Professional Tips: Dealing with problem eaters

Is getting your child to eat a new food a stressful experience? Do you find yourself cooking 4 different meals for the family dinner? Have you given up on trying to get your child  to eat fruits and vegetables? These are common experiences for parents of children with Autism Spectrum Disorder (ASD).. Picky Eating, or Problem Eating is much more common in children with ASD.  We spoke to Judy, Feeding Therapist at Opya, to help us, as parents, understand why a child self-limits their diet and what we can do to help them and ourselves.

“Why is making my kids eat different foods such a chore?”

Eating is a multi-sensory experience. Each mouthful brings the possibility of a variety of flavors, textures and temperatures. They include:

  • Flavors: Sweet, sour, salty, spicy, bitter planty, and bready
  • Textures: Hard, crunchy, chewy, soft, puree,  thick liquids, thin liquids and mixed consistencies
  • Temperatures: Cold, room temperature, warm, and hot

A child/adult on the spectrum may have an aversion to one or many attributes listed above, depending on their sensory profile.

“What do kids with ASD experience?”

Food choices are based on individual children’s sensory experiences. Many children who are picky or problem eaters may have Sensory Processing Disorder (SPD). A child maybe hypersensitive, hyposensitivity, or a mixture of both.

A child with hypersensitivity, has heightened sensitivity to flavors, textures, temperatures, and smells, or hyposensitivity, may seek out strong flavors and hard textures to make up for experiences they are missing.

The smell and/or texture of a food may elicit the same noxious sensory response as being stuck in a room with skunk stench. “GET OUT OF HERE!” is the message the body will send.

It can be difficult for parents to understand their child’s preferences when they themselves do not share the same sensory experience.  The symptoms in some children with ASD can be further exacerbated by their strong preference for routine.. This preference for sameness can show up at meal time as well. For example,  wanting chicken nuggets only from McDonald’s on a specific plate.

“What is considered typical picky eating and when is a child a problem eater?

While it is common for toddlers and kids of all ages to be picky or fussy about foods …  

… a typical picky eater tends to exhibit different behaviors and often outgrow these tendencies. This is often not the case in kids who are “problem eaters.”

A typical child may exhibit some or all of the symptoms below:

  • Have aversions to some foods, but still eat a variety
  • Eat foods from each texture group and food group
  • Tolerate the presence of new food
  • Be willing to touch or try new foods

A child with problem eating may exhibit some or most of the behaviors below:

  • Eats 15 to 20 foods or fewer
  • Refuse one or more food groups (example: preference of carbohydrates or refusing fruit)
  • Refuse one or more texture type (example: preference of crunchy or puree, not both)
  • Preference of color (example: eat only white foods)
  • Preference of flavor (often sweet or salty)
  • Preference of specific brands of a certain food. example, chicken nuggets only from McDonald’s
  • Tantruming or meltdown at meal times
  • Gagging when trying new foods
  • Displaying anxiety over the presence of new foods on their plate, or even in the room
  • Finding the smell of certain foods to be noxious

“My child is already has a busy schedule, I don’t see this as a priority!”

Parents may get dissuaded from thinking that feeding is an issue because the pediatrician’s growth chart shows the kid(s) growing normally. However the reality is that kids can grow quite well on diets that are not nutritionally balanced, eg. a carb-only diet. Additionally, communication difficulties, meltdowns and lack of time makes any eating issues seem trivial and hard to prioritize.

Having a family add one more commitment of weekly Feeding Therapy can feel daunting. Research has shown that for the vast majority of children problem eating presents itself when they are toddlers and they do not “outgrow it”. Early intervention for feeding is the key to having the best outcome, just as in the case of other therapy types (speech, behavior, & OT).

Additionally, research has proven that a nutritionally balanced diet is essential to thrive and has several benefits.

  • Improve Constipation: Constipation is more common in children with autism than the general population. This problem usually is caused by a child’s limited food choices and it often leads to discomfort and some unnecessary behaviors during this time.This can typically can be remedied through a high-fiber diet, plenty of fluids and regular physical activity.
  • Prevent obesity: It’s important to seek professional help because weight problems in autism seem to follow a specific course. The pounds start to pile on at a younger age, and persist into adulthood more often. Starting early is essential to break the cycle and help your child thrive.

Kids with ASD are 2x likely to be overweight, 5x likely to be obese, and 2x likely to develop Type 2 diabetes.

  • Balance blood sugar: A balanced blood sugar level helps any child’s brain function. The reserve of it may impede a child’s brain function and affect an ASD’s child’s behavior. A balanced and nutritious diet can potentially help avoid and even improve some behaviors.
  • Social functioning: According to spectrum.org, researchers are adapting programs to help children with autism expand their food choices and be less sedentary. The data showed that the benefits of the program go beyond physical health. In some young people with autism, they can also boost social functioning and self-esteem.
  • Social Ramifications: As an individual grows in to a teenager the social ramifications around being a “problem eater” increases. When a child is a toddler many parents pack foods and drinks to go out to eat or visit friends and family. As the child grows and becomes more independent, needing to pack and bring specific foods to a playdate, sleepover, or a date draws attention.

“What can I do to get a head-start?”

Parents and professionals working with children are responsible for preparing and providing a well balanced meal at an appropriate schedule and setting. The child is solely responsible for whether they eat and how much they eat.

Before each meal

  • Meal times should be a stress-free experience for a child. Stress not only makes them avoid mealtimes but it also decreases their appetite.
  • Create the best schedule and setting for successful eating. Have meals and snacks at predictable times and locations. A written or picture schedule can be helpful.
  • Eating and drinking should be done at the table for all  snacks and meals. Avoid eating while watching tv other electronics.
  • NO GRAZING. If children are allowed to eat preferred foods throughout the day, they will not be able to regulate sensations of hunger and will eat fewer healthier foods at meal time.
  • Do not serve the same food everyday for the same meal. This sets a child up to “food jag and they will want the same food everyday, sometimes multiple times a day.
  • Have children participate in meal planning and preparation is developmentally appropriate. Include them in shopping, choosing foods, preparing and cooking foods, setting the table, serving food etc.

During each meal

  • Never force a child to eat
  • Let children chose the plates and cups they use at meal times.
  • Mix it up. It is okay to have pancakes for dinner.
  • Offer a variety of foods at every snack or meal. Include preferred foods and non-preferred foods.
  • It can take 15 to 20 exposures for a child to decide they like a food. If they are not exposed to non-preferred foods they will not add new foods to their diet.
  • Don’t use dessert as a reward. This reinforces idea of having to eat “bad food” to get “good food.” Incorporate small amounts of dessert items into meals.
  • Do not substitute nutritional drinks/shakes for snacks and meals
  • Redefine “Success.” Even if no bites are taken: smelling, touching, poking with a fork, touching to lips chin, or licking is a measure of success and should be recognized. 
  • PRAISE, PRAISE, PRAISE any participation in food-related experiences.

“How can I take action?”

As a parent you can intervene by:

  • Consulting your pediatrician and/or nutritionist with concerns regarding adequate growth, nutrition and hydration.
  • Pursuing a Feeding Evaluation. It is important to find a feeding specialist who has experience with problem eaters. Speech or Occupational Therapists often specialize in feeding.Feeding therapy is generally covered by insurance.   
  • Programs addressing sensory processing and exposure to foods in a play based, non-threatening way are recommended. Programs using force feeding are not recommended.
  • Seek out support from other parents of problem eaters.
  • Continue to educate yourself about Sensory Processing Disorder  and problem eaters.

Think long term, small steps today can make a huge difference! See a doctor or a professional before starting any new meal plan.

If you’re in the area, please contact Opya for any questions regarding our feeding services.

About

Judy is a licensed Speech Language Pathologist and the Director of Speech & Occupational Therapy at Opya. Judy brings 25+ years of experience in her field. Her level of expertise extends from pediatrics to neurologically impaired adults. She also served as a therapist and manager in the Department of Rehabilitation at Stanford Hospital for many years. Judy was the founding president of the Special Education PTA of Redwood Citv (SEPTAR). Her experience as the parent of an adult child with ASD provides her with a unique and beneficial perspective. She  holds her Certificate of Clinical Competence (CCC) from the American Speech, Language and Hearing Association (ASHA) and is licensed by the state of California.