Getting healthy nutrition in the bellies of babes is often the discussion, angst, and battle for many parents. Ask the parent with an autistic or special needs child about nutrition and their child and the response of groans of desperation and exasperation often prevail. Good nutrition and autism children rarely go hand in hand. Often parents give up and pick their battles elsewhere.
Autism affects each child uniquely. In some children with autism, sensory issues can make introducing new and nutritious foods extremely hard for parents and professionals. If that was complicated enough – dealing with children who like “sameness” and routines even when it comes to the food they eat each day provides another interesting challenge. Oral sensitivity issues can also make this difficult situation worse.
For my family, the eating healthy battle was no different. Cajoling, airplane noises, dancing with spoons, creative food presentations, threats of starvation, friends eating the healthy food, parents eating the healthy food, more cajoling and dancing would not budge my autistic son Jeff to eat a new healthy food. The “one bite rule” was more a joke for Jeff and not even remotely an accepted policy! He was the slyest kid I ever met with no desire to change and reluctant to fall for any of our efforts. Variety when it came to food was the last thing in the world he wanted to venture on. And for me, it was a constant point of frustration. Each step of the way towards Jeff eating a new foods meant another defeat for mom.
I knew there had to be another way. And for my child’s health sake, I had to find it. To find a solution first I had to look back.
Early on, our son Jeff used to eat anything you put on his high chair tray and then some. He was a healthy eater and not picky when it came to food. Food was food and all foods were his friend. Fast forward to after two years of age, Jeff selected down to only six foods – all very unhealthy including; French fries, peanut butter & jelly sandwiches, Tigers Milk bars, Burger King chicken nuggets only, and ½ gallon of milk every day. Nothing resembling good nutrition made it past his lips. He was a carbo loading, milk loving, sugar junky eating child. Even a stressed out parent with a crying, hungry kid knew this was wrong. So what happened?
Jeff was diagnosed with Autism about 6 months following his food de-selection timer period leading to some clues of why we were having so much difficulty. After much research, in home behavioral based programs, speech and occupational therapy began. Beginning biomedical intervention also started in hopes to improve Jeff’s health. Included in this intervention plan was the implementation of a Gluten Free/Casein free (GFCF) diet. Going dye free and offering organic food replacements became part of Jeff’s daily food repertoire.
After introducing the GFCF diet in January 2000 we were able to change his diet and hide some nutrition in mini-meat loafs (in all organic meat varieties,) cookies, and the ever versatile muffin. Out went the Burger King nuggets and various other unhealthy foods and enter the better, nutritious, organic foods. This took months to master and be successfully and mom finally prevailed! At last! A victory!
During this process, some nutrition including fruits and vegetables made their way into Jeff’s stomach but not in there “natural” recognizable form. It was always buried in another tried and true food for Jeff and resembled nothing like a piece of fruit or a side of vegetables. But rather everything I served him looked like a chicken nugget (without the deep frying.) He could eat like this forever, but I was getting bored with his choices! Where was the variety? How would he ever eat if I did not bring food where ever we went? I had to take another step forward.
To introduce the new foods, I went back to the dancing and cajoling again to no avail. The one bit rule again was met with a stone faced child. Enter a new problem – oral sensitivity. Jeff was so sensitive to foods, tastes, and textures that if you ate the foods sitting directly next to Jeff – he would gag. The smells, textures of the food and general vicinity of the food was just too much for him to handle. Time to try something new … again.
Working with Jeff’s behavioral therapy team (using Applied Behavioral Analysis) principles and occupational therapists together we developed a plan to get Jeff to eat new, natural foods in their natural form. This entire process took six months, but the efforts have paid off.
We started with a list of foods I wanted Jeff to eat. The list included items such as; peas, corn, watermelon, bananas, pears, applesauce, and fruit leathers.
To get Jeff to cooperate with the new foods we had to introduce them slowly into his environment. This was a pain staking process but netted good results.
We took the long road in getting Jeff used to foods by following these steps:
1. You eat the food next to the child and comment “this ___ is yummy”. (It was important to make sure you had his attention and observed you eating the new food.)
2. A friend of the child or a highly reinforcing person eats the food next to the child comments “this ___ is yummy”. (Again, it is important to gain attention on this step and all others.)
3. In home therapy time, school, and down time have the therapists/parents take a picture of the desired to eat food and talk about it. Do drills or sort foods in the similar category. We moved from pictures to actual whole bananas and other fruits into his therapy and play activities.
4. We then put a small amount of the food on a separate plate NEXT to your child’s plate. Point to it and discuss. Eat a few off the plate and comment “this ___ is yummy.”
5. The big step: Put the food on your childs plate. He/she does NOT eat the food. But has to tolerate the food being on the plate. Tell your child “you don’t have to eat the ____. It just needs to be on your plate during your meal.”
6. Next big step: put the same food on your childs plate and during the meal your child needs to TOUCH the food. Tell your child “you don’t have to eat the ____ it just needs to be touched with a finger during your meal.”
7. Getting really big step: put the same food on your childs plate and during the meal your child needs to PICK UP the food. Tell your child “you don’t have to eat the ____ it just needs to be PICK UP THE FOOD ONCE during your meal.”
8. Now we are moving: put the same food on your childs plate and during the meal your child needs to PICK UP AND PUT THE FOOD ON THE LIPS. Tell your child “you don’t have to eat the ____ it just needs to be PICK UP AND PUT THE FOOD ON THE LIPS during your meal.”
9. Guess what – the next step includes the dreded tongue! Put the same food on your childs plate and during the meal your child needs to PICK UP AND PUT THE FOOD ON THE TONGUE. Tell your child “you don’t have to eat the ____ it just needs to be PICK UP AND PUT THE FOOD ON THE TONGUE during your meal.”
10. Last step – the holy grail: PUTTING THE SMALLEST PIECE in the mouth and finally swallowing the food.
11. Note, it is highly possible little chewing happens the first go around. Work with your child to chew as the final step!
Note: introducing the first food choice – peas was the hardest. All other new foods were introduced in a much shorter period of time. Now food introductions can be done in an accelerated day or so. Some foods such as carrots have never succeeded but others are getting added on a weekly basis.
Some children are observed avoiding foods they are highly allergic to. If you feel this is an issue for your child, it is recommended to perform an allergy panel on your child. However, for many kids food avoidance is food avoidance due to behaviors and sensitivities.
For Jeff, working with some good professionals in the area of behavioral intervention, speech, occupational therapy rounded out the team work approach to getting Jeff to eat real food, control behaviors and make amazing gains. For all parents with special needs kids, this team approach will help make a difficult situation move in the right direction.
By the end of the six month period, we had Jeff eating from the new, healthy food list including; organic hamburger meats & sausage, and a new, healthier variation of chicken nuggets including lots of real fruits and vegetables in their natural form! Looking back, the process was long, but worth it. While I realize Jeff could have just come to the conclusion himself or the therapies could be paying off – it doesn’t matter – he is eating a healthier variety of foods.
Eating outside the home, while still preserving the GFCF healthy diet principles, is now possible and enjoyable. Jeff now has some favorite restaurants, we can go to family gatherings without a cooler (with a little education to our families about Jeff’s dietary restrictions,) and mom gets a break from cooking now and again. Here’s to solving your picky child syndrome!
-- By Lisa Ackerman