Many parents of autistic children battle with their child's feeding issues with limited resources to guide them. This is partly because there isn't sufficient research on autism and mealtimes to provide a full proof formula. Finding a specific reason can be challenging as there are a few factors in play. Let's discuss some factors that make mealtime difficult and how we can help our children.
In order to identify and manage the child's negative association during mealtime, it is crucial to first evaluate why they react a certain way and take appropriate steps. Firstly, children with autism frequently experience medical problems that make eating difficult. These may include unpleasant acid reflux, oral cavities, and physical difficulties such as chewing (Leader et. al, 2020). Therefore, make sure that your child's doctor checks for and addresses any such difficulties.
Next, behavioural issues such as crying, throwing items or escaping should be addressed and measures should be taken to reduce those behaviours. Spitting, whining, banging on the table, and other behaviours are among the ways that many kids learn to get out of the family meal. Have a discussion about the meal to deflect attention away from the inappropriate behaviour.
Behavioural issues can be shaped through ABA therapy, using aids like visual cues (Grindle et al., 2009).
After medical conditions and behavioural problems have been addressed, environmental factors, such as sensory challenges, might be taken into account (Cermak, Curtin, & Bandini, 2010).The approaching mealtime causes severe anxiety in a lot of autistic children. Sensory intolerances and a fear of trying new meals can be the underlying causes. By trying to push a child to eat, families may unintentionally worsen the anxiety and create a negative association with mealtimes.
After understanding the factors that could play a part in troubled meal times let's discuss some ways to reduce them. It can't be emphasised enough how crucial it is for a family to regularly eat together. All kids, but notably those with autism, may learn what's expected of them thanks to environmental clues. Additionally, sharing meals with the child encourages imitation learning. Kids are hardwired to mimic others. A child will also be more inclined to try a new cuisine after witnessing it (Ausderau, & Juarez, 2013).
To add on, start with small achievable goals to encourage success. As advised, families can begin by letting their child join them, even if it's just for a minute. Increase the time spent at the table to about 20 minutes over time with encouragement and modest rewards. Reassure the child at first that eating is not required. Just make sure the toddler can get to the food while the rest are eating. Here, the goal is only to make eating more comfortable as a routine. To further teach where to sit and what to expect, utilise the same table for all meals and have family members sit in the same chairs.
Next, do breathing techniques if the child shows anxiety/ behavioural issues. Give the child some time to unwind before meals in order to break this tendency. Spending five minutes together practising deep breathing is one way to do this. This can be accomplished by just breathing slowly and deeply for four counts, followed by a slow and complete exhalation for seven or eight counts. Alternatively, you may spend those five minutes performing a "deep pressure tactile exercise" (Maskey, 2014).
Next, gradually expose your child to new meals. Often, mothers may offer a different selection of numerous new foods every day out of desperation, hoping that by chance the child will try something. The more options, the greater the probability of success, this seems logical, but not for a child with autism spectrum disorder (Emond, 2010). Be calm and non-controlling while creating a plan to increase the quantity and variety of foods your child will eat. In actuality, the most positive experiences occur when the child is given some control, or at the very least when they feel like they do. For example, white spaghetti without sauce is a kid's go-to dish. By providing a different brand of white spaghetti, the child’s acceptance is stretched. Over time, progress to dishes like spaghetti with a little butter, white sauce, etc. The goal is to provide a dish that still looks familiar while fostering tolerance for subtle, gradual changes. For instance, switching from spaghetti to penne pasta could be too much to manage just because they appear so different.
Another option, which you can try is, space out meals and snacks every two to three hours throughout the day (Emond, 2010). Cut out between-meal snacks such as milk and juice. The goal is to associate certain mealtimes with the child's internal hunger cues. This enables the child's body to anticipate and accept food at specific times. Also take note to not withhold food or meals. Withholding food until a youngster is sufficiently hungry to eat is an often-advised method for many kids with eating and feeding issues. This strategy has been proven to be risky and inappropriate for a child with autism (Silbaugh & Swinnea, 2019).
Lastly, play is how children learn, and playing with food is part of play. This fits in well with the idea of "gradual exposure" that was previously discussed (Chistol et al, 2018). Encourage the child to use all of his or her senses to engage with food. Discuss how foods feel and look. Use cookie cutters and other tools to create unique shapes to make it interesting and engaging for your child. They could also be allowed to interact with their food in a fun but appropriate way in the initial stages, eg. They can touch and manipulate food with their hands, but not throw food on the floor.
We understand how it can be challenging for parents when their children are picky with food. Patience for the process, as well as the effort in making sure the child is engaged during meal times is necessary for optimal results. It will take time, but don’t give up and keep trying!
References
Purdue University Extension. (2016). Family mealtime [Photograph]. Eat Gather Go. https://eatgathergo.org/wp-content/uploads/2016/10/family-mealtime.jpg
Leader, G., Tuohy, E., Chen, J. L., Mannion, A., & Gilroy, S. P. (2020). Feeding problems, gastrointestinal symptoms, challenging behavior and sensory issues in children and adolescents with autism spectrum disorder. Journal of autism and developmental disorders, 50, 1401-1410.
Grindle, C. F., Hastings, R. P., Saville, M., Carl Hughes, J., Kovshoff, H., & Huxley, K. (2009). Integrating evidence-based behavioural teaching methods into education for children with autism. Educational and Child Psychology, 26(4), 65.
Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238-246.
Ausderau, K., & Juarez, M. (2013). The impact of autism spectrum disorders and eating challenges on family mealtimes. ICAN: Infant, Child, & Adolescent Nutrition, 5(5), 315-323.
Maskey, M., Lowry, J., Rodgers, J., McConachie, H., & Parr, J. R. (2014). Reducing specific phobia/fear in young people with autism spectrum disorders (ASDs) through a virtual reality environment intervention. PloS one, 9(7), e100374.
Emond, A., Emmett, P., Steer, C., & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 126(2), e337-e342.
Silbaugh, B. C., & Swinnea, S. (2019). Failure to replicate the effects of the high-probability instructional sequence on feeding in children with autism and food selectivity. Behavior Modification, 43(5), 734-762.
Chistol, L. T., Bandini, L. G., Must, A., Phillips, S., Cermak, S. A., & Curtin, C. (2018). Sensory sensitivity and food selectivity in children with autism spectrum disorder. Journal of autism and developmental disorders, 48, 583-591.
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