eating

Gradually introducing a new food will help the child to become desensitized to the smell, look and possibly feel of an unfamiliar food. If a new food is chosen that has highly desirable sensory qualities to the child, you will have a better chance at success. Start with a food that has the “best” sensory fit. Offer the food on a daily basis by putting it where the child will be able to desensitize to it. Think of how your child might best accept a new item in his/her space. Frequently a small separate bowl or plate in close proximity to the child’s seat will work. Sometimes a child can tolerate the new item on his or her plate as long as they understand that the only expectation is that it will just stay on their plate. Repeated exposure of the identical food item should be offered once or twice a day, at meals, with no expectations attached. Sometimes this technique paired with others in the family, especially a sibling, modeling the enjoyment of eating this new item, can make it easier for the child to try tasting it. You may try the same food item for two or three weeks. For children who respond to Social Stories (Gray, 2000; Gray & White 2003), information can be offered in this format, at times other then mealtime. In the Social Story, focus on the wonderful benefits of trying this new food. Sometimes, in the Social Story, describing a favorite character like Barney or Spiderman eating this particular food gets them interested enough to taste it.

If desensitization, modeling and a social story have not resulted in the new food being tried, the strategy of offering alternating small bites of a highly desirable food with a small bite of the new food is another option. As always, it is important that this technique not be made into a battle. The idea is to make trying a new food as pleasant and successful as possible. This is a common strategy that is used for all children. The information can be made visual (by putting the different bites in view on the plate) along with the instructions “First favorite food, then new/undesired food, and then favorite food.” An example might be “First macaroni, then peas, and then macaroni.” Both of these approaches for introducing new foods are positive and non-threatening to the child. The child can feel like s/he has some control.

Children do not want to be tricked. Tricks such as hiding “extra” vegetables in spaghetti sauce and or supplements in a child’s favorite drink do sometimes work but can also backfire. Sometimes, after detecting “additions” to familiar favorites, the child learns to be suspicious of all foods and will limit his/her diet even further. This strategy probably works best when the sensory characteristic the child is focusing on is the “look” of the food. If a child is more sensitive to the smell, taste or texture of a food, it may be harder to make “additions” because they are usually easier for the child to detect. Be cautious when using this strategy.

The auditory sense is generally not directly related to eating and feeding issues. Indirectly sounds can contribute to the comfort of the actual environment where eating and feeding take place. It is very common for individuals on the autism spectrum to get overwhelmed in noisy and crowded environments such as a school cafeteria or McDonalds on a Saturday afternoon. It is important to accommodate individuals’ needs so that the environment itself is not preventing successful eating because of sensory overload. Some children take longer switching from a bottle to a cup or learning to use utensils. Part of the issue is that change is hard for these children in general. The sensory issues can also be a partial reason for this difficulty. A desensitization plan for using a cup and/or utensils can be developed. If the problem is severe, an occupational therapist with sensory integration training may be helpful in suggesting desensitization techniques. Sometimes adaptations are possible and appropriate such as allowing the use of plastic utensils instead of metal.

In addition to the sensory properties of foods and the sensory stimulus in the environment affecting the child’s ability to eat in a particular environment, a third common issue is the ability to sit at a table and eat a meal with others. There are a number of reasons why this may be difficult. Eating at a table with others is a social activity. Eating may not be a very motivating or rewarding activity in itself. Pair that with the social issues involved in eating with others and you may begin to better understand the situation from your child’s perspective. Additionally, many of our children are active and have a hard time staying still in one place no matter what the activity. There are several possibilities to address when looking at the issue of sitting at the table with others to eat.

Determining the reason your child is not able to sit at the table will help in deciding what to do to address your child’s needs. Some children need to organize their bodies with a little physical activity before they are asked to sit at a table. Sometimes a timer needs to be set to show more concretely that sitting is expected at mealtime, at least for a few minutes until the timer rings. The length of time a child is expected to sit may be gradually lengthened so success is built up slowly. Some children can sit and eat quickly at the table but will not be able to sit and wait for others before being served and/or after they have finished their food. This inability to wait can sometimes be addressed with special waiting toys or activities. Sometimes items to focus on while waiting are helpful. Even some older children and adults on the autism spectrum have a need to develop waiting strategies to use at mealtime while eating with others. In this situation, bringing something to read or a pocket sized game to focus on while waiting, is a positive coping strategy for older children and adults, too.

Eating and feeding problems can sometimes dominate family life. It is easy to get overwhelmed when eating problems are severe and are so closely tied to your child’s health and development. The fact that mealtime occurs at least three times a day, and families and children are not always able to eat at home, adds to the stress. Get help for any biomedical and behavioral concerns. After those areas are addressed, families’ can often tackle the environmental factors by calmly working to desensitize the child to new foods with structure and a non-controlling plan for trying a new food. The expectation to sit and eat at the table can be structured in small steps and paced so the child is successful. Patience with this process is also a key to success. Network with other families to share successes and failures, and to gather new tips or resources that can make a difference. Also when you reach out to others you will be reminded that you are not the only one coping with these challenges!

Problem 1: Sensory Misreading in the Mouth or Poor Oral-Motor Skills. A child with tactile defensiveness often exhibits hypersensitivity in the mouth and/or craves oral stimulation, such as chewing on his clothes. Low muscle tone in both mouth and face often coexists with deeper oral-motor issues. Poor sucking, chewing and swallowing skills can cause gagging or terror by merely being near food. Passing a medical swallow study does not guarantee that a child can chew and swallow consistently and has the stamina to consume an entire meal.

Possible Solutions for Problems in the Mouth. A speech or occupational therapist with oral-motor training can help. Teaching the child to use an electric toothbrush to massage (desensitize) the mouth or to drink from a straw can strengthen oral-motor skills and greatly reduce eating anxiety. Helpful books are Progress with Puppets and Out of the Mouths of Babes.

Problem 2: Nutritional Deficiency. Poor eating creates nutritional imbalances, which further reduce appetite or increase carbohydrates cravings. Deficiencies in zinc and vitamin B-1 contribute to anorexia, but a specific nutrient deficiency need not be present. General malnutrition can contribute to disinterest in food, leading to further mal-nutrition, reducing appetite increasingly over time.

Possible Solutions for Nutritional Deficiencies. Children cannot be forced to eat the necessary diet to correct mal-nutrition. Once they become malnourished, diet alone may not correct the deficiencies, particularly if children have poor absorption or delivery of nutrients. Best to use nutrient supplements with moderate levels of a broad range of vitamins (C, E, and B-6) and minerals (magnesium, molybdenum, chromium and selenium) that are most deficient in an overly processed diet. Liquid nutrients are available for children who refuse chewables. Pills ground up in a mortar and pastel can be mixed with frozen grape juice concentrate, applesauce, strained pears, or, in desperate cases, chocolate syrup.

Problem 3: Weak Digestive Function. Children with a history of reflux, colic, frequent antibiotic use, allergies, diarrhea, constipation, and low tone, often have a digestive system that is immature, inflamed or inefficient. Most cases are subtle, with a heavy or sinking feeling accompanying eating. These youngsters are uncomfortable and tend to avoid eating, becoming high risk for malnutrition. They do not know how a happy tummy feels, from lack of comparison.

Possible Solutions for Weak Digestive Functions. The Comprehensive Digestive Stool Analysis by Great Smoky Labs is one of the several tests that evaluate subtle digestive issues. A physician must order these tests.

Another solution may be digestive tonics. A traditional remedy for weak digestion and internal inflammation is ginger tea, made by boiling peeled root slices, then cooled and served a few teaspoons at a time (possibly with honey for children older than one), several times per day.

Digestive enzymes in small amounts may increase appetite, but, if used in excess, can loosen stools or cause intestinal cramping. Digestive capacity diminishes as the day progresses, so, if trying enzymes, always start at the most problematic meal for poor digesters.

Problem 4: Drug Side Effects. Stimulants such as Ritalin and Dexedrine decrease appetite. Antibiotics can also reduce appetite by increasing yeast overgrowth and damaging the intestine's lining. Yeast overgrowth can turn the intestines into a fermentation machine. When yeast digest sugars, the intestines bloat, sending either a "full" signal or a call for more carbohydrates.

Possible Solutions for Drug Side Effects. If stimulants severely affect the appetite, re-evaluate the side-effect/benefit ratio. Stimulants are controlled substances, and their use in a young child should yield huge benefits to justify the long-term costs (both known and unknown). If stimulants are deemed absolutely necessary, feed the child dinner foods for breakfast, because he will eat little while the drug is in the system. After school, when the medicine is breaking down, feed a second dinner, rather than snacks. Then at 7:00 p.m., bring out the low-sugar cereal, toast and snacks.

Although picky eating can be interpreted as a behavioral issue and treated with behavioral modification, it frequently has nutritional causes. By playing detective, parents can determine which solution is right for an individual.

Food, textures, and swallowing

Kid-Co food grinder is a miracle worker--must have! (as well as nice and compact)

Z-Vibe and different tips: Great thing so that the tounge can sense when food is going to slide down the throat... AND GREAT FOR ENHANCING DIFFERENT FOOD SELECTIONS! Wake up the mouth and throat.

Drink a cold drink before meals to help wake up your throat also, and stops some of the tactile defensiveness in the throat that can cause a lot of gaging, etc.

Oral-motor feeding therapy is also wonderful!!

You can get the products above at www.achievementproducts.org

PS: I also recommend juicing a lot as it helps abundantly over crushed ice (although may need some taste acquiring to because of the Autism)... We mix like apples, strawberries, grapes, bluberries (great anti-oxidants) and carrots... that's just a sample of what we do.

Hope this helps!

Luv,

Kris

Luv,

Kris

PS: LOL, our names are similar!