At SPOON Foundation, the nonprofit that I started with another adoptive mom, we decided to start compiling all the information we were learning about the nutrition of adoptees so that other parents could access it.  It’s now all together on our Adoption Nutrition website, and although much of the information is specific to parents who have adopted (such as the printable list of tests to complete at the first doctor’s visit), much of the information is also pertinent to parents who have not adopted.  I’ve even printed out our top tips (to share with families I work with whose biological kids are having feeding difficulties).

The site has suggestions for kids who have oral-motor difficulties, kids who are slow to gain weight and grow, tricks for sneaking in high-vitamin and mineral content food, and a place where parents can submit their ideas for making snacks and mealtimes more fun (my sister submitted the Star Wars dinner idea).  And, of course, we’ve got recipes.  Some of them, like the Russian blinis that were a big hit in my household, are scattered throughout the site.  Most are compiled into a cookbook that can be downloaded for free.

One of the most popular parts of the site is the Nutrition Profile where parents share their stories about nutrition and their kids.  Based on the variety of the stories, it’s clear to see that although each family is impacted in a different way by their kids’ early beginnings with malnutrition or institutional feeding practices, nutrition and adopted kids is an area that matters to parents.  It’s also helpful for me to see that my kid is not alone.  When Cindy and I started SPOON, we worried that we were tackling an issue that only mattered to us.  I told and retold Bakha’s story, but now hers is not the only one.

Bakha is very proud to be part of a movement that brings awareness to the nutritional needs of kids around the globe.  Recently, after a hard day of school, an emotional conversation ended with a statement along the lines of “I know I’m important to you, but I don’t matter in the world.”   I explained the butterfly effect to her and told her how her willingness to share her story is helping kids get healthy on the other side of the world (and even right here in the U.S.).  She didn’t believe me, so I pulled out the laptop and showed her the map on Google Analytics that shows all the countries in which people have accessed our websites.  She didn’t say much, but just yesterday she told me that her third grade teacher described the book “Three Cups of Tea” to the class and then asked the kids how they make a difference in the world.  Bakha told me with clear disappointment that she didn’t get called on to answer the question.  “What would you have said?” I asked.  “That I matter because kids in the world are getting help because I told my story about what it was like to have my bones hurt when I didn’t get good food.”

At a recent orthodontist visit, my 9 year old daughter was given bite blocks that prevent her from biting her teeth together.  “You’ll need to make sure she doesn’t eat food that requires much chewing,” the orthodontist told me.  My jaw dropped and I watched his expression that I assumed was judgment when I described how limited her diet already is.  As someone who will eat just about anything, I’ve historically had a low tolerance for picky eaters, you know…those adults who ask a million questions in restaurants before ordering, or vegetarians who hate vegetables (I dated one of those once).  Then I became Bakha’s mom and I had to expand my views.

Due to her early institutional diet and years of malnutrition, Bakha has been a picky eater since I adopted her.  Apparently, she wasn’t a picky eater at the orphanage.  Her caregivers told me she’d eat anything.  But the first night I took Bakha out of the orphanage to the hotel, she refused her dinner.  I naively thought she would gobble up food from her culture because it would be familiar.  I quickly realized the food of one’s country is not the same as the food of one’s orphanage.

I spent the next several years expanding Bakha’s repertoire of foods.  I had worked for years as a speech-language pathologist, often working with children with feeding disorders, so I understood the reasons for her food aversions and I knew the methods that should help her increase the foods she’d accept.  Here are some of the tips I incorporated into our mealtimes (for more tips click here, ):

• Try adding a small amount of a new texture to a preferred texture.  If the small amount is accepted, add slightly more each time the preferred food is offered. The same can be done with new flavors.
• Kids are more likely to eat if they see others doing the same. That is especially true when they are fed in the presence of other kids who are eating, and is often how they acquire a liking for a new food.
• Encourage your child to be active before meal time – if possible, time outside in fresh air stimulates appetite.
• If your child tends to fill up on fluids, offer drinks at the middle or end of a meal.
• Lots of praise for trying new foods or finishing a meal can actually backfire. If your child realizes how important his eating is to you, he may use it to gain the upper hand at mealtimes.

It did take longer than I expected, but little by little Bakha added new foods.  After we’d been home a week, I let her drink milk out of a bowl after she’d picked out each piece of cereal.  After that she accepted milk.  At three months home, she watched a little boy repeatedly ask for more pesto at dinner and she was intrigued.  Pesto has been a staple ever since.  At six months home, I put four small bowls of mac and cheese in front of her and let her try different toppings.  Soy sauce won out and it’s still the only way she’ll eat cooked cheese.  At twelve months home, she discovered that everything tastes better with turkey bacon.  She’ll now eat oatmeal if it can have bacon crumbled in it; her pizza consists of crust, pesto, and bacon.  She recently tried an omelet (a bacon omelet, of course).  Yes, some of her food choices are a bit odd, but they are her own choices after years of never having choices about what she could eat, when she could eat, or how much she could eat.  They are powerful choices, and it’s always in the back of my mind that as important as the nutritional content of her food is, her relationship to food is even more important.  It’s one she’ll have for the rest of her life.

So when the orthodontist told me that her slowly expanding diet would have to be limited again, I swallowed hard and waited for his judgment.  His response?  “I completely understand.  My kids are picky eaters, too.  Any suggestions for me?”  Oh boy, I thought, just get me started…

Do you have suggestions that work with your picky eater?

With SPOON Foundation established, Cindy and I began to explore our options for helping to improve the nutrition of institutionalized children.  Our original idea was to ship multivitamins to Baby Houses in Kazakhstan, but we quickly realized this idea had several problems; most importantly it was not a sustainable model.  We also needed to make sure that the multivitamins were an appropriate intervention, and we were not qualified to make that judgment.  Luckily for us, Dr. Dana Johnson  from the International Adoption Clinic at the University of Minnesota took an immediate interest in SPOON’s new Orphan Nutrition Project as did several of his colleagues.  Our medical advisers, along with our partners in Kazakhstan, helped us plan a more sustainable model of intervention, one that relied on local resources and aimed to answer a question that surprisingly hasn’t been answered before now: what is the best way to improve the nutrition of orphans overseas?

Even though many of the children appeared to be getting sufficient macronutrients, our initial analysis determined that they needed more fat, calories, and protein.  We were somewhat surprised to find out that these chubby, stocky kids were malnourished.  I was reminded of the time I was chided by an orphanage doctor for feeding Bakha an orange: “If you keep feeding her, she’ll get fatter and never walk.”  She couldn’t walk because of rickets.  She looked stocky but didn’t have an ounce of fat on her.  She had a slightly chubby appearance because of stunting  which is a condition sometimes seen in preemies and internationally adopted kids in which their frame is too small for their weight.  The children are not chubby from excess fat, but from excessively short length.  Stunting reflects not just inadequate calories, but also hormonal changes, triggered by stress hormones such as cortisol, that stunt linear growth. It is probably a mixture of stress and malnutrition that produces the body type that mistakenly leads parents to think that their adopted children are well-nourished.

When Bakha came home at age 5 weighing 28 pounds and only 32″ tall, her developmental pediatrician encouraged me to feed her a diet high in fat, calories, and protein, the same type of diet that children are encouraged to eat when they’ve been diagnosed with “failure to thrive.”  She assured me that the calories would go to height and not girth.  Here are some of the tips I followed to increase fat and calories (for more tips click here):,

• Top crackers with cream cheese, hummus, cheese spread, egg salad, or meat spread.
• Sprinkle parmesan cheese in soups, on vegetables, meat, or pasta.
• Puree legumes and add to sauces and soups.
• Add yogurt to a fruit shake.
• Fold butter or oil into pasta, meat, vegetables, hot cereal, and rice.
• Add avocados to sandwiches or mash them up for a dip. Puree into yogurt or smoothies.
• Stir in some hemp or flax seed oil to sauces, soups, or a fruit shake.
• Whisk salad dressing, whipping cream, or cream cheese into scrambled eggs before cooking.
• Add a tablespoon of cream or coconut milk to 1 cup of milk or milkshake.
• Buy whole fat dairy, such as yogurt, cream or cottage cheese.
• Use whole milk instead of water when preparing hot cereals or soups.
• Cod liver oil comes in many flavors and can be hidden in yogurt and smoothies.

The pediatrician was right.  The extra calories all went to height.  I punched up Bakha’s food with so many extras, she grew like a weed.

Here is Bakha, age 5, standing next to her 3 year old cousin.  This was taken the day after we got home:

And here are the two of them 16 months later.  You can see that Bakha’s high-fat, high-calorie diet went straight to height.

Do you have tips for sneaking extra nutrition into your child’s food?

Within days of entering the U.S., my newly adopted five year old daughter, Bakha, was diagnosed with malnutrition and rickets.  Her symptoms were so severe that it was hard to imagine that malnutrition could be the sole cause.  She was started on a high dose of Vitamin D, and I was told we would wait and see what happened before running tests to find some possible underlying diagnosis.  I watched her improve on the Vitamin D, but truth be told, I waited for that other shoe to drop.  But 4 ½ years later, that other shoe still hasn’t dropped.  My daughter received many diagnoses, but every one was likely the result of poor nutrition.  Once she started receiving the Vitamin D, a multivitamin, a better diet, activity, sunshine, and love (yes, love and attention have been shown to improve growth and development in kids), she started to thrive.  I, however, was a little slower to get over it.  Malnutrition?  That was it?  Something entirely preventable?  Even though she was institutionalized, she was well-cared for.  Although short, she was sturdy looking.  What went wrong?

I have to say, there’s nothing like an extended stay in a less fortunate part of the world to shake up one’s priorities.  When I returned to the U.S., I vowed to change my ways.  I was thinking small at the time:  I would stop throwing away leftover food.  I would never again buy a new car.  I would be happy living in my 730 square foot loft even though I had a child who was fast becoming a pack rat.  But soon enough those resolutions did not seem like solutions.  I couldn’t get the thought out of my mind that there were other kids living my daughter’s early, preventable life of pain and discomfort.

Soon after returning home and starting our life together, my daughter and I met up with another mom who along with her husband adopted a little boy from the same country as my daughter.  They lived less than a mile away from us, and before long we were meeting up on a regular basis.  Cindy was struggling with Jadyn’s feeding.  Although less than a year old, he wouldn’t take a bottle.  He refused all formula and he was significantly underweight.

Cindy and I began to wonder if Bakha and Jadyn were that unusual for kids adopted from their part of the world?  We had been under the impression that the kids in the Baby Houses (orphanages for little ones) were usually very healthy due to the high standard of care.  How then did Bakha and Jadyn come to be so malnourished?  And what about the other kids being raised in orphanages?  Were they as healthy as they could be given their less than optimal situations?

If it was just me with those thoughts nagging at me, I’m afraid they’d still be nagging.  But Cindy’s a go-getter and a networker.  She’s the kind of person that inspires other people, or in the least, makes it difficult for people to say no.  Before I knew it, we had established a nonprofit called SPOON Foundation with the mission to both improve the nutritional status of institutionalized children overseas and to educate parents and medical professionals about the unique nutritional needs of adoptees.

The adoption of my daughter happened so suddenly and quickly, that for a while I joked I had accidentally adopted.  At 38 and single, I was still undecided about having kids.  Some days I couldn’t wait to start a family; other days I gave it no thought.  I had a demanding job that I loved.  I lived in a trendy loft in the heart of a vibrant city.  I spent many hours each week volunteering as a wilderness search and rescue canine handler.  Where would kids fit in?

I’ve found, though, that the big decisions cannot always be decided by reasoning but by letting go.  When I was out on a search for a probable suicide victim, a careless jump over a stream resulted in a badly sprained ankle.  Home from work, sitting on the couch for hours on end, I kind of let go.  When I heard about a little girl far away somewhere (I didn’t know where), of some indeterminate age (was she 2 or 5?), with a whole range of diagnoses (her doctor said cerebral palsy; a Shriner’s report said Muscular Dystrophy), I took an immediate leap of faith and followed my heart.  The decision was easy and I didn’t care what the consequences were.  I started to love her, the thought of her anyway, right away.

Six months later, after spending several weeks with her on the other side of the world, the two of us sat in a courtroom together and became a family.  She was five, but the size of an 18 month old.  She was just starting to walk, but the contractures in her hips and knees caused a slow, painful gait.  She was weak.  She was spirited.  She was absolutely delightful.  Her name was Bakha.

I knew full well (or thought I knew anyway) that Bakha had a life of walkers and wheelchairs, medical appointments, surgeries, and therapies in front of her.  Before I knew her, I was okay with that fate as she was an abstract little being to me, a few blurry photos, some video clips, a medical chart.  I would help her through her surgeries, encourage her in her therapies, sit through IEP meetings at school.  I even tried to envision her as an adult, maybe bagging groceries down the street at Whole Foods.

But once I knew her, once I was charmed by her sense of humor, and awed by her willingness to let me mother her, my heart seized up at the unfairness of what I thought was her future.  I wanted her to play outside with the other kids instead of sitting on the windowsill watching.  I wanted her to have a fair chance.

On the long flight home I mentally prepared myself for her first doctor’s appointment and the news that she had something bad, something incurable, worst of all, something progressive.  She, on the other hand, sat like a queen in her airplane seat 40,000 feet in the air, pointing at the door, demanding to be let out.  She wouldn’t take no for an answer.

Throughout this week, I will continue this story about my adoption and how it led me to co-found the nonprofit organization SPOON Foundation.  SPOON works to improve nutrition for international orphans and for adopted children in the US.  A video of my daughter, Bakha, is available online at http://www.spoonfoundation.org/.