At my first visit with Kayleigh and Charese they shared the story of their daughter’s premature birth and year of serious illness. Alana’s failure to gain weight occupied every waking thought as they monitored every ounce she took in. Yet here they were 4 years later; the child I met on Zoom appeared healthy and robust. Her parents recognized that she was now thriving. Alana engaged me in play after a brief period of shyness, asking “Can I run with Dr. Gold?” After a year of virtual work I had gotten somewhat used to the challenges to my vestibular system: I was taken up in the joy as her smiling image filled the screen while the background whizzing by.
A colleague referred the family to my behavioral pediatrics practice for fraught daily battles around eating, with narrowing food choices causing Charese and Kayleigh increasing alarm. At that first visit they shared the story of infertility and high risk pregnancy that preceded Alana’s birth. Now I had a chance to simply play and get to know Alana. Though Charese opened the visit with a story about a recent food battle, I gently steered the conversation away from the subject of eating.
Alana took me to the window to show me their yard. Somehow the conversation turned to the subject of poop, a favorite of the 4-year-old crowd. I took that as an opportunity to explore the question of how control issues played out at that end. “Alana loves raisins,” Charese told me. “She eats them to keep her poops soft.” She turned to Alana who had become absorbed in playing with her dollhouse. “You used to eat apricots,” she said, directly addressing her daughter. “Why don’t you eat apricots anymore?” As Charese was now holding the phone, I had a perfectly clear close up view of Alana’s face. She froze.
Neuroscientist Stephen Porges described the way what he calls the “primitive vagus” takes over when a person experiences terror. Moving beyond fight-flight, the body reacts with dissociation. Charese, Kayleigh and I all witnessed to just this response. Alana stopped talking. Her facial expression turned blank and her body became still mid-movement.
After a few moments Kayleigh broke the silence. “This is what she does whenever we talk about food.” They now saw the fear in their daughter, but when I asked how long this fear had been present, Charese immediately thought of herself. She said softly, “Since she was born.” For Charese and Kayleigh the terror we saw in Alana connected directly to their own memory of terror that their daughter might die. The feeling now expressed in Alana’s behavior held a grip on the whole family. The hour-long visit allowed us to slow the process down.
We sat together for a few moments in the possibility of unbearable loss. Both Charese and Kayleigh shared how they had been so consumed by keeping track of the calories Alana took in over that first harrowing year that they never had a chance to connect with their own emotional experience. When the severity of the health issues began to subside as Alana entered toddlerhood, the meticulous attention to food intake shifted to the typical battleground of control that characterizes this stage of development. But the terror came too. While her moms could put it out of their conscious minds, Alana showed us that their feelings of terror still lived in her body.
Following the pause, we talked about how Alana showed through her behavior that she did not like talking about food. The mood shifted from tense to calm. The four of us discussed a plan for keeping conversation about food to a minimum while having an expectation that eventually Alana would learn to eat when she was hungry. As the visit came to a close, Alana led us all in a game of “pizza party,” offering me a pretend slice through the screen. “We just want her to find joy in eating,” Alana’s moms told me at that first visit. In our one-hour second visit we navigated together through suffering to rediscovered joy.
When I met again with Charese and Kayleigh alone a few weeks following the session with Alana, they described slow progress, with moments of extreme frustration. They recognized how this pattern of interaction was laid down in hundreds of thousands of fraught moments over that first harrowing year. Change would take time. But they now knew it was possible. They were on their way.