By Rebekah Devlin
Talk to any parent of a toddler and they will complain about picky eating. But for many with sensory issues, eating can be overwhelming, terrifying and can even make them physically sick. Speech pathologist and feeding therapist, Renee Cansdale, explains how to avoid mealtimes becoming a battleground.
What causes feeding difficulties and why do they seem to go hand in hand with autism and other neuro-developmental conditions?
Feeding is one of the most sensory outrageous things you can do! You take substances of many different shapes, sizes, colours, textures, temperatures and flavours. Then you put them in your body, and are expected to experience those sensory properties from within your body, and change them with chewing before swallowing them even further into your body. Children are particularly perceptive to their sensory world, so it stands to reason that eating is much more difficult for many.
What are some of the physiological reasons kids can struggle to eat?
Other than the sensory challenges with eating, children can have high and/or narrow palates, dental differences, tongue and lip ties, oro-motor co-ordination difficulties or oral apraxia (a disorder where a child exhibits difficulty easily coordinating and initiating movement of the jaw, lips, tongue and soft palate. This may impact feeding and/or speech skills), food intolerances or allergies or gastric motility issues. Often autistic children have a combination of these difficulties and may be diagnosed with Avoidant/restrictive food intake disorder (ARFID).
What are common misconceptions about feeding difficulties?
“If children are hungry enough they will eat” is definitely the most common. “Grazing causes feeding difficulties”, “it’s behavioural” – I particularly hate this one as it suggests not eating is about defiance.
Feeding is an area that stresses a lot of parents out. And for good reason, because many of our kids also have other health issues and are underweight or lacking in nutrition. So how can parents balance this worry and encourage their child to eat enough of the foods they need?
Unfortunately, we cannot make our children eat. Thus our job becomes giving our children the best opportunities to explore and become familiar with foods, and also help them regulate their sensory world whilst accessing as many essential nutrients as possible. This is where an experienced dietician can help tremendously. Once you are doing all that you can, it’s important to acknowledge that ‘you are doing all that you can’ and embrace an unconventional diet. You can also focus on having a food discovering culture and routines in your family and building up your child’s confidence, ability to be brave, and flexibility – both generally and with food. In 90 per cent of cases, if you force foods that your child is not comfortable with, they will go in theother direction.
Why do some kids prefer crunchy foods and others prefer soft textures?
Crunchy foods are often highly processed and therefore extremely consistent and predictable in their presentation and the experience of eating. This predictability is likely what makes them so appealing above soft foods, which are more likely to be a variety of temperatures, and have differences in taste, texture and smell.
Crunchy, highly processed foods are also often easier to process from an oro-motor perspective. It’s why chicken nuggets are so popular – they’re crunchy, beige, not too smelly, and readily available, as well as predictable.
Some children might prefer soft foods or purees. This is usually when the food is highly familiar or predictable. An additional appeal of these food could be that they can often be delivered to the mouth quickly via spoon or pouch, and don’t need much skill or time in the oral cavity to process.
Some kids seem to hate food touching or being mixed. What can I do to help this?
Some kids definitely don’t like food touching, perhaps because one food can taint the taste of another. Things like divided plates can be helpful and also bento boxes or zip lock bags in these instances. Tongues, forks, spoons, toothpicks and corn on the cob holders can also be helpful for reducing the sensory input of touching a food with fingers. For some children, pouches are also helpful because they cannot see the food and it is delivered straight to the back of their mouth. See what your child responds best to, and work from there. Spilling foods or drink can also sometimes de-rail a great food interaction, so try to keep things contained at first, then work towards relaxing these contingencies once your child is comfortable and settled.
It is important to remember that many neurotypical and neurodiverse children find mixed textures like casseroles and spaghetti bolognaise really challenging. As parents we see one easy, familiar food but children see a mixture of ‘who knows what’ tastes and textures and an expectation of eating them all TOGETHER! Involving your children in the preparation and exploration of these foods will help demystify mixed textures.
What can I do to help my child start learning about new foods?
Often as parents we can get obsessed with the final goal, which is the child swallowing a certain food. But it’s important to remember that actually swallowing the food is the very last of a series of steps involved. And each step they reach along the way is an achievement.
When trying a new food, it can be important to get familiar and comfortable with a food’s many sensory properties before tasting it. Some children will have difficulties with even the sight or concept of a food – just as many neurotypical people may have difficulties with the sight or concept of something like a slug or ear wax.
This can be a very long process but don’t lose heart or give in to the temptation to pressure or bribe! When children are having fun they will learn and explore, but it will be on their own terms according to their own comfort levels. We can’t expect children to put things into their bodies that they feel revolted by or scared of, however we can support them to manage the sensory properties of foods and be flexible to explore new things.
HELPING STEPS TO GET YOU STARTED
Choose the right food to encourage: Consider some foods that are similar to the ones that your child already tolerates eg if they like chicken nuggets, try chicken schnitzel and also choose a food to try that is as consistent and familiar as possible.
Start at a distance: Present the food away from your child, then move it closer once tolerated.
Discover the food together: What are its colours, texture, temperature etc?
Get closer: If your child feels confident, they may be able to move the food with a utensil, pick it up with their fingers or touch it to their body (on their arm or leg, for instance) or face. It’s important that all exploration is done in a fun and playful manner as we learn most, and will challenge ourselves most, when we are having fun.
Once it feels ok to have a food around the mouth, you might be able to touch or hold it with the lips, then a lick or three seconds on the tongue.
Rockets and Spit Cups: Once your child feels comfortable playing and exploring with food around their mouth, it’s time to include rocketing (spitting it out with some force while you yell rocket!) into the bin and using a spit cup. The spit cup is especially helpful as it will allow your child to taste, bite or crunch a food without pressure to swallow it. From there, multiple chews may be possible and eventually a swallow.
Renee Cansdale is director of Let’s Talk, Let’s Eat, which specialises in Feeding Therapy. She follows many of the strategies from the SOS approach to feeding.
More info can be found at sosapproachtofeeding.com/start-here-parents
PRACTICAL HELP and insights for parents –
With 50 years’ experience, Professor Tony Attwood is considered a world authority on autism. Together with Tony, Source Kids has produced a series of videos covering a variety of key topics including What to do during a meltdown, When to tell your child about their diagnosis, How to find your child allies at school, Strategies to help build your child’s emotional awareness and Identifying the signs of anxiety.
To watch, head to https://sourcekids.com.au/tony-attwood-in-conversation/