This blog discusses childhood eating problems and treatment approaches
The holidays are approaching, and with them come gatherings with friends and family. These often involve food, especially in the form of elaborate, time intensive holiday meals. Although these meals can bring a great deal of joy, they can also bring stress. Perhaps your child refuses to eat most of the meal or takes off running as soon as you all sit down to eat. Maybe he has a serious tantrum if a disliked food is too close to his plate. Regardless of the specifics, these behaviors can make meals a challenge.
It’s likely these issues don’t occur just during the holidays. It’s been reported that eating problems occur in a high percentage of children diagnosed with autism. Challenges may include: restricted eating patterns, over or under consumption of foods or liquids, and refusal to participate in mealtime routines.
The assumption that ‘he’ll grow out of it’ or ‘he’ll eat when he’s hungry’ can also be problematic. Having a highly restricted diet or refusing to stay at the table means your child may not be getting his/her nutritional needs met and is missing out on being part of family meals. In addition, chances are it’s causing you stress as you take extra time cooking additional foods your child will eat, or sacrifice food variety for the rest of the family in order to appease your child.
First things first…
If you have a child who has eating problems and these problems 1) compromise his or her health or 2) interfere with his ability to participate in social routines with friends and family, then you should seek assistance from someone with expertise in treating these issues. Often the approach to treatment is multidisciplinary. Physicians, dieticians, speech pathologists and occupational therapists all play a role in assessment and treatment. Behavior analysts also plays a pivotal role in this process. They can complete a comprehensive assessment, determine the function of your child’s eating problems and provide treatment strategies to increase your child’s mealtime success in and out of the home.
Gaining assistance from so many professionals can be a lengthy process however, so here are some general tips for decreasing eating problems.
- Create and maintain consistent routines.
- Teach and reward your child for following directions.
- Avoid the ‘eating rut’ where you serve the same foods over and over.
- Model healthy eating.
- Keep eating at the table and do not allow your child to leave the table with food.
One specific approach you may find helpful getting your child to try new foods is ‘shaping’. This process rewards a child for doing things that get them closer to the ultimate goal of taking a bite. To use shaping:
1. Pick 2-3 foods you want your child to try. Start with foods that may be easier for your child to tolerate e.g., foods they used to eat or foods that are close in texture, taste, and/or color to preferred foods.
2. Pick a powerful reward for your child e.g., a sip of his favorite drink, a bite of her favorite food, a minute or two of iPad time, etc.
3. During a calm time period (not mealtimes), expose your child to the food by having him follow these steps:
- Take a small bite
- Take a big bite
4. You can tell your child to do each step e.g., “Touch the blueberry” or you can have them imitate you e.g., say “Do this” while you touch the blueberry. Praise your child for each step followed!
5. If a full bite is taken or a particularly difficult step followed, deliver the reward immediately e.g., “You just took a bite of spinach! You get iPad for 2 minutes!!”
6. If at any point, your child refuses, backtrack to an earlier, easier step. Once compliance occurs again, stop and end on a good note. Try again later.
Remember this is a process. It takes practice and patience. The moment your child takes that first bite of turkey at Thanksgiving dinner though may make it all worth it.
Lobato, D. (2011). Feeding problems common in children with autism. Brown University Child & Adolescent Behavior Letter, 27(5), 1-7.
Barker, M. 'Assessment And Treatment Of Eating And Feeding Problems Of Children With Autism'. 2013. Presentation.
Written by Sherry Oldenburg, M.S., BCBA