enzymes. No anger, no threats or disappointment, just a matter-of-fact approach. When she's ready, use a lot of encouragement and positive praise: "Hey, good choice!" or "I'm so glad you are ready now!" things like that.
One other technique we use that has worked wonders to help our girl start swallowing them whole (and perfect for when you are out), is to use those baby puree pouches to deliver the enzyme capsules. I'm not sure if they are available everywhere, but in NZ you can get pouches of baby food that have a suckable end under the cap which is the perfect size to slot in a capsule, and when the child sucks you can squeeze the pack so they swallow the capsule along with the puree. We always show her what we are doing and warn her when it's coming: "big swallow!" and it works like a charm. At 2.5 she now takes the capsules whole with a drink of water.
Kids of this age need to find their own independence and they feel bad if they are forced to do anything, especially if they don't know why. I always try to explain to our daughter why we need to do certain things, what they are for etc. Whether or not she understands completely I don't know, but I'm sure she gets something from my tone of voice, facial expressions and body language. "These enzymes are important, they help you digest your food, and help you grow strong. Without them you might get a sore tummy. You need to take them before you eat. If you don't want them right now, that's ok, but I will put your food away until you are ready." She'll get it eventually.
Best of luck
 
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Gammaw

Super Moderator
AboveAll, I have spent the morning reviewing the Satter material in your link. Fascinating and I love it. I did have trouble getting to the page with directions and your story - the link wouldn't work for me but with a search of the site with the word "medication" I found it here. . . http://ellynsatterinstitute.org/fmf/fmf58.php. I still would want to make sure no little one thought they found harmful foreign material in their food and yet were forced to eat it! I used to mix my toddlers enzymes at the counter food prep area not realizing he was facing away from me and couldn't see what I was doing. He appeared to think I was sneaking stuff on him and he began to not trust me. How horrid! When I repeatedly mixed the enzymes in front of him, I restored his trust after a bit. Satter obviously recognizes that medication doesn't fit into the Satter mold - no choices there. They have to have it. My sons BMs were soft and stinky for the couple of days he continued to refuse, but no other ill effects. And our approach was stress free.
I am continuing to read the Satter material. I have found it helpful for our DD who has been envious of her brothers eating style of high fat and high calories! Kudos . . . .
 
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Aboveallislove

Super Moderator
Yes, that is the article. And I totally agree re explaining the reason and making sure no issues. We had never hid so that wasn't an issue. But I was too glib saying "stubborn." It was more likely that it was "hard" for him and he had to work himself up to take it, kinda like when I had to give myself injections and I'd aim 10 times before I could do it! And explaining it as medicine that helps his tummy healthy etc. For me, though, I have the horror of a DIOS hospitalization AND the fact that DS approaches things VERY SLOWLY if given a choice, i.e., it took him 2 years to try an M & M, not withstanding my 20-pounds of extra modeling to show him how yummy they were! So in my mind it wasn't about "you don't eat until you take your medicine" but that this is your medicine and you need to take it." She does recommend doing somewhere else than where they eat so it doesn't interfere with perception of food, i.e., 'that I'll starve you if you don't take" as oppose to "you need to do your medicine" and that we just wait for him to get brave, and it would be that way whether it was antibiotics, enzymes, or whatever he was prescribed. This has worked for everything EXCEPT flagyl, which it did for 3 days to the shock of the pharmacist, but again, he had violent reactions so he just couldn't do it no matter what. And the other time was with real anxiety when he vomited from the enzymes, which after a day we gave him grape juice to calm his anxiety (and also because he wouldn't get sick), and then he worked himself up to it. Anyway, I think its great to have so many different ideas for folks to fit with their views and their little ones temperament!
Also, fyi: She had shared with me some bravey training info which I used for throat cultures and blood draws to much success!!
 
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Gammaw

Super Moderator
Nice approach Imogene. But Lisa Greene always make so much sense. And she's so gentle about it. I don't suppose she has anything on blood draws or IVs that you've seen?! But that's another post!
 
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sierradavis

New member
I never really thought of explaining the enzymes while mixing them. I have always done it in front of her bc we mix all her medicines on the table next to her highchair but I have never told her what I am doing! I will have to try that!

I did have success with the Welchs fruit snacks so I went out and bought a bunch of bags and different flavors. I cut them in half and mush the beads in them and put them back together and she eats them perfectly! This child....this entire last week she has ate her enzymes with the fruit snacks but twice she refused them so I just sat her enzymes in her high chair and walked away. She grabs them and swallows them! I am almost certain she is doing it to mess with me now LOL! Thank you all for your help!
 
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TreasureGoddess

Member
We had to change up food as my son got tired of it. Went through applesauce, chocolate pudding, the best was those little jelly packages you can get at diners. Easy to transport and he liked to pour them into the tub of jelly after I'd open them. It got my son involved and he thought he was very grown up. Once the taste of those got old, we moved to chocolate frosting, carried it around in little baggies and used plastic spoon, poured the enzymes on top and he'd spoon them right down. Lots of extra sugar & calories, but he loved the treat of the frosting, so it worked out well.

I agree with not sneaking the enzymes into the food, it makes the kids paranoid about eating anything later. He also began learning to swallow pills by starting with nerds candies, then those tiny m&m's, then regular m&m's. By 3 yrs old he could pop a handful of 4-6 enzymes in at one time, no problem. It'll get better, hang in there! :)
 
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Gammaw

Super Moderator
Great suggestions for mix ins! We used tapioca after applesauce became repulsive, then moved to ketchup packets which we bought in a huge box at Sam's Club. The packets worked great at daycare and school - no one had to measure anything messy out and he loved it! I never thought about the jelly packets - that's a great idea!
 
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