It boils down to three things, really.
She is losing weight.
The weight loss is pretty self-explanatory. Her weight should be going upwards or at the very least, staying the same. It should not be going downwards. We shouldn't be back in the 20's, when we fought so hard to get into the 30's. Which brings us to Concern #2...
She hasn't changed her base level intake in over two years.
This one is a bit of a no-brainer, too. Two years ago, she was a lumpish little doll whose biggest activity was rolling around on the floor banging a couple blocks together or perhaps sitting up for a couple minutes, if she was feeling WILD. Now, she is a preschooler. She goes to school. She walks, talks, and plays. She tries to run and jump, albeit unsuccessfully, but trying is hard work, too. She has baby dolls to nurture and pretend food to cook. She has make-believe vacuuming to do, for goodness sakes! She simply MUST change dresses six times per day! She is very busy with all sorts of extremely important preschooler-type business, and her body needs fuel for these very important tasks, fuel in the form of NUTRIENTS, which she just might not be getting enough of. If she was getting enough, her weight (see Concern #1) would be going upwards, rather than downwards. Everyone expected her to begin to eat as she aged, but she hasn't. That is a problem in itself, and it is compounded by Concern #3...
She gets sick quite often and we get caught in the illness, dehydration, and occasional hospitalization cycle, complicated by ENDLESS rounds of everyone's favorite new game show "Will My Child Urinate Today?"
KayTar gets sick. A lot. KayTar stops eating. KayTar stops drinking. KayTar stops peeing. I spend every illness documenting intake/output and watching the clock to see if it is time to go to the hospital yet, helpless to do anything about the situation other than write about it ad nauseum and try to push fluids without appearing to care about the results at all. This is clearly failing, because when she finally peed yesterday, she exclaimed "Mooooom, guess what's in my diaper for YOU? PEE PEE!" I think my nonchalant cover has been effectively blown. She started school and will now be directly exposed to more illnesses, which might hurt her already tenuous-at-best balance. If she isn't getting enough on a good day, every time she gets sick and is getting little to nothing, it just increases the deficits.
When this came up the first time, I was really blindsided by it. It seemed to me that there was no way that this kiddo who CAN eat by mouth would need a surgical intervention. The truth is, CAN does not equal WILL or DOES SO RELIABLY, this I know. When it came up again in the feeding clinic appointment this week, especially in light of her illness and weight loss, it felt logical and appropriate. Subsequent conversations with the pediatrician were very much the same, rational and relevant. I will be honest and say I did feel a little twitch in my gut, a bit of emotional uprising to hear it confirmed by two of her doctors, but it wasn't strong enough to obscure the bigger picture. I've spoken with parents whose children have had feeding tubes, I've read medical studies, I've even watched videos of multiple surgeries and subsequent tube replacements. This is a strong possibility for KayTar, and I think I'm okay with it now. I think Josh is, too, actually, which is really saying something. He's not too fond of medical interventions. Watching her struggle to stay afloat in the midst of recent illnesses has been eye opening for us, and if this is what she needs to continue to thrive, then we are on board. No one is telling us we have to do it right now, but it does sound and feel like the time is approaching. Eight months ago the thought of it left me reeling, but today, looking at my gorgeous girl beaming from her first (belated) day of school, I know that we will do absolutely anything to keep her happy and healthy. If trying our very best isn't quite enough anymore, then we have to find a way to make our best even better. If a feeding tube can do that for her and for us, of course, we'll embrace it.