There are so many different reasons a child may have difficulty with feeding including delayed oral motor development, difficulties with visual motor skills, grasping skills, etc. which all can affect skills involving using utensils, chewing, and swallowing. Some children have trouble eating due to sensory issues.
Think of a time you went to the dentist and had Novocain. You probably didn’t feel like talking much…and drinking water from a cup or eating food probably was very uncomfortable because you couldn’t feel anything. Although this is not exactly what it feels like for some kids, it’s comparable. For example, a chid may not know how much of a bagel to bite off or they may overstuff and shovel food into their mouths. This may be because they don’t have a good sense of how much food they have in their mouth or where it is in their mouth. If a child is having trouble eating, cut their food up into small pieces and monitor how much they eat at a time. This can prevent overstuffing and a choking incident.
Furthermore, some children have trouble with trying new foods because of taste or texture. They may crave extremely strong tasting foods such as sugary sweets or salty/ sour/ spicy foods. On the contrary, strong flavors may be very offensive to another and he/ she may only stick to bland foods such as breads or pasta. Food with certain textures can also be intolerable for children with oral sensory sensitivities.
Another common issue related to eating and children on the autism spectrum is the need for “sameness.” This can cause extreme anxiety when the child is presented with new foods. Please know that unusual eating patterns and behaviors as well as food aversions are a common symptom of autism. As a parent, you should never feel guilty or place blame on yourself. You are doing the best you can and doing a great job! If you can introduce a healthy, nutritious option to your child’s meals, this is a great start. Please note that if you have serious concerns about your child’s eating habits, always consult with your pediatrician to rule out medical problems or consult with a dietician/ feeding therapist. However, for some practical everyday tips and ideas, read below!
- Try cutting food into similar shapes and sizes. Slice your child’s food into smaller pieces. You may even want to try Fun Bites, which is a food cutter that cuts food (grilled cheese sandwiches, peanut butter & jelly sandwiches, fruits, veggies, quesadillas, pancakes, etc.) into bite-size pieces. It also makes food on the plate more neat and organized (which can be visually appealing for children on the autism spectrum.)
- Introduce a visual schedule. Many children with autism tend to do best with clear routines. Use a written list and/or pictures to indicate the day’s mealtimes. Post this in the kitchen with a gentle reminder that mealtime is approaching
- Does your child crave sugar? If your child prefers a certain sugary cereal, try crushing a little bit to make a crumb powder and sprinkling on top of a healthier alternative such as an unsweetened oatmeal. This will provide the flavor of the food your child likes, while introducing a healthier option. Also, a great replacement for cake and cookies is to bake a low-sugar version of banana, zucchini, or carrot bread. You can make these into muffins as well.
- Experiment with textures and different flavors. A food aversion may be due to hypersensitivity to texture and the way the food feels inside the mouth (rather than the flavor). For each food your child refuses, try serving it a different way. Sometimes the way a food is cut or cooked can make a huge difference. For example, a child may not be able to tolerate the texture of a banana when it’s sliced, but be able to eat it whole (the outside texture of a banana is completely different than the more “slimy” inner part). You can also experiment with cooking veggies different ways. Roasting vs. sautéing vs. steaming vs. grilling on the bbq can make the texture and taste of food completely different. A child may dislike steamed broccoli, but love it grilled or roasted. Another example is sweet potatoes. If you child will not eat them, try slicing thin, drizzling with oil and baking in the oven to make sweet potato fries. Serve with ketchup or their favorite dipping sauce (ranch, sweet and sour, etc). If your child gravitates to more strong flavored foods, maybe sprinkling Old Bay or Cajun seasoning over food may be a fun option. Get creative!
- Change the environment. Try switching up your mealtime routine. Sometimes changing the experience of eating can help a child eat the food on their plate. Try having a “picnic” outside and eating on a blanket on the grass. Or, if you have a patio or deck, eat outside instead of at your usual kitchen table. Changing the environment may help make a difference!
- Lemon zing! For children who refuse to drink anything other than sodas or juices, try introducing water with a squeeze of lemon/ lime. The strong, sour taste of the lemon may be enough to satisfy your child’s craving without the added unnatural sugar. Or, you can make lemon juice ice cubes to put in water. If your child is very oral seeking, pouring some juice into plain cold carbonated water may be a great way to provide the sensory input they’re craving.
- Switch up the utensils. A mother once discovered that her children were more willing to try different foods if it was introduced to them on a toothpick! This realization eventually lead her create PickEase, which is a safe kid-friendly version of a tooth-pick. Trying this may help your child try different foods. Keep in mind that not all foods work with PickEase, however, if you think this is something that would appeal to your child, it’s worth giving it a try!
- Try some movement before meals. Movement can be used to “wake up” a child’s body and senses. You may find that it helps to engage in a some physical exercise before sitting down to a meal. Physical exercise can also help to decrease anxiety related to mealtime. Run outside, go to the playground, jump on the trampoline, etc.
- Offer your child the same food that you’re eating, even if you think they’ll refuse it. As Temple Grandin once said, “You have to stretch these children just outside the comfort zone. You stretch just enough so they develop, but don’t go into meltdowns and problems.” Therefore, don’t stop introducing certain foods and always keep trying. The proximity of the food on their plate and the look/ smell of it may help your child eventually progress to eating more food in the near future.
- Color the food. Did you know that there are brands of food dye that are 100% natural and plant based? (e.g., red dye that’s made solely from beets). Because some children on the autism spectrum have color preferences and will only eat foods of a certain color, adding their favorite color to a food they normally would never touch may be helpful. You can color white sauces, deviled eggs, waffles, pancakes, mashed potatoes, yogurt, omelettes/ scrambled eggs using this natural food dye! Coloring food may sound extreme, but if the goal is to add variety to the diet of a child who will only eat foods that are “red,” this may be a way to introduce new foods.
- Offer Choices. Try offering a variety of foods and allow choices within the nutrition categories. Sometimes anxiety related to mealtime can be alleviated by giving your child more control over what’s put on their plate. Offering choices, giving more control to your child and adding a variety of options during mealtime can really make a difference.
- Be sneaky. If your child is extremely picky, you can always try “sneaking” veggies into other foods. For example, you’d be surprised how much baby spinach you can put into a yummy fruit smoothie without it being able to be detected or tasted! You can also try to put veggies into omelettes by chopping them up very finely and adding to eggs.
Other things to consider…
Is mealtime difficulty related to frustration using utensils?
-Remember, the purpose of a fork is to stab food. If the food isn’t thick or hard enough to pierce, a younger child shouldn’t be using a fork (or at least until they are old enough and have the appropriate fine motor coordination). Instead, give your child a spoon for foods such as rice, elbow macaroni, ground beef, etc.
-It’s easier to learn how to use a spoon when eating thicker foods. For example, applesauce, thick chowder, yogurt, and pudding are easy to learn from because they stick on the spoon. Liquid soup or milk/ cereal are more difficult foods to learn how to use a spoon with.
-Give hand over hand assistance. If your child is having a hard time stabbing a piece of chicken with a fork, put your hand over theirs and physically guide and demonstrate for them. This can help him/her motor plan the motions needed to use utensils the right way. The visual feedback and demonstration is also very helpful.
-Proper seating. Stable positioning helps with feeding. Some children use abnormal patterns of movement while feeding themselves. Making sure their feet are planted firmly on the ground (knees at 90 degree angles) can really make a big difference!
Proper seating posture:
- Head is upright and slightly forward.
- Body is upright.
- Arms are forward (and should be able to rest comfortably on the table)
- Hips and knees are bent to a sitting position (90 degree angles)
- Feet are resting flat on the floor
Thank you for visiting the Sensory TheraPLAY Box blog! I hope you were able to take away some information from this post and use it to make a positive change at home. If you have a certain technique or tip that has worked for your child in the past, please share in the comments below for other parents to see.
Author: Christina Kozlowski, Occupational Therapist & Owner of Sensory TheraPLAY Box