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Many parents will swear that their mealtimes feel more like a prizefight than a family dinner. Small children are often picky eaters, but children on the autism spectrum can take pickiness to extremes. These children are sometimes called “self-limiters.” Even when parents recognize the potential benefits that can result from dietary intervention, they may hesitate to remove some of the few
foods that their children will eat.
Self-limiting children often eat fewer than five different foods; the list generally includes foods like milk, yogurt, bread, chicken nuggets and fries. These foods contain gluten, casein or both. It is probable that such children are limiting themselves to foods to which they have a physical addiction (see OPIATE EXCESS).
All of these children can (and most will) expand their diets once all traces of gluten have been removed (see NUTRITION).
Common Reasons for Pickiness: Self-limiters are choosing foods that support a very real addiction. Going for a few hours without gluten or dairy may cause sensations of pain and discomfort. Those who have been put on a “GF/CF diet” that retains traces of gluten or dairy may continue to narrow their food choices until they are down to just one or two foods. A classic example is a child who started out with several foods, and is now eating just one, such as a specific brand of store-bought fries or potato chips. It is highly likely that these contain traces of gluten from the manufacturing process, and the child is sensitive enough to notice the difference. When switched to homemade fried potatoes, the food repertoire may quickly expand.
Eating is a very different experience when one of your senses is disrupted. Children on the autism spectrum often have severe disturbances in several of their sensory channels; this dysfunction renders them unable to process sensory information, and affects the way they experience food. If olfaction is overly acute, ordinary cooking smells may be seem disgusting. For others, an insensitive nose may mean that food simply is not appetizing. Foods of particular textures or temperatures may be intolerable.
If texture seems to be the limiting factor, introduce new foods that are similar in texture to foods that are already accepted. If a child only eats crunchy foods, look for crunchy gluten and casein free foods. If they refuse to chew, you can make puddings, purées and even “yogurt” from appropriate ingredients.
Some parents find that their children will not even try a new version of a favorite food. This may be due to the characteristic “need for sameness” common to children on the autism spectrum. For these children it will be important to try to approximate the appearance of their favorite foods as closely as possible.
Here are some ideas for increasing the number of foods in the diet:
the nugget envelopes or boxes (most store managers will give them to you if you ask – if they are reluctant, offer to buy them).
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If a child is a confirmed ‘milkaholic,’ a similar technique may be needed to introduce an acceptable substitute. There are several excellent milk substitutes on the market that provide the required vitamins and calcium, but if your child won’t drink them, he may not be getting the nutrition he needs. When first making the switch, try adding just a tiny bit of milk substitute to the milk carton. Each day, increase the proportion until there is no milk at all. For the truly stubborn, a little milk-free chocolate syrup may be the shortest route to a successful switch. The flavoring can then be slowly phased out to minimize sugar in the diet.
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One woman reported that her child only ate muffins, so for the first few weeks, she made chicken muffins, pork muffins and beef
muffins, including puréed vegetables in the batter.
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Let your child help you cook; following a recipe and taking pride his participation may induce her to taste the result.
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Introduce a new food when he is especially hungry.
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“Run out” of the foods that he is used to having, and explain that the new food is all there is.
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Introduce foods in a new environment, such as at Grandma’s house.
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Use peer pressure. Serve other children the food, and reluctantly tell him he can try a little if he really wants to.
For severe tactile issues, it may be necessary to work with an occupational therapist trained in sensory integration dysfunction. These professionals work slowly and gradually to increase the child’s tolerance of many textures, temperatures and smells. They can desensitize the child’s lips and mouth, which will allow them to eat a more normal diet. For more information, or to find an OT in your area, write to the American Occupational Therapy Association at P.O. Box 31220/ Bethesda, MD 20824-1220 or visit www.aota.org.
Feeding the Self-Limiting Child by Susan Wallitsch
Whether switching to GF/CF, SCD™ or any new dietary intervention, parents are often faced with children who simply refuse to eat. I think we are all biologically compelled to feed our children, which makes it extremely difficult to continue to offer foods that a child refuses to eat. It is also heart-rending at times, to steadfastly withhold food that we know our child wants. These factors are probably responsible for most failures to give dietary interventions a proper trial.
I speak from experience, because I too have a child who refused many new food items. Fortunately we worked with Toni Haman, a wonderful behavioral specialist. Toni convinced us that forcing a reluctant child to eat will make the avoidance problem worse.
She devised a method to introduce a new food very gradually, and it worked very well for my family. The process involves a very slow acclimation to the food in distinct stages. The steps are:
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The food is present in the room with the child for a short time.
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The child is shown the food (nothing else is asked of the child).
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The child is asked to touch the food (nothing else).
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The child is asked to pick up the food.
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The child is asked to hold the food near his mouth.
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The child is asked to hold the food near his mouth and touch it with his tongue.
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The child is asked to put the food in his mouth and then allowed to spit it out immediately.
The child should have the food in his mouth for 10 to 20 trials at this step. The child will either begin to tolerate eating the food or if the child continues to spit the food out, the food is probably really aversive to the child and a new food should be started.
Do the steps in order and only one at a time. Stay with each step until your child is comfortable with it and tolerates it well. Only then move to the next step. Each step may take several days. Each time you present the step and your child complies, provide lots of rewards (hugs, tickles, even a small amount of a permitted food, whatever your child loves) and praise.
Use gentle prompting, but never force a child with the food introduction program. Do the step you are working on 3 to 6 times over the course of a day, but never all in a row. Work on one food at a time. For example, if you are introducing steak, cook a portion and cut it into small, bite sized pieces. Freeze the cut up steak and thaw only the amount you need for the program that day. This way you are not cooking (and wasting) a lot of food. This program is much easier if your child is able to do non-verbal imitation.
Another tip for introducing a food like meat is to make it very flavorful and soft to chew. My son first ate stews and roasts prepared in the crock pot because they were so tender and moist. His favorite is roast beef. There are many recipes online and in various cookbooks. My son was a very limited eater. With lots of experimenting to find his favorite flavors and textures we were able to expand his diet remarkably. He now loves to hang out in the kitchen with me and we are going to start to teach him to cook as part of his home program. It may seem impossible now, but keep with it and you will be rewarded with a child who eats well.
Susan Wallitsch has extensive experience counseling other families about autism interventions.
Here is a similar, more detailed behavioral approach. Again, this is a process that should not be rushed, and may take several weeks to complete:
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Eat the food next to the child and comment “this is yummy.” (Be sure you have your child’s attention and he is watching you eat the new food.)
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A friend of the child or a highly reinforcing person eats the food next to the child and comments “this is yummy.”
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In home therapy time, school, and down time, have the therapists/parents take a picture of the desired food and talk about it. Do therapy or sort foods into similar categories. Move from pictures to actual whole bananas and other fruits during therapy and play activities.
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Put a small amount of the food on a separate plate next to your child’s plate. Point to it and discuss. Eat some off the plate and comment “this is yummy.”
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The first big step: put the food on your child’s 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.”
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Next big step: put the same food on your child’s 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.”
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Really big step: put the same food on your child’s 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 picked up once during your meal.”
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Now we are moving: put the same food on your child’s 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 picked up and put on the lips during your meal.”
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Next, put the same food on your child’s 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 picked up and put on the tongue during your meal.”
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Last step – putting the smallest piece in the mouth and finally swallowing the food.
Note: it is possible that there will initially be little chewing. Work with your child to chew as the final step.
All I can say is WOW! The difference has been amazing— she is eating. Although she did not care too much about dairy foods, when I first removed gluten Sarah basically went on a food strike. I did not worry too much, since she continued to nurse well, but she ate virtually nothing else for about ten days. Then, once she started eating, she began to accept more foods within just a few days. Now, the change in her diet is amazing. She is eating GF chicken nuggets, broccoli, GF/CF pizza and Canadian bacon. She will now accept three different kinds of juice. She even ate the Breakfast “Cookies” (from Special Diets for Special Kids II) and sucked down half a bottle of her toddler formula! I am thrilled.
-Heather Madden, reprinted from The ANDI News
There has been a great deal of emphasis on the strictness and firmness that parents must show their children during the difficult withdrawal and transition from their favorite foods. But it’s worth mentioning that from the child’s point of view, this will probably mean several days of real discomfort. Listening to whining and crying can be upsetting, but remind yourself that it’s probably a good sign, and that it will pass. Be patient, and make him as comfortable as possible. Do not give in and allow him a “treat.” This will only prolong the addiction and discomfort.
Note: If your child refuses to eat, make sure he is getting plenty of liquids. Consult a doctor or nutritionist if you need help or advice. An occupational therapist specializing in sensory and eating issues may be helpful.
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