During my 20+ years of treating children diagnosed on the autism spectrum, I have always been asked: “How do I get my child to eat healthier foods?”
The first step I take in addressing feeding concerns is to complete a full history assessment. To properly assist with the issue, we must learn what is/are the possible cause(s).
First, I want to state I am not a nutritionist or a doctor. I am an occupational therapist and it is not under my practice guidelines to diagnose a child. I can, however, provide an insight as to why your child might be avoiding certain foods. Second, there are an abundance of reasons why a child is a picky eater.
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Overcome Picky Eating
If your child is not eating enough, it will affect their mood, digestion, sleep, and attention. Seeing a physician, feeding therapist, speech therapist, and/or an occupational therapist will help provide you with a better understanding, as well as set you up with some tools to get your child to eat healthier.
What is autism feeding therapy?
Feeding therapy is when a trained occupational or speech therapist helps provide children with autism or feeding disorders with the necessary skills that they require during mealtime. Each child is different and therefore various approaches are taken. Feeding therapy sessions target areas that affect your child during eating. For example, building up muscles in their mouth to improve clearing a spoon. The feeding specialist will work on chewing, swallowing, and prevention of choking.
Four reasons why your autistic child avoids eating
Here are some guidelines to assist you in homing in on your child’s reasoning for avoiding foods.
1. Low muscle tone
Children with decreased muscle are impacted in everyday life. First, to maintain an appropriate posture while seated, you require your core muscles to work, as well as stability from your shoulders and neck. If a child is unable to sit upright, they will not be able to use their hands accurately. This is known as proximal stability for distal movement. In other words, if a child is unable to sit upright, they will not be able to feed themselves with proper utensils. Low muscle tone will also affect their eye movements and ability to switch between near and far sight.
Therefore, they will have eye-hand coordination issues as well. The hand has many muscles. If a child has low muscle tone, they will have an adapted weak grasp causing the utensil to drop or will inaccurately utilize the utensil. Low muscle tone also impacts the feedback from the muscle to the brain. This process is crucial for accuracy of motor movement, proprioception/pressure gradation, and coordination. This directly affects eating. One requires precision, fine motor skills, oral motor skills, and feedback to assess and process the information for self-feeding.
2. Sensory processing disorders
Sensory processing is the way in which the brain registers, interprets, and responds to information from the body and the environment. This information is registered through the eyes, ears, skin, muscles, joints, and movement receptors (visual, auditory, tactile, olfactory, gustatory, proprioceptive, and vestibular sensory systems). Disorders in sensory processing adversely affect a child’s ability to automatically process, organize, and respond to information.
This is how your body utilizes its senses to interpret information. If your body misinterprets information, you will have difficulty eating properly. For example, a child who is “Hyporesponsive” does not receive information about temperature and texture. They will not feel the food in their mouth causing it to fall out. On the other hand, a child with “Hyperresponsiveness” towards food will gag or even vomit because their brain is processing too much information.
Sensory processing is considered a spectrum disorder in that children range from hyper to hypo. A child can be under-responsive or over-responsive. A child with food aversion may want only one color or lots of colors, bland non-spicy foods, or only very spicy foods, hot foods, or cold foods. If their visual system is overwhelmed, they might have poor tracking/eye-hand coordination (they will not know when they are messy) or poor target accuracy (scooping with a spoon and hand to mouth).
On the contrary, a child with hyperresponsiveness can appear distracted secondary to a busy environment. If a child’s auditory processing is not working correctly, they will misinterpret sounds (cannot follow instructions secondary to distractions). Or, they will have the inability to tolerate noises (including others chewing, others smacking their lips or loud noises such as a blender) and they will become so distracted or irritable they cannot eat. If a child is not processing olfactory input, the sense of certain smells can elicit a gag reflex and negative reaction to food. A child who displays difficulty with proprioception will have difficulty organizing movements for chewing or biting.
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Children will also have an inability to coordinate movements of their hands to mouth or piercing the food (poor pressure gradation). A child with poor vestibular processing will appear distractible. They will have a decreased ability to maintain a seated position secondary to poor stability and poor attention skills. They have an inability to calm the body to sit for the meal. Children with sensory concerns should see an occupational therapist who specializes in sensory processing dysfunction. They will help your child adapt and interpret various senses and become more independent.
3. Medical impact
As mentioned earlier, muscle tone directly impacts one’s ability to partake in a feeding task. If a child has low muscle tone, it is possible they have decreased coordination with swallowing appropriately. This will cause them to choke. Sometimes, a negative correlation is formed between not wanting to eat out of fear of choking. In these cases, a swallow study will assess how a child swallows (through a series of x rays, you will learn what your child’s throat and esophagus does when swallowing).
A speech-language pathologist will assess the results and let you know if this is an area of concern. Children should also visit a dentist or who works with children on the spectrum. There could be a dental problem causing them pain and impacting their ability to tolerate food. An allergist and gastroenterologist are recommended as well. They can rule out any allergies affecting mood and behaviors as well as any GI issues such as inflammatory bowel disease, pain in the abdominal area as well as frequent constipation.
4. Oral motor skills
These skills include muscle strength regarding the mouth, the ability to open and close mouth and lips, coordination of the mouth (chewing). When a child has low muscle tone, their ability to chew and swallow is affected.
Different forms of feeding therapy
Now that we have possibly found some of the causes of feeding disorders, here are some ideas that will help your child improve their eating.
For your child to improve their tolerance towards tactile input, they need to desensitize. The best way to help them is by introducing various textures. Through fun exploratory play, your child will improve their willingness to partake in textured activities. For example, purchasing dry rice and placing it in a shoebox (or Tupperware about the size of a shoebox). Encourage your child to play with the rice, scooping it into a cup or bowl, looking for hidden objects, or burying their hands. I have worked with children from birth to late teens and they all love the rice bin!
Movement prior to eating
Many children, especially those with low muscle tone, have poor attention. It is hard for them to sit, hold up their body, utilize their hands and eyes all at the same time. These children have the inability to sustain the endurance for eating. Using movement to help organize your child’s body and senses will improve their alertness and body awareness allowing them to be successful. You can have your child complete jumping/frog jumps, marching, push-ups, wheelbarrow walking, or crab walking. Be silly and make it fun so your child will not even realize they are getting a workout.
Play with your food
When a child has a food sensitivity or sensory processing dysfunction, they become aversive to food and mealtime. Make food a fun activity rather than a forced situation. Depending on your child’s age, you can have them start with play-doh, creating pretend meatballs and spaghetti. Have them play with plastic foods, or Velcro wooden ones they can “slice”. Have them talk about colors, smells, textures to improve their language. This is also a great way to introduce picky eaters to new foods!
Use a visual schedule
Children with autism do better when they follow a routine. Provide your child with a visible routine to help prepare them for their day. You can use pictures of the food to represent. You can offer them choices as well (which one do you want for a snack – a sliced apple or hummus and chips).
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Have your child help serve everyone
By having your child serve everyone, they are seeing that each person is eating the same food. The visual and olfactory senses are also getting acclimated to the sight and smell of the food.
Your child’s plate should have the same food as everyone else. By doing this you are visually desensitizing them to the sight of the food as well as the scent. This will make your child more likely to try the food in the future.
Have a better understanding of why your child is not eating a variety of foods. Speak to a doctor and/or nutritionist to make sure your child is getting the proper diet and supplements to help them. Get a referral for a speech pathologist or an occupational therapist to help your child improve their feeding. Try your best to make mealtime a non-stressful time. This decreases anxiety in both caregiver and child.