I once worked with a non-verbal, 5-year-old girl who had autism and severe feeding issues. When her father brought her to me, she was only eating McDonald’s french fries. The parents were so desperate to feed her; they were making trips to get fries up to 9 times a day! They had to make several trips because she only liked certain fries with the right texture and temperature. It was a heartbreaking situation. Her mother was a fantastic cook and so badly wanted her child to eat with the family. It was a long road; it took the hard work of a dedicated team of physicians, Speech-Language Pathologists (SLP)s, Occupational Therapists (OT)s, Board Certified Behavior Analysts (BCBA)s, behavior therapists all under one roof to pull it off, but eventually she ate moms cooking!
If you work with children autism, or any children for that matter, you have likely worked with families struggling with feeding disorders or picky-eating. This is a tricky endeavor because there is so much variability from case to case; it could be an easy fix or something very medically complicated. In my experience, therapists (SLPs, BCBAs, and OTs) feel they need more training in this area. There are “feeding specialists,” but they are not common. The ones that exist are not always the best fit for a child with autism or a child with severe maladaptive behaviors. Therefore, families and professionals are faced with either handling feeding issues on their own without proper training, or not addressing it at all.
If you are a BCBA developing mealtime goals for a child, it is essential to consider that he or she is not eating normally for a physical reason. Often there are things going on in the mouth that make eating difficult or uncomfortable, such as weak and uncoordinated muscles in the lips, tongue, and jaw. A child may be sensitive to certain textures, temperatures, or smells. Address these things in collaboration with an SLP or OT trained with oral-motor and sensory feeding techniques. I find the resources through TalkTools to be particularly helpful for addressing these things. They offer hands-on workshops and books on their website http://www.talktools.com.
In addition to oral-motor and sensory difficulties, there could be serious medical issues you are not aware of; this is why a child must be evaluated by their pediatrician and recommended specialists such as a gastroenterologist and dietitian before feeding therapy. If possible, have him or her tested for food allergies as well.
Now to the fun part. There are simple, creative ways to achieve feeding goals with your clients. Some examples are:
Change the Texture
When you are working on fruits and vegetables, this is particularly effective. You would be surprised how much better carrots are received when they are steamed vs. raw! If you have an engaged parent with time, ask them to bring soft vegetables to your sessions. If this is not an option, go to Trader Joes. They have every vegetable and fruit you can imagine in “crunchy” form. Children often prefer a crunchy green bean to a cooked or raw one. The crunchy broccoli is one of my personal favorites to use. It crunches like a potato chip and comes in a bag ready to use. Once you have a child eating and loving crunchy broccoli, try mashing it up and sprinkling it on top of a piece of steamed broccoli and voila! Just that little bit of texture change to vegetables can make a big difference.
Change the Temperature
Sometimes children are really sensitive to the temperatures of food. Restaurants, in particular, tend to serve food that is way too hot for any child. A child with autism may not understand that the food will cool down eventually and then they can eat it. Just knowing it was too hot initially could turn them off altogether. This is something to keep in mind with food in your sessions, as well. If you heat something up in the microwave, be mindful of the temperature when you place it in front of the child. For some children, frozen fruit can be a real hit! You can get creative with this with smoothies or popsicles. If you are short on time, freeze some berries and serve them plain. Some kids respond well to this.
Change the Taste
Two simple ways to change the taste of foods are to include dipping sauces or spices. Kids LOVE to dip. You can use ketchup, sour cream, salsa, bar-b-que sauce, Nutella, whipped cream, mustard, powdered sugar, melted soft cheese, cream cheese, honey, butter, ranch dressing; you name it. Some children like spices like salt, pepper, garlic powder, or dried herb blends. There are great options for herb blends in the Trader Joes spice section.
Change the Shape
This is such a simple thing to do, and it can be effective. If a child won’t eat apple slices, cut them into apple “fries.” You can use cookie cutters to make different shapes in bread or sandwiches. Or just cut those into fry-shapes too.
I saw this Dinner Winner plate at the Children’s Museum in Phoenix a couple of years ago, and I felt like I struck gold! It was regularly priced $25 and on clearance for $8 each! It was such a good find. I bought the ten plates they had left on the shelf! It has a little cover for their reinforcer at the end, so they have the element of surprise. I like that it allows for flexibility to accommodate individualized goals, yet it still offers the consistent structure that kids and therapists love! You can alternate preferred and less preferred foods. You can adjust portions over time to increase the intake of healthier foods and decrease the consumption of unhealthy foods. Sometimes I engage the child in choosing their prize and covering it up (they love that). There are so many ways to get creative and have fun with this plate! It is of high quality too. I searched Amazon, and the prices for this are all over the board. If you end up paying full price, you won’t regret it.