Feeding the Child with Special Needs

Autism Support Group

June 28^th, 2022

Leisa Hutchison, M.S. CCC/SLP

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Ben Hutchison

Ben’s First “Spa” Treatment!

PICKY EATER vs. PROBLEM EATER

Picky Eater

Resistant Eater

• Selective about food
• Accepts 30 or more foods
• Will eat certain foods for many days at a time
• If picky eater tires of a food and stops eating it, he will eventually accept it again after a break
• Will usually eat one food from each food group
• May eat different sets of foods than family but will eat with the family

• Accepts only a few foods – less than 20 (10-15)
• Strong phobic reaction to new foods (gag, vomit, cry, tantrum)
• May not be able to touch a new food
• Experiences food jags – (same food must be present prepared in same manner).
• Usually has a diagnosis of ASD, Developmental Delay, etc.

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Types of Feeding Disorders

Motor-Based - Difficulties due to neuromuscular and/or difficulty with oral motor structures (compensatory motor patterns)

Examples – Cerebral Palsy, neuromuscular diseases, cleft palate, etc.

Sensory-Based - Difficulties most often caused by unresolved physical issues – normal oral motor structure with food refusals.

Examples – prolonged feeding tube use, lack of oral motor stimulation during g-tube feeding

Ben at six months – NG tube

Behavioral Feeding Problems

• May result from either sensory or motor-based feeding problems
• examples: Sensory -not being able to manage the cookie crumbs after taking a bite, therefore, learning to never eat cookies, crackers, etc. for fear of choking
• Motor – not having the ability to move the tongue to get bread “unstuck” from the roof of the mouth and pocketing foods for hours.- excessive drooling

Sensory Feeding Problem Examples

• Selective about food textures, colors, flavors
• Highly sensitive to odors
• Like foods that are unusually bland or only have very strong flavors – potatoes without butter or salt or broccoli and asparagus
• Only drinks white liquids from a bottle – at age 5
• Has unusual routines before he can eat – wash hands, turn plate three times, put green things on right, etc.

What Can Parents Do To Help?

Environmental Changes that can help:

Maintain the general mealtime/snack routine

Play soft music in the background at meals

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Set a timer to let children know when the mealtime is over

What Can Parents Do To Help

• Develop Mealtime Rules: (Use pictures for non-readers)
• 1.) Keep food on your plate
• 2.) Use a utensil to serve food from bowl.
• 3.) Stay in seat until timer rings.
• 4.) Let the adult know when you are finished. Use your words or a picture card for “finished”
• 5.) We will only eat at mealtime or snack time at table
• 6.) We will only say Nice or positive things about our food at the table.

Food Chaining

• Initially developed by Cheryl Fraker (parent/therapist), this approach explores the relationship between foods (texture, tastes, colors, etc.) that your child currently eats and foods you eventually want them to eat. Gradual changes are offered in foods to get acceptance.
• If your child eats french fries it might go like this:
• French fries >hash browns >sweet potato fries >breaded zuchinni sticks >steamed veggies

How Does Food Chaining Work?

• Food chaining works by taking a food that your child is already eating and identifying new foods that they are similar in color, shape, texture, smell, or taste to serve them at meals.
• The more two foods are alike, the more likely a child is to eat it.
• For example, your child eats chicken nuggets and other types of bread and carbs, but eats no other protein
• Offering other breaded proteins like breaded fish nuggets or homemade breaded chicken nuggets is a great way to start working on new foods.

Food Chaining Video

https://www.youtube.com/watch?v=_hhZxjPC8zA

Food chaining: �from pretzel to carrot stick

• Start with pretzels or something child loves
• Move to white veggie stick
• Then orange veggie stick
• Then raw carrot
• Then cooked carrot

Food chaining:

• Builds a bridge to get to those foods you really want your child to eat one step at a time through links to food they’re already eating.
• Uses your child’s strengths (what they are already eating) to get to the needs (what they are hesitant to even try)

How do I start Food Chaining? �Steps 1-3

• Step 1 – Make a list of your child’s foods

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• What are the common themes between these foods?

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• All white, stick-shaped, crunchy, spicy, smooth, bland
• Try to identify a pattern if you can
• Sometimes there is a pattern while sometimes it is totally random

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Food Chaining steps

• Step 2 - Circle a few foods on the list that your child really likes and brainstorm some other foods that are similar in some way.
• Cheetos, white Cheetos, French fry, potato stick, etc.
• Vanilla pudding > vanilla yogurt> vanilla ice cream> vanilla flavored milk> white milk
• Try not to limit yourself – the more similarities, the better and more likely they are to eat new similar foods

Food Chaining steps

• Step 3 - Start serving the most similar foods regularly during meals.
• Depending on how picky your child is, these strategies may help them begin to eat new foods without other strategies being needed
• Extremely picky eaters may need additional strategies to help address the underlying cause – (sensory, oral motor weakness or problem) or strategies to help them interact more with food.

Food Chaining Tips

• Give your child advance warning to when it will be snack or meal time.
• Give your child two choices between 2 fruits, 2 puddings, 2 yogurts, or any food you are trying to work with.
• Not every meal has to be a “therapy” meal. Choose a time when your child is not stressed or tired.
• Time meals and snacks wisely – space appropriately

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Food Chaining Tips

• Offer a divided plate at meals. The divided plate will have a section for eating as well as a section for looking and one for touching food. Example
• “the looking place”-look up the food item on Pinterest or in images online. Viewing information about the food prior to putting it on the plate may be very helpful and reduce the risk of a refusal.
• A menu with photographs is important when trying a new food.

Food Chaining Tips

• Put a small amount, 1 tsp to 1 Tbsp of a new food on the plate in the looking place. This should be a particular food selected for learning/looking or it can be a food that you are eating. (no strong-smelling foods)
• Another section is the touching or feeling place for food. Once a food has been in the looking place for a few meals or snacks, Steven can help select one for touching place on the tray.

Food Chaining Tips

• Later you can work toward a tasting spot (most kids lick a food first), it may take a while, so don’t feel you need to rush these learning stages.
• Have fun learning about foods, where they come from, how grown, etc.
• Talk about how good the food tastes without pressuring or even asking the child to take a bite. Let them decide without pressure. (Can work on encouraging a number of bites this later if necessary)

Food Chaining Tips

• Encourage food activities
• Baking cookies together
• Making food rainbows
• Growing foods together
• Picking berries or other produce
• Going to an orchard, etc. and selecting foods
• Grate cheese, melt cheese, make shapes with cookie cutters, make a quesadilla or make a face on tortilla using salsa

Food Chaining Tips

• Make mealtime setting attractive to the child
• Keep distractions to a minimum
• Motivate your child to succeed
• Shift focus off your child at mealtimes – don’t pay attention to the fact that he/she is not eating
• Don’t reward negative behavior
• The entire family should support your child’s program

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Food Presentation Ideas

• Let the non-preferred food “reside” on the child’s plate even if he doesn’t try it.
• Try to have some preferred food on the plate, but not an overwhelming amount.
• Give beverage with the meal (preferably milk)
• Try “layering” a non-preferred food onto a preferred such as (corn on top of a potato chip or cheese on top of broccoli).

Food Presentation Ideas

• Start helping the child dip out smaller amounts of foods so that they notice the food decrease when they try a small bite.
• If the child tastes a food and does not like it, allow him to spit it into a napkin and put in trash. If he vomits have him clean it himself while you provide the supplies. No judgements here, just guide them.
• If child is fed, always look for their acceptance of a food by leaning toward bite, opening mouth, licking

Other Ideas

• We should teach children by giving them experience in food preparation and selection if possible.
• Setting the table
• Preparing “ants on a log” snack
• Cutting cheese with cookie cutters
• Helping to stir or serve themselves
• Helping with clean up and dishwashing

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Nutrition Resources

• https://www.choosemyplate.gov/health-and-nutrition-information

Nutrition Lessons

• Former feeding experience group at WKU Communication Disorders Clinic at the CEC used these ideas.
• Talk about the Food Pyramid as a Rainbow – organize the food groups into the colors
• Red – tomatoes, cherries, apples, strawberries
• Yellow – lemons, corn, etc.
• Blue(use plastic foods to categorize according to colors)

Nutrition Lessons

Toy Foods – from housekeeping center

- sort them into groups based on the food pyramid

Sometimes foods – ice cream

Every Day Foods – fruits, veggies, dairy

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https://www.nal.usda.gov/fnic/ethniccultural-food-pyramids

Food and Nutrition Resources

• “Milk Matters program” on-line at www.nichd.nih.gov/milk/ may be very helpful.
• Use to download activities and other “Milk Matters” materials or contact the NICHD Information Resource Center at 1-800-370-2943; e-mail NICHDInformationResourceCenter@mail.nih.gov.
• www.dole5aday.com/ Dole 5 a Day program online may help teach child about fruits and vegetables.

Ben, two years, practicing “oral motor” skills

Oral Motor Play

• Oral Motor Toy Kit for exploration and using as utensils
• These children may not have had the opportunity to explore toys with their mouths due to motor delays etc.
• Include: Nuk brushes, whistles, age-appropriate chewy toys, bubbles and bubble pipes, plastic blocks from Pre-K to keep them from mouthing all of them, give them their very own. Usually they just need to explore and soon don’t need them any longer.

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Oral Motor Toys/Tools

Resources

Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet

• Walbert, Laura, Cox, Sibyl, Fishbein Dr., Dr. Mark, Fraker, Cheri
• ISBN 10: 1600940161 / ISBN 13: 9781600940163
• Published by Da Capo Press, 2007

Resources

Food Diaries

Questions????