Transcript Making food fun!

Making food fun!
Helping children with aversive
feeding
OT/SLT Dept. BOCSS
Sensory processing
Session outline
1. What is aversive feeding
2. Possible causes of aversive feeding in ASD
3. Steps in helping my child
-Food Diary
- Environment
- Becoming comfortable with food outside
meals
4. Fun with Food programme
5. Checklist for helping my child
“I had a big problem with food. I liked to eat
things that were bland and uncomplicated.
My favourite foods were cereal- dry with
no milk- bread, pancakes, macaroni and
spaghetti and potatoes. Because these
were the foods I ate early in life, I found
them comforting and soothing. I didn’t
want to try anything new”.
Sean Barron p135 Asperger’s Syndrome: A Guide for Parents and Professionals.
1. What is food aversion
• “faddy eating” is a common in children. It can be stressful, but rarely
causes any serious nutritional, medical or growth problem’s and is a
phase that is grown out of.
• However, there are some children whose faddy eating continues
much longer that the common toddler faddy eating. This is common
in children on the Autism Spectrum. Up to 75% of children on the
Autism Spectrum present with self-limiting diets.
• Extreme limiting of the one’s diet can cause:
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growth problems
nutritional deficiencies
severe tooth decay
dehydration and severe constipation
Stressful mealtimes to be extremely stressful.
Fatigue
Reduced concentration
Reduced self-esteem and socialization if they are unable to eat with
their peers.
Characteristics of Aversive eaters:
• Aversive eaters often exhibit one or more of the
following:
– Limited food selection. Total of 10-15 foods or less
– Limited food groups. Refuses one or more food
groups
– Anxiety and /or tantrums when presented with new
foods. Gag or becomes ill when present with new
foods.
– Experience food fads. Requires one or more food to
be present at every meal prepared in the same
manner.
2. Causes of Aversive feeding in
ASD
Social
Communication
ASD
Social Interaction
Social
Imagination/
flexibility of
thought
Causes of Aversive feeding in ASD
• Children on the Autism Spectrum who have food
aversions are a mixed group! There are a number of
reasons that children may become resistant eaters:
• Medical issues- eating certain foods hurt, causes
discomfort
• Sensory issues- they are over sensitive to the feel,
taste, look, smell of food
• Oral-motor issues- don’t have the tongue control,
chewing or swallowing abilities.
• Routines and resistant to change- learnt that they only
eat certain brands, certain foods, certain colours etc
Food Diary
• It is important to understand your child’s food
patterns and this is best learnt by filling in a food
diary.
• Fill in the diary for 2 weekdays and 1 weekend
day.
• You will find out the best places, times and ways
to offer food to your child and which new foods
your child might be willing to try.
– E.g. some children really distracted by bright lights
– Some children prefer to be distracted by music
– Some children prefer certain colours, smells, textures
etc
Food diary
Meal
Time
Food
Description
Location
Distracters?
Who
Independence
level
Anything
else
Analysing the Food Diary:
Environment
What changes do you need to
make?
What can I do to help?
Top Down: Environmental and behaviour strategies
Bottom Up
Supporting sensory strategies
And Oral motor development
Environment
This is the tried and tested standard advice, which helps with common faddy
eating. Try these ideas first before moving on the later strategies in this section.
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Offer 3 meals a day- breakfast, lunch and dinner and 2-3 nutritious
snacks
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Try to eat meals and snacks at the same time each day.
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Offer small portions to that your child is not overwhelmed, they can
always ask for more.
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Drinks can fill up your child’s small stomach- avoid giving them for at
least thirty minutes before a meal or snack. Try giving a drink at the end
of the meal or at a snack time instead.
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Limit milk intake one your child is over 1 year to one pint or 600ml a day.
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Preserve in offering new foods- a child may need to try it more than 1020 times before they start to like the taste
Environment
• Sit together at the table and eat at the same time as your child
whenever possible, as they will learn from you.
• Try not to rush or drag meals. If you child has not eaten their food
after 30 minutes, take it away without comment.
• Offer your child food without coercion. Never try to force feed
• If you child refuses to eat food, put it in front of them at mealtimes,
take it away without comment, and do not offer any other food until
the next planned meal or snack.
• Do not use food as a reward. Better rewards are praise and star
charts for good meal time behaviour.
• Try involving you child in shopping, food preparation and laying the
table.
• Use visual supportsVisual supports can be very powerful for children
on the Autism Spectrum. Examples:
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Daily timetable showing where meals come in
the day- e.g. get up, dressed, breakfast, brush
teeth, get bag, car, school.
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Visuals:
Break cards, Stick kids, timers,
number of bites to eat etc.
Examples of visuals
• Encourage your child to sit at the table
If your child finds it hard to sit at the table, be
realistic and set your goals small- e.g. 5 minutes.
Use a TIMER and praise for good sitting.
• If you child can sit for other activities but not for
eating, try removing their plate from them calmly
if they try and leave the table and praise them
for returning to the table and sitting and eating
well- don’t chase your child around the room.
• You may have to incorporate sensory breaks
into the mealtime routine to help your child to sit.
Considerations around sitting to eat
Need for stability
Need for movement
Difficulty waiting
How to include sensory breaks
• Incorporate them into the schedule
after each activity
• Allow your child a break when
you see him/her gets anxious,
distracted, restless etc
• Decide if your child needs a break away
from the table, at the table or a combination
• You child may need a fidget toy or another
sensory activity throughout the session
Why sensory breaks?
• Prepare the child for the sensory experience
(‘wake up’ and focus the system)
• Calm and desensitise the
tactile (touch) system
• Reduce anxiety and sensory overload
before, during and after food exploration
Motivating your child
• Focus on motivating your child to change one thing at a
time.
• The best motivator is consistent rewards for even the
smallest step towards the change. - E.g. allowing the
new food on the plate.
• Rewards should NOT be food related. Use strategies
such as praise, star charts or treats such as stickers,
comics, watching favourite TV programme, longer on the
computer, staying up later etc.
• Be sure you are clear as to which specific behaviours get
a star or sticker, and offer a bigger reward.
Analysing your Food Diary
Look at food patterns- colours,
textures, food groups etc
Becoming comfortable with food
• It may take months for your child to feel comfortable with
a new food- so PERSEVERE and be patient!
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1. Introduce one new food at a time and set small goals.
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Staying at the table
Small piece of food on plate near their plate
Small piece of food on their plate
Touching food with finger
Touching food on arm
Smell food
Touching food on cheek
Touching food on lips
Lick food
Put it in mouth (and spit out if necessary)
Put it in mouth and Swallow
• When choosing a new food use your food diarytry a food from an already accepted food groupe.g. a different type of bread , or a food in a
similar colour, texture or taste to preferred food.
This is called food chaining.
• Give your child CHOICE but not absolute
control. Compare “which of these 3 foods will
you try this week” versus “will you try a new food
this week”.
Helpful hints
Children who are comfortable across all levels of food play make the transition
to oral eating more easily. It is worth investing considerable time and effort in
this area from the outset.
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1. Set up a predictable beginning and end- e.g. putting on aprons, getting
materials and end- clearing the table and washing hands etc.
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2. Many children find it difficult to progress from dry to wet food play- this
transition can be facilitated by
– Make a barrier between the children hand and the wet food- e.g. manipulating
tomato sauce and mayo to make pink sauce when they are in a bag.
– Allow child to wear surgical gloves and gradually reduce the barrier by cutting
some of the fingers from the glove.
– Use utensil for stirring e.g. spoon.
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Use the softly, softly approach. Reward your child for playing with food, even
if it is for a short period of time i.e. 10 seconds.
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Always have your break card at the ready so your child can request a break if
he/she needs it.
Fun with Food group
• Fun with Food is a group to support children
who have a selective or total aversion to oral
eating. It is a multidisciplinary approach that
acknowledges the possibility that aversion may
be due to multiple factors that are interlinked
and often difficulty to distinguish.
• Components and strategies used in the group
include- social stories, sensory food play,
visuals, behaviour charts and rewards, sensory
breaks and activities with calming sensory
elements.
The aims of the group are:
1. Building up the children’s confidence and pleasure
around eating and reducing the stress associated
with eating
2. Support and peer motivation:
• Providing an opportunity for carers to share ideas, issues
and concerns with other carers in a similar situation.
3. Application:
• Providing repeated opportunity for carers and children to
practise strategies under the guidance of the therapists
and in a structured environment.
4. Education:
• Develop broader understanding of feeding skills and
issues.
Some videos of Fun with Food
Group!
Making food fun!
Setting goals
1. From your analyses of your child's food diary,
look at the patterns you have discovered.
– Certain times, places, people?
– Certain food groups, colours, textures etc
2. Decide on the changes you are going to make to the
environment and then what food exploration
changes you will make.
3. Base your child’s progress on the participation levels
below
Levels of participation
0= refused to
participate
child refused to participate
child became distressed when presented with activity
child was not able to pay attention to the activity
child was not able to sit for activity
1= attends to activity child watched the facilitator and/or peers doing the activity but did not
attempt to participate
child showed interest in activity but did not attempt to participate
2= attempts activity
child tried the activity but stopped
child seemed cautious around participating but tried
child placed tips of fingers only into food
child tried the smell/taste etc but withdrew
3= partial
participation
child carried out half of the activity only before stopping or leaving.
child carried out the activity in a rushed (get it out of the way) manner
without fully engaging
child carried out activity but subtle difficulties observed e.g. making
faces, wriggling etc (see below for more examples)
child participated in activity with no obvious difficulty but could not
withhold attention throughout activity, got very distracted etc.
4= full participation
child had no issues or difficulties with the activity
child could maintain attention for most/all of the activity