It’s that dreaded time again. You open the refrigerator door and scan the wholesome ingredients that seem to mock you with their bright, healthy colors in illuminating shades of greens and yellows.
“Easy meals” on Pinterest and books on “picky eaters” clearly do not know the true definition of your child’s eating habits.
Another monochromatic meal sectioned off in its three-part divided dullness.
I get it. I’ve been there. Chicken nuggets and French fries (I mean, I would at least applaud myself for feeding him the most natural of frozen foods, though I’ve never categorized chicken nuggets as a protein) would grace my son’s plate more times than I would like to admit.
In my son’s case, his kryptonite was meat.
Food sensitivities are a common challenge with kids on the spectrum. Research conducted by Sharon A Cermak, a Science and Occupational Therapist Professor at the University of Southern California, found that “management of food selectivity and concerns about dietary adequacy have been found to be major reason for referral of children for nutritional services.”
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As parents, the daily challenge to put together a meal for our selective eaters yields realistic worries. Additionally, in the same study, selective eaters are also “associated with inadequate nutrition as a result of their restricted diet.” Aiming for the idyllic five food groups collage—grains, vegetables, fruits, protein (meat, fish, and beans), and milk (which includes yogurt and cheese) seems anything but realistic.
Patience
“The whole progression is baby steps—it doesn’t happen overnight. It can take years. Just having patience and persistence is important,” says Jenny Friedman, a nutritionist who specializes in working with children on the autism spectrum.
As I continued to speak with Ms. Friedman via Skype, she shared additional insight into her dietician’s brain, providing useful and informative advice from her experience of having worked with numerous children to overcome various challenges with their diet.
For me, I have been working slowly with my son for years until last year when we overcame some significant hurdles in his diet. When your child makes any type of forward growth, don’t be afraid to relish in your child’s accomplishment as well as yours. It will be those small steppingstones that will one day reveal a larger victory.
Comfortability
“I’ve always felt the hands-on approach to food and engagement is the way for kids to get more comfortable with food. It [SOS Approach] moves along our natural inclination on how to eat when we are little.” Her approach is dictated by the client, mixed with a methodology called the SOS Approach to Feeding that supports the child leading the rate of progress and engagement.
So what exactly does that mean? Essentially, the child is the driving force of his/her nutritional plan. Since every child has varying health needs and food sensitivities, not every nutritional blueprint will look the same.
For example, let’s say one of the goals is to ease the discomfort of eating out at a restaurant.
“In therapy, we can work on introducing and getting them comfortable with food that is commonly found on restaurant menus. Introduce more [food] variability and again using the same desensitization method—getting the child used to the food in a safe environment so it can be easier to translate outside of the home. Preparation is helpful too.”
So how does one find his/her footing in this specific field?
Ms. Friedman’s response comes off with a casual, heartfelt genuineness—“I was working in schools and would see that eating was a real struggle…I saw that kids were struggling to eat and was simultaneously interested in the medicinal, therapeutic side, so I married the two.”
Having grown up in and exposed to the field with her mother as an occupational therapist, she had no doubt her career would eventually land her working with children.
Common questions like:
“How do I get my child to eat vegetables if he or she can’t even handle them on their plate?”, “We like to eat at restaurants; how can I make eating at a restaurant an enjoyable experience both for my child and the family without the stress?” and “My child refuses to eat anything other than chicken nuggets and French fries. How can I get him to try different foods?”
Sometimes the thought of overcoming these food hurdles can seem daunting, but Ms. Friedman calmly answers these frequently asked questions with these thought-provoking tips:
“How can we change it so they may like it a little bit better?”, “Is it pairing the food item with something else?”, and “Or can we substitute it with something they do like that provides similar nutrition?”
Adaptability
This segues into point number three—with the above questions in mind, think about how you can minimize the adaptation by using a menu item or food characteristic your child is already accustomed to eating.
If chicken nuggets are his/her only source of protein, try wrapping the chicken nugget in a whole wheat tortilla. Although the same color adds a source of whole wheat into his/her diet that can then be paired with other food.
My son was (and still is) sensitive to textures, but he mostly gravitated toward crunchy foods. So I would test out different foods with texture similarities by cooking them in different ways, especially foods that provided a source of protein. One day, I tried roasting garbanzo beans. I added a drizzle of olive oil, salt, and pepper until they were somewhat crunchy on the outside. It worked. He loved them. We celebrated.
As we know though, reaching a celebration point also means working diligently with patience to expand the palate while using parameters a child is still comfortable with.
In working within these parameters to help them adapt, Ms. Friedman illustrates how she incorporates this when working with one of her kiddos on the spectrum, “I try to think most about the texture which is often the primary [issue], within that same food group how can we find something a little bit more comfortable [for them to eat].”
“I try to think most about the texture which is often the primary [issue] within that same food group, how can we find something a little bit more comfortable [for them to eat].”
Seventy percent of children with autism compared to only 11 percent of neurotypical children choose their food solely based on the texture. According to Merriam-Webster dictionary, texture is defined as the tactile quality of a surface—in this case, texture is the way the food feels in their mouth.
What type of food is your child routinely attracted to? Sticky? Crunchy? Smooth? Lumpy? Hard? Chewy? The types of textures are endless. It is okay to stick with his/her comfort zone, but explore the area he/she is comfortable with to discover new foods that give him/her the nutrients he/she needs.
Toleration
Toleration of a particular food is part of the beginning process. This initial step alone, depending on the child, can take some time before forward progression takes place. First, have the child allow the food to be on the same table, then to touch the food, then later to allow the food to stay on his/her plate.
What is also important to keep in mind is that each child is different. Although Ms. Friedman uses the same methodology in her practice, it is the client that steers the direction and pace of his/her therapy. Ms. Friedman will frequently incorporate a dietician technique she calls “play scenario.”
“It’s not a matter of you forcing them to eat—let’s focus on the desensitization and familiarization process.”
In a “play scenario,” a food situation is created for the child, but it can be guided and prompted appropriately as needed because it is being played out in a safe environment compared to experimenting in an uncontrolled atmosphere such as a restaurant. Increasing his/her familiarity with a particular food over time will naturally evolve to his/her nutritional growth.
Supplements
Ms. Friedman emphasizes that whole foods are always better. We can already agree with that advice, but it is also easy to get in the habit of giving a child supplements thinking they are a permanent nutritional replacement.
“Now if a child is not eating any fruits or vegetables, I support having a multi-vitamin just in case. Fiber supplements can also be important. I think there is a time and place for incorporating them [supplements] but they are not a long-term solution.”
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While you are working with your child to diversify his/her diet, it is okay to use supplements. In the interim, continue working on the permanent goal of eventually replacing the supplement with real food.
If you need additional one-on-one guidance, reach out to your medical provider to schedule a consultation with a nutritionist. Even a certified nutritionist who may not work directly with children with ASD can still provide valuable support and dietician advice.
Last year, we had back-to-back food celebrations. One month my son went from eating one bite of a pork chop to eating up to two pork chops in one meal. His diet presently includes tri-tip and steak (of course, not in the same meal). I can now happily serve a three-part divided plate tastefully adorned with a brown protein, shades of green lettuce, and red-sliced apples that sweetly remind me that after years of patience, my son’s diet has made healthy strides.
Cermak, Sharon A. (2010, Feb). “Food Selectivity and sensory sensitivity in children with autism spectrum disorders.” US National Library of Medicine and National Institutes of Health, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601920/. Accessed 31 March 2020.
(2015, May) “Should you get your nutrients from food or supplements?” Harvard Health Publishing, Accessed 6 April 2020.
https://www.merriam-webster.com/dictionary/texture. Accessed 6 April 2020.
This article was featured in Issue 104 –Transition Strategies For Kids With Autism
