Autism and Feeding- Selectivity or Feeding Refusal

January 29th, 2010

As a speech language pathologist working with a large population of children with feeding and swallowing difficulties I see my share of children labeled as “refusing to eat.” This label “refusing to eat” is a tip off that something is not working for this child. For some children this is an undiagnosed medical issue such as GERD or gastroesophageal reflux disease (acid reflux), severe allergies such as eosinophilic esophagitis ( a form of food allergy that could cause severe heartburn symptoms, nausea, vomiting, weight loss and food impaction), severe constipation, or other unknown causes. These children have learned to associate pain with eating. It makes sense that they would begin to reject or refuse food if every time they ate they were in pain. Obviously, identifying the underlying medical issues to determine and offer appropriate treatment is crucial in helping the child to learn to eat.

The second category of children that “refuse to eat” are more restrictive eaters. They will eat only certain foods and are unable to branch out and try new foods. Medical underpinnings are benign but rather this child is making visual decisions about what they will eat and what they won’t. This rigidity is often seen in children on the Autism Spectrum who demonstrate rigidity in all areas of development. Language, play, social interaction and feeding are all likely to be rigid. We find that children on the spectrum have difficulty learning to engage with a new toy, new interest, new ways of learning and using words and new foods. Language and learning is much less threatening. It is easier to “expand” a play scenario helping the child to learn new ways to play with toys and how to use language then it is to expand the food repertoire. Food has added sensory properties that are inherently personal to us all. We all, to some extent, make judgments based on the look and smell of a food, as to whether we want to eat it. Some of us are adventuresome and will try anything. Others of us are more sensory sensitive and have a list of foods that we would never try based on the look, texture and smell. Children, especially on the Autism Spectrum, are pre-wired for more selectivity and more scrutiny when approaching food. The world of food is so diverse. Think about how many cereals and crackers there are alone!!!! If you are use to the orange cracker that looks like a fish then one that looks like a square with a dot in the middle has got to be something inedible!!! The point being, children on the Spectrum are very concrete. They tend to learn something in one setting or situation and have difficulty generalizing to another. And, if you are very particular about the visual details you will quickly note that one cracker looks absolutely unlike another. When working with children on the spectrum I often scrutinize what food they do eat and try to match something similar when offering a new food. There are many feeding specialists that talk about “food chaining” or “food stretching”. Food chaining means that you take a food a child likes and match another by a similar shape, color or feature. So, I could take another orange fish cracker of pizza flavor, or triple cheese, crush up the crackers in sight and see if the child could tolerate the tastes. My idea is they look the same. Would the child be willing to try some tastes if the foods looked similar? I could introduce all different flavors of fish crackers allowing for a change in color over time as well.  Food stretching is a similar idea. The point being, start with a food a child likes and help them accept gradual changes so that they can begin to accept new types of those preferred foods. If children are stuck or rigid about food they will eat it is hard to introduce foods they won’t eat and expect them to try it. They are more willing to try foods that are within their comfort zone.

So, my take away message is, if your child demonstrates little tolerance for trying new foods remember, as early on as possible, to continue to change the brand of food you buy. If the child is struggling with that now, try to change the food they do eat by changing the shape. If it is round cut off the edges and make it square or long. All foods they eat should be changed any way you can without initially changing the flavor. Small steps allowing the child to deal with changes in the way their preferred foods look is the best way to start. Take everything out of containers and boxes so that the child doesn’t become attached to those either. Match skinny pretzel sticks of the favorite brand with skinny pretzel sticks of a different brand. Children on the spectrum are unbelievable detectives. They can detect subtle differences that most others cannot. (This could come in handy later as a career choice but for now we’ll defer to less selectivity). So, for now, work on flexibility within the foods that your child can except. That would be a huge step forward. Let me know how it goes. And any creative ideas, please let us know!!! Creativity is so much a part of this process!!

Feeding Treatment Strategies for Infants and Children

December 28th, 2009

Determining the issues surrounding feeding difficulties helps to drive treatment goals. As a speech pathologist, with over 25 years of experience working with infants, toddlers and children, I’ve learned that understanding how the feeding issue has developed is key to understanding how to help. Feeding issues develop for many reasons. Sometimes definable such as prematurity, syndromes, cardiac issues, digestive and allergy related. Sometimes the issues are related to poor oral motor skills and weak oral musculature. For some infants and children, early difficulty with sensory or motor planning may be causing the issues.  As a speech pathologist my job may be to help sort out these issues. Sometimes we are lucky and can find the cause. At other times we must work knowing that we have not come up with the underlying cause.  However, despite not knowing the underlying cause, we can work on those areas of difficulty that seem to most impact the child and their willingness and/or ability to eat.

There are several dominant approaches to addressing feeding issues with infants and youngsters. I’ve found that approaches that honor the child, develop competent oral motor skills and develop confidence generally work best. This is similar to most skills we hope to teach children. Approaches that help allow the child to explore, practice oral motor skills such as biting, chewing, moving food in and out of the mouth, transferring food to the back molars and ultimately swallowing work well. Focusing on the eating itself is often too overwhelming for the child and family. Focusing on understanding how we use our mouth to eat often increases confidence in the child and family. Building confidence and success for the infant and child ultimately allows for progression in eating skills and the desire to try new foods. For some children with significant sensory issues, the progression can be slower. That child needs repeated exposure to new foods. Looking, smelling, touching and hopefully tasting over time. Patience and persistence seems to be the most important ingredient to helping children with feeding difficulties

Welcome to

December 2nd, 2009

Welcome to!