Helping children who have severe limited diets who are on ...



Helping children on Autism Spectrum, who have severe limited diets

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Introduction

It is common for children to go through phase of refusing to eat certain foods or at times refusing to eat or drink at all. This is especially common in younger children but can occur at any time. It is often a child’s way of showing independence and is a normal part of growing up. This common phase of “faddy eating” can be stressful, but rarely causes any serious nutritional, medical or growth problem’s and is a phase that is grown out of.

However, there are some children whose faddy eating continues much longer that the common toddler faddy eating. This is common in children on the Autism Spectrum. Up to 75% of children on the Autism Spectrum present with self-limiting diets.

Extreme limiting of the one’s diet can cause growth problems, nutritional deficiencies, severe tooth decay, dehydration and severe constipation and can cause mealtimes to be extremely stressful. It can affect your child’s ability to learn properly and can impact on your child’s self-esteem and socialization if they are unable to eat with their peers.

Normal eaters picky eaters Food aversion

What Causes Food aversions in children on the spectrum?

Children on the Autism Spectrum who have food aversions are a mixed group! There are a number of reasons that children may become resistant eaters:

• Medical issues- eating certain foods hurt, causes discomfort

• Sensory issues- they are over sensitive to the feel, taste, look, smell of food

• Oral-motor issues- don’t have the tongue control, chewing or swallowing abilities.

• Routines and resistant to change: learnt that they only eat certain brands, certain foods, certain colours etc

Filling out a food diary

It is essential to keep a log of exactly what your child is eating to help you to figure out patterns.

It is recommended that you fill out the dairy for 2 days during the week and 1 day at the weekend.

The diary will help you to:

• Understand your child’s preferences for food: colours, smell, textures, food groups, has to have potatoes, etc

• Environment preferences: places, noises, lights, at the table, standing, number of people, certain cutlery, certain place

• Best times to eat: morning, evening etc.

The diary is essential to help you understand your child’s eating pattern and to make realistic and appropriate goals.

What can I do to help?

We need to support you child from both sides!

Top Down: Environmental and behaviour strategies

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Bottom Up

Supporting sensory strategies

And Oral motor development

BOTH NEED TO BE TARGETED!

1. Top Down

Aim: to create a successful routine and environment to support eating behaviours.

1. First things to try with a faddy eater[pic]

This is the tried and tested standard advice, which helps with common faddy eating. Try these ideas first before moving on the later strategies in this section.

• Offer 3 meals a day- breakfast, lunch and dinner and 2-3 nutritious snacks. Offer 2 courses at a meal: one savoury and one sweet. This is better than letting your child “pick” throughout the day.

• Try to eat meals and snacks at the same time each day.

• Offer small portions to that your child is not overwhelmed, they can always ask for more.

• Drinks can fill up your child’s small stomach- avoid giving them for at least thirty minutes before a meal or snack. Try giving a drink at the end of the meal or at a snack time instead.

• Limit milk intake one your child is over 1 year to one pint or 600ml a day.

• Try to give drinks from cup or beaker rather than a bottle after their first birthday.

• Preserve in offering new foods- a child may need to try it more than 10-20 times before they start to like the taste

• Sit together at the table and eat at the same time as your child whenever possible, as they will learn from you.

• Present food in fun and attractive ways- e.g. make a face, use the letter pasta etc

• Try not to rush or drag meals. If you child has not eater their food after 30 minutes, take it ways without comment.

• Offer your child food without coercion. Never try to force feed

• If you child refuses to eat food, put it front f them at mealtimes, take it away without comment, and do not offer any other food until the next planned meal or snack.

• Do not use food as a reward. Better rewards are praise and star charts for good meal time behaviour.

• Try involving you child in shopping, food preparation and laying the table.

2. Top down approach: Next step with Food aversion

1. Create a structured daily eating routine:

Serve 3 meals and planned snacks at similar times of the day, this helps to establish a routine. Make sure your child knows this routine. Try and use visuals- e.g. picture schedule, written on the notice board etc.

2. Use visual supports-

Visual supports can be very powerful fro children on the Autism Spectrum. Examples:

• Daily timetable showing where meals come in the day- e.g. get up, dressed, breakfast brush teeth, get bag, car, school.

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• Visuals: e.g. Break cards, Stick kids, timers, social stories, number of bites to eat [pic]

3. Encourage your child to sit at the table [pic]

If you child find it hard to sit at the table, be realistic and set your goals small- e.g. 5 minutes. Use a TIMER and praise for good sitting. You may need to incorporate movement breaks before and during the meals to help them to sit. You may need to use a movement cushion. Your Occupational Therapist can advise you regarding this.

If you child can sit for other activities but not for eating, try removing their place from them calmly if they try and leave the table and praise them for retuning to the table and sitting and eating well- don’t chase your child around the room.

4. Try to refuse constant demands for favourite foods

Remember that they are unlikely to be physically in need of food of they have eaten in the last couple of hours and they refused their last meal or snack, giving in to their demands in between scheduled eating times is not going to help establish a routine in the long run.

• Stick to your regular mealtimes and back it up with visual supports. Refer to these if your child demands food in between.

• Keep undesirable food out of sight and out of reach!

• Don’t let your child help themselves to food or drink- make sure they have to request it from you first.

5. Motivating your child [pic]

Focus on motivating your child to change one thing at a time.

The best motivator is a consistent rewards for even the smallest step towards the change. - E.g. allowing the new food on the plate. Remember to use the Participation Checklist to make realistic goals for motivation.

Use rewards that not food related such as praise, star charts or treats such as stickers, comics, watching favourite TV programme, longer on the computer, staying up later etc.

Be sure you are clear as to which specific behaviours get a star or sticker. (e.g. sitting for 5 minutes, letting the pea on my plate

3. Bottom up

Aim: to support your child’s ability to tolerate sensory elements of food. [pic]

It may take months for your child to feel comfortable with a new food- so PERSEVERE and be patient!

1. Introduce one new food at a times and set small goals.

▪ Staying at the table/watching

▪ Small piece of food on plate near their plate

▪ Small piece of food on their plate

▪ Touching food with finger

▪ Touching food on arm

▪ Smell food

▪ Touching food on cheek

▪ Touching food on lips

▪ Lick food

▪ Put it in mouth and spit out

▪ Put it in mouth and Swallow

2. When choosing a new food use your food diary- try a food from an already accepted food group- e.g. a different type of bream , or a food in a similar colour, texture or taste to preferred food. This is called food chaining.

3. When introducing your child to new textures use the food play stages to help you grade it correctly. Remember to use sensory breaks to help your children throughout play activities/.

4. Give your child CHOICE but not absolute control. Compare “which of these 3 foods will you try this week” versus “will you try a new food this week”.

5. Please remember the participation checklist- your child may not reach all levels- that is ok.

Appendix

1. Examples of food play activities

2. Helpful hints for food play

3. Oro-motor Shopping list

4. Participation Checklist

5. Checklist for helping my child with new foods

6. Food Diary

Food Play Stages

Outline of Food stages or phases and activities that can be carried out to facilitate play with the food types in each phase.

Note: Do not mix textures, try bland colours first and then experiment with more colours before moving to next stage. When working with dried foods, deep fill containers, with wet textures use shallow trays

|Stage 1: |Drive trucks through the food |

|Small dry smooth texture e.g. couscous, lentils |Scooping food from one tray to another |

| |Finding items in the food |

|Stage 2: |Drive trucks through the food |

|Small coarse dry food: Rice |Scooping food from one tray to another |

| |Finding items in the food |

| Stage 3: |Drive trucks through the food |

|Large smooth dry food e.g. broad beans |Scooping food from one tray to another |

| |Finding items in the food |

|Stage 4: |Drive trucks through the food |

|Large course dry food: e.g. Chickpeas. Different |Scooping food from one tray to another |

|textured pasta etc |Finding items in the food |

|Stage 5: mixed dried textures |Drive trucks through the food |

| |Scooping food from one tray to another |

| |Finding items in the food |

|Stage 6: |Cutting out shapes using cookie cutters |

|Moist firm consistency: dough, playdough, mashed |Finding items in the dough |

|banana |Ball games: roll a ball and throw/ use as a bowling ball |

|Stage 7: |Dirt tracks- driving the cars up jelly hills, through muddy fields of mousse etc. |

|Wet semi solid consistency: set custard, jelly, |Painting with brushes |

|mousse |Finger painting |

| |Make hand prints |

| |Colour in pictures. |

| |Writing letters/numbers etc in the child’s hand and they have to guess what it is.|

| |Take turns! |

|Stage 8: |Dirt tracks |

|Wet liquid consistency: Pouring custard, pouring |Painting with brushes |

|cream, yoghurts, batter |Finger painting |

| |Make hand prints using sauces while the child is lying over a gym ball. Splatter |

| |painting by blowing food with a straw. |

|Stage 9: |Driving cars up and down pasta hills etc |

|Wet tacky consistency: cooked rice, cooked pasta |Find items in the pasta, rice |

|stage 10: |Dirt tracks- driving cars through swamps of rice pudding, cereal mixed with water |

|Wet mixed textures: rice pudding, pasta and sauce, |for mud etc. |

|minestrone soup |Find items in food |

| |Finger painting |

| |Make hand prints using rice pudding on black paper. |

| |Find letters in alphabet spaghetti to make words. When your child is comfortable |

| |with the game above, encourage them to guess which letter they are holding from |

| |touch alone (i.e. blindfold them). |

Helpful hints for food play

Children who are comfortable across all levels of food play make the transition to oral eating more easily/ It is worth investing considerable time and effort in this area from the outset.

1. Set up a predictable beginning and end- e.g putting on aprons, getting materials and end- clearing the table and washing hands etc.

2. Many children find it difficult to progress from dry to wet food play- this transition can be facilitated by

▪ Make a barrier between the children hand and the wet food- e.g. manipulating tomato sauce and mayo to make pink sauce when they are in a bag.

▪ Allow child to wear surgical gloves and gradually reduce the barrier by cutting some of the fingers from the glove.

▪ Use utensil for stirring e.g. spoon.

▪ Use the softly, softly approach. Reward your child for playing with food, even if it is for a short period of time i.e. 10 seconds.

▪ Always have your break card at the ready so your child can request a break if he/she needs it.

Oro-Motor-Sensory Shopping List

|Things to chew |Things to suck/lick |Things to crunch/munch |Intense taste/temperature |Non food items |

|Licorice sticks |Smoothies |Crisps |(see also things to suck) |Chewy tubes |

|Bubble gum |Milk shakes |Apples |Carbonated drinks |Chewerly |

|Toffee |Actimel type yoghurts |Bread sticks |Sour fruit lollipops |Balloons |

|Dried fruit |Toffee bars |Cheerios |Sour gums balls |Blowers |

|Cheese |Lollipops |Corn chips |Curry |Bubbles |

|Chips |Flat sugarless bars |Crackers |Sherbet |Blow out candles |

|Roll ups |Food dips (variety) |Granola bards |Ice |Cotton balls (to blow/touch |

|Gummy bears |Fresh orange wedges |Nuts |Chilli |face) |

|Cheese strings |Grapefruit wedges |Pickles |Cinnamon |Harmonicas |

|Jelly worms |Jelly cubes |Pretzels |Hot drinks: |whistles |

|Lemon drops |Juices: |Popcorns |-tea |Latex squeezies tags |

|Marshmallows |-cranberry |Rice cakes |-hot chocolate |Sports bottles |

|Oranges |-lemonade |Raw veggies |-hot lemonade |Straws, long |

|Raisons |-apple |Sweet tarts |Bitter fruits |Straws, Curly/silly |

|Skittles |-grapefruit |Toast |-lemon |Straws, thin |

|Sugarless gums |Ice-cream |Kit kats |-grapefruit |Straws, short |

|Snicker bares |Ice lollies |Sesame sticks | |Thera-bands |

|Muesli |Juice smoothies |seeds | |Theratube |

|Brown bread |Peanut butter |Vegetable sticks | |Blow football |

|Toast |Ice pops |-carrot | |Horns |

|Bread rolls |Custard |-cucumber | |Electric toothbrush |

| |Ice |-celery | |Biteblocks |

| |Sherbet | | | |

| |Jam | | | |

| |Nutella | | | |

| |Honey | | | |

| |Boiled sweets | | | |

Checklist for helping my child try new foods

|To do |Tick when complete |

|I have completed a food diary for 2 weekdays and one weekend day | |

|I have analysed the diary and know my child’s food patterns | |

|I have set realistic goals | |

|I have a set routine established of 3 meals and 2-3 snacks a day | |

|I have visuals in place to let my child know when the meals are happening and what is | |

|expected from him/her | |

|I have used my child’s preferences to create an environment that suits them best for eating | |

|(e.g. music off) | |

|I have scheduled appropriate sensory breaks to help my child with food activities | |

|I am involving my child in food shopping and cooking | |

|I have started using structured play activities to help my explore food | |

|I am completing the participation chart for various food activities to continue to build on | |

|my child’s goals | |

|I have set up an appropriate rewards chart for my child’s participation level | |

|I am contacting my child’s team for ideas, to support me in updating my child’s goals etc | |

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Characteristics of Aversive eaters:

Aversive eaters often exhibit one or more of the following:

1. Limited food selection. Total of 10-15 foods or less

2. Limited food groups. Refuses one or more food groups

3. Anxiety and /or tantrums when presented with new foods. Gag or becomes ill when present with new foods

4. Experience food jags. Requires one or more food to be present at every meal prepared in the same manner.

Break

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