The Sunnyvale Sun

Cover Story

Photograph by Jacqueline Ramseyer

Three-year-old Yashovar Mohan plays with his father, Sundar, in their Sunnyvale back yard. The boy recently completed treatment for an eating disorder similar to one commonly labeled 'failure to thrive.'

Failure to Thrive

Some babies just won't eat. Behavior adjustment can be the answer

By Michelle Maghribi

For the Mohan family in Sunnyvale, the adage "when the child gets hungry, he'll eat" definitely did not apply.

Three-year-old Yashovar Mohan weighed just 26 pounds, dropping to nearly the lowest percentile for children's weight for his age group. He showed no interest in food. At 9 months, Yashovar was too weak to lift his head.

Alarmed, parents Sundar and Vidya Mohan looked for solutions.

"It was frustrating that no one could explain to me what exactly was wrong," says Vidya Mohan. "I had no reference point; none of my friends who had children had ever experienced this."

Some good news came when doctors ruled out any serious physiological conditions such as esophagus blockages and gastrointestinal issues.

However, doctors were unable to pinpoint the reason for Yashovar's continuing disinterest in food, which eventually led to speech and developmental issues.

While doctors did say they believe Yashovar has an overly sensitive mouth and treated him for a "tongue tie" (a condition where the tip of the tongue is attached to the bottom of the mouth), none of their findings or intervention helped reverse his refusal of food.

When Yashovar starting missing childhood milestones, which included gross motor skills such as walking, running, and talking, doctors referred the Mohans to the California Early Start Program, designed to aid children in overcoming developmental disabilities.

Treatment included speech therapy, physical therapy and occupational therapy. The Early Start program is funded by federal funds and general funds from the state.

Even with these three new therapies, Yashovar still was not taking solid foods, prompting the Mohans to seek treatment at the Los Altos Feeding Clinic run by behaviorist Ben Zimmerman.

Founded by Zimmerman, the clinic works from a behavioral model, specializing in the treatment of pediatric feeding disorders.

He currently treats between five and six children and reports a success rate of approximately 95 percent for those who stay in the program. The clinic opened in June 2005.

Prior to being accepted by the clinic, a child must be evaluated by a physician to determine whether it's physically safe for the child to eat, ensuring both the safety of the child and establishing the potential for the treatment's effects.

Zimmerman, a California native, said while the psychological/behavioral concept is considered "alternative" on the West Coast, back East there are approximately 10 clinics that treat feeding disorders as a behavioral issue.

"Any feeding problem can usually be resolved," he said, "but the key is--in the end--a parent needs to be able to learn how to continue the treatment at home after the child leaves the clinic."

Zimmerman's clients are mostly through referral and word of mouth. He cites cases in which a nasal or gastrointestinal tube has been inserted in the child to deliver nutrition as being the most difficult to successfully resolve through behavioral therapies.

Zimmerman's résumè includes a stint working at the John Hopkins Medical Center's feeding unit in Baltimore. He said all patients he sees today are treated through behavioral intervention. He compares severe food refusal to any childhood behavior that needs to be fixed.

According to a report published in January 2000 by the Department of Pediatrics, University of Maryland School of medicine in Baltimore, recent statistics show one in four children has some sort of eating disorder. Causes for food refusal can include food selectivity, dependency on their feeding tube, bottle dependency, texture selectivity and poor oral intake in general.

"Eating is an integral part of life that needs to be taken with utmost seriousness when it comes to treatment," said Zimmerman.

Zimmerman points to the case of parents Reuven and Gitty Goldstein who became concerned when their daughter Moussia, 2, was unable to eat without the aid of a gastrointestinal tube. Since becoming Zimmerman's patient, Moussia has been in intensive therapy during the past month. Zimmerman said, in all probability when treatment is completed, she will be able to take foods orally.

Gitty Goldstein lauds Zimmerman for his effort and patience, calling his treatment of other patients nothing short of miraculous. Moussia's treatment may help break her dependence on her feeding tube. Moussia's intensive treatments cost up to $2,500 per week and are not covered by insurance.

As for the Mohans, Zimmerman reassured them Yashovar's disinterest in food was behavioral, and while the term "behavioral" can carry a negative connotation, it simply means that the behavior must be changed.

"Anything we do is behavior, including our hearts beating," Zimmerman says. "Behavior has nothing to do with positive or negative, and I have to explain that to parents when they come in. It has nothing to do with their parenting," Zimmerman said, adding that any behavioral correction should be done before the age of 9.

"The longer you wait, the harder it is," Zimmerman said. He typically begins treatment at the age of 9 months.

Fortunately for Yashovar, there was still time to develop his interest in food. Zimmerman said he was able to interest Yashovar in food after four sessions. According to Yashovar's mother, the next step will be acclimating Yashovar to food textures that are more solid. He currently eats only baby food.

Mohan said although Yashovar expressed no interest in food, he was able to take milk and liquids. That fact spared him from surgical implantation of a gastrointestinal tube.

Yashovar completed his treatment at the Los Altos Feeding Clinic last month and has gained two pounds. He continues to make strides through the ongoing efforts of his parents.

Vidya says she and her husband agreed that the most important thing was getting help for their son, even if it meant seeking alternative therapy and paying for it themselves. As the Goldsteins discovered, most health insurance providers do not cover the costs for treatment at the clinic.

"Initially I worried, when doctors couldn't find anything, but I knew we had to do whatever it took to help our child," Vidya said. "Ben was very patient and calm with Yashovar. He just kept trying until Yashovar started to take the food."