What Parents Need to Know About Feeding Therapy

Should I Have my Child Evaluated for a Feeding Disorder?

Does your child…

  • Experience extreme anxiety or exhibit behaviors during mealtime?
  • Find mealtime to be an exhausting process that requires too much time and energy to complete?
  • Have difficulty tolerating a variety of food groups?
  • Require you to prepare a separate meal from the family dinner or snack time at school?

If so, a feeding evaluation by a qualified speech-language pathologist or occupational therapist may be warranted.

What Does an Evaluation Look Like?

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The parent interview often provides the most valuable information and it is important to fill out all case-history information completely. The therapist may inquire specifically about your child’s medical history of any respiratory, gastrointestinal, renal, and craniofacial issues. Report any food allergies or restrictions (soy, gluten, dairy, egg, nuts) to ensure your child’s safety. If time allows, a 3-4 day feeding diary that includes a detailed report of all the food/drink ingested would allow the clinician to analyze any patterns of behavior and preferences related to feeding. The therapist should know the child’s regular feeding times, a list of all foods and drinks preferred/tolerated, any foods the child used to enjoy but no longer accepts, the length of a typical mealtime, and any positive or negative behavioral or physiological reactions to foods.

The clinician will examine the oral cavity (jaw, tongue, hard/soft palate, dentition, etc.) for appropriate symmetry, strength, and range of motion for feeding. Based on your child’s level of comfort, food and/or drink brought by the parent may be presented. The clinician will observe the child’s postural stability, acceptance of food/drink, munching or rotary chewing patterns, chewing side preferences, and the timeliness/success of the swallow response, and overall rate of feeding. The clinician will take note of signs/symptoms of airway penetration such as coughing, wet vocal quality, watery eyes, or excessive throat clearing. All of this information will assist the therapist in making appropriate referrals and/or developing a feeding treatment plan tailored to fit your child’s needs.

What’s the Difference Between a Picky Eater and a Problem Eater?

A picky eater is a child who accepts 30 or more foods, requires repeated exposures prior to eating the food consistently throughout varying food environments, and has specific routines with food presentation (e.g., needs crust cut off, no foods can be touching, will only eat one specific brand of chicken nuggets). Children who are picky eaters are still able to maintain adequate nutrition and hydration without nutrient-based supplements. Parents complain that new food experiences such as going to restaurants and birthday parties are often difficult due to their child’s feeding preferences.

A problem eater is a child who accepts roughly 5-10 foods and has no more than 20 foods in their food repertoire. The child presents with extreme phobic reactions to new foods such as crying, screaming, throwing foods, and most often times, absolute refusal if their foods are not preferred. Physiological symptoms become evident with facial grimacing, gagging, or vomiting when presented with or during mastication of foods. Parents often feel obligated to allow their child any food so they will eat something. A problem eater likely has underlying medical or functional impairment such as autism spectrum disorder, gastroesophageal reflux disease (GERD), reduced strength and coordination of the oral musculature, and/or sensory processing disorder. Extreme self-restriction can occur if problem eating is left untreated and most often leads to pediatric undernutrition (PUN). Most parents express that the “wait it out” approach does not work with a problem eater and they will continue to self-restrict for days until preferred foods are presented. Children who are problem eaters often require nutrient-based supplements to maintain their health.

A speech-language pathologist can treat both a picky and problem eater to expand the food repertoire and increase tolerance of various tastes, foods, and textures.

What Does Feeding Therapy Look Like?

There are many different approaches to feeding therapy. Your speech or occupational therapist will choose a technique and plan of care that suits your child’s needs most appropriately. Since feeding is a daily activity that requires parent assistance and preparation, you will likely be included in the sessions for education and training purposes.

A feeding therapy session will focus on creating a positive mealtime experience for the child. Intervention targets will likely include increasing awareness, stability, or strengthening the oral cavity, improving the motor plan sequence for feeding, and/or imposing behavioral modifications during feeding, and educating the parent. Behavioral modifications may include a daily mealtime schedule, with no “grazing” in the kitchen allowed, restricting the amount of preferred foods presented to the child, or implementing positive reinforcement for when a child is trialing a new food (access to a favorite toy for 1 minute.) Parents also benefit from behavioral modifications, such as allowing the child to choose foods from two choices, reestablishing trust after hiding something nutritious in the food, and maintaining the promise of “just 5 more bites.”

A technique called “food chaining” uses the child’s core diet (what they will reliably eat across all settings) to “chain” or transition to another similar flavor and texture of foods.

Here is an example of the steps taken while food chaining:

  1. Core diet – what the child will eat reliably across all settings.
  2. Flavor mapping – analysis of your child’s flavor preferences
  3. Flavor masking – use of a condiment or sauce to mask a new taste
  4. Transitional foods – favorites used to transition a child to a new food.  These foods cleanse the palate in-between bites of new foods
  5. Surprise foods – new foods that are significantly different – something you make together, for example: chocolate to peanut butter, apples to pears, and chips to veggie sticks.

Food chaining often incorporates all senses to transition to a new food using a feeding hierarchy. A feeding hierarchy is a tool to teach the child how to taste/trial food in slow increments in attempt to reduce the amount of anxiety associated with trialing new foods. The feeding hierarchy may include providing the child with a goal to interact with the food, or an item of similar consistency a number of times.

Some examples of what may be included in a feeding hierarchy are:

  • Tolerating the food and its scent in the room
  • Allowing the food on the table or on the child’s plate
  • Touching the food with a utensil or hands
  • Touching the food to the lips (kissing) teeth, and tongue
  • Licking or sucking the food
  • Sinking the teeth into the food
  • Taking a small “nibble”
  • Taking an average bite of food

If your child is experiencing these symptoms consult with your physician regarding your concerns. Should you have any questions regarding a feeding evaluation/therapy, consult with a qualified speech-language pathologist or occupational therapist as soon as possible.

References:

  • Fraker, C., Fishbein, M., Cox, S., Walbert, L. (June 2004). Food Chaining: A systematic approach for the treatment of children with eating aversion. Retrieved from Journal of Pediatric Gastroenterology and Nutrition: Volume 39, pg. 51.
  • Fraker C., Fishbein M., Walbert L., Cox S. Food Chaining: The proven 6-step plan to stop picky eating, solve feeding problems and expand your child’s diet. Cambridge, MA: Da Capo Press; 2007.
  • Roth, M., Williams, K., Paul, C. (August 2010) “Empirically Supported Treatments in Pediatric Psychology: Severe Feeding Problems”. Journal of Pediatric Psychology, vol. 24, no. 3, 193-214.
  • Toomey, K. Ross, E. “SOS Approach to Feeding”. Perspectives on Swallowing and Swallowing Disorders (Dysphagia). 2011. 20: 82-87. Retrieved from http://spdfoundation.net/library.html#effectiveness.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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Picky Eater’s Guide to Thanksgiving

Ahhh, Thanksgiving. For some kids, it’s their favorite meal that comes just once a year! For others, they may dread the sticky mashed potatoes that get plopped on their plate or the smell of Aunt blog-picky-eater-main-landscapeCathy’s green bean casserole. Preparing your picky eater for this time of year might help you avoid the epic battle you fear is coming!

Here are 5 tips to help this time of year be fun and festive, not frustrating and frightful for a picky eater:

  1. Exposure!- Don’t let the Thanksgiving meal be the first time your picky eater sees all the new foods. Thanksgiving foods are not commonly seen throughout the year and can be overwhelming (in an already overwhelming situation!). In the weeks leading up to the big meal, try incorporate one or two Thanksgiving-type foods a week into your family meals or a snack time. Even if they don’t want to eat it, they can touch it, smell it, play with it and talk about it!
  2. Encourage your child to be your sous chef Incorporating your picky eater into cooking and creating the meals gives them a varied sensory experience. Even if it’s a food they’ve never had (or have tried and disliked), they get to see and feel the ingredients, use spoons and mixers to combine it all, and smell the final product, and feel accomplished for helping!
  3. Let your child choose something to make- Allowing your child to choose a menu item guarantees they will have something they like! Macaroni and cheese, or mozzarella stick appetizers, chocolate chip cookies, or homemade rolls may be some favorites.
  4. Bring sauce!- Sauces and dressings can be the key to kids eating new or less-preferred foods. Even if you’re not hosting, bring it with you. If they love barbecue sauce, put a small bowl next to their plate and let them add it to whatever they want!
  5. When in doubt…bring foods they like– If you’re going to someone’s house where you have little to no control as to what is served, you can always bring a few healthy foods you know your child likes. You can re-heat it when the other food is served, and explain to the host that they don’t even eat your cooking (so the host isn’t offended!). Just prepare for all of the kids at the kids table to be jealous!

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NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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What Parents Need to Know About Feeding Therapy

There are a variety of reasons why a child may need feeding therapy. To many of us, it would seem like Feeding Therapyeating should be a basic instinct. However, eating is one of the most complex activities we do, especially for the developing, young child. Eating involves several processes in the body, including sensory, oral-motor, muscular, neurological, digestive, and behavioral systems. Feeding problems can arise involving any one of these systems, and often more than one of these is implicated.

The following are reasons why a child may have feeding difficulties:

  • Sensory processing issues
  • Picky eating
  • Food allergies or severe reflux
  • Autism
  • Developmental delays
  • Complex post-op recovery course
  • Transition from feeding tube to oral nutrition

Feeding therapy is usually done with one or more clinicians. Depending on the type of feeding problem, therapy may involve a speech-language pathologist, an occupational therapist, a registered dietitian, a social worker or behavior therapist, and/or a physician.

A speech-language pathologist will approach feeding in a comprehensive manner, looking at the actual physical swallow mechanism as well as the sensory aspect of feeding. Before beginning a more structured feeding treatment approach, it is key to rule out any medical reasons that a child is not safe to be taking food or drink orally. If there are concerns regarding vomiting, choking, gagging, etc. then the family should seek further guidance from their pediatrician who may recommend a modified barium swallow study. This test looks at the actual swallow mechanism in real time using x-ray to determine whether or not food or liquids are being aspirated (i.e., food items may slip into the lungs rather than where it is supposed to go). If a child is aspirating, physical symptoms may or may not include choking, wet/gurgly voice, and refusal to eat. Feeding therapy can move forward once it has been determined that a child is safe to take food by the mouth.

In addition to safety concerns, therapists will also look at the various chewing and swallowing stages to see if there is a breakdown in this complex process, once food is in the mouth. There is a developmental sequence of chewing for a child as well as development of independent feeding, first using hands and then moving to use of utensils. Each child will have different needs and a feeding therapy plan should be developed that is unique to your child. One approach to feeding therapy that has high success and is evidenced based is the Sequential Oral Sensory Approach to Feeding.

The Sequential Oral Sensory Approach to Feeding is a therapeutic intervention developed by Dr. Kay Toomey. Certification by Dr. Toomey and her associates through a training course is required for therapists to utilize this technique. Once certified, occupational therapists, speech language pathologists, dieticians, social workers and other health care professionals can intervene using the SOS approach. Under this approach, children are exposed to a variety of foods to increase their comfortability with a range of foods, focusing on exploration of the foods using all the senses: sight, sound, touch, smell, and taste.

Each week, the therapist will send the family a list of 8-14 foods based on sensory characteristics that will help the child experience foods that he/she might never have tried before. The family then brings these foods to the therapy session that week. During the session, the child and therapist (and often the caregiver) engage with the food in a playful manner to move up the “Steps to Eating” with each food, a 32-step process involved in eating developed by Dr. Toomey.  The ultimate goal is for the child to explore a variety of foods and expand the range of foods that he/she tolerates. The goal initially is not for the child to eat the food, rather discover and interact with a variety of foods and develop the skills needed to do so. Parents receive feedback after each session and are given recommendations to continue practicing these techniques at home during the week for ultimate success and generalization across environments. Using this approach, children become more comfortable with and generalize the skills needed to eat a wide variety of foods.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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This blog was co-written with Julie Paskar.

J-PaskarJulie Paskar is a speech-language pathologist, and the Branch Director at the Lincolnwood clinic. She joined North Shore Pediatric Therapy in August of 2012. Julie obtained both her Bachelor of Arts in speech and hearing sciences and her Master of Arts in speech-language pathology at Indiana University in Bloomington, Indiana. She has lived and worked in the Chicago area for the past eleven years. During that time, Julie worked for a pediatric clinic providing Early Intervention services as well as speech-language therapy services to children ages 3-12. She has her Early Intervention credential in speech pathology as both a provider and an evaluator. Julie’s areas of interest include: phonological disorders, motor speech disorders: specifically childhood apraxia of speech, feeding disorders, and expressive language disorders/delays. Julie is a Hanen certified therapist, has also attended both the Introduction to PROMPT and Bridging PROMPT trainings, has attended Picture Exchange Communication System (PECS) Level 1 and Level 2 trainings as well as the Kaufman Speech to Language training. She has been trained in the Orton-Gillingham program which is a treatment program for dyslexia. Julie is a member of the American Speech-Language Hearing Association and is licensed to practice in the state of Illinois. Julie is dedicated to working with children and their families to make communication both fun and functional.

Food Milestones: From Mashin’ to Munchin’

Mealtime and achieving food milestones can be a stressful time for many families, especially for those whose kids demonstrate Food Milestonesdifficulty consuming a variety of flavors and textures. Instead of stressing over consuming those calories and pumping on the weight, take time to relax and enjoy a meal. Take away the stressors from your day and use mealtimes as an opportunity to bond with your little one. There is great variety in the development of infants and toddlers due to differences in the rate of physical and mental development as well as how often these skills are promoted by caregivers. As children develop their preferences for different foods (tastes & textures), they learn to accept or reject specific foods, which is OKAY!

The old mother’s tale “you can’t get up until you finish your peas” has proven to be an ineffective way to have children smoothly go through the realm of trying different foods. Instead of “forcing” your child to eat different foods, give them options…”you can eat 5 or 6 peas…you pick!” Give great verbal praise despite how big of a gain the child has made that meal.

Please see the developmental chart below that guides you through a variety of food milestones while providing ideas on how to keep mealtime positive!

Age Strategies and foods that should be introduced Tips and Tricks
Birth-2 months
  • Nipple feeding by breast or bottle
  • Semi-reclined position during feeding

Foods:

  • Breast milk or formula (approx. 18-28 ounces)
  • Sing songs or tell stories while you feed your infant, build a rapport
2-3 months
  • Start forming a consistent schedule

Foods:

  • Breast milk or formula (approx. 25-32 ounces)
  • Make silly faces with your infant, make meal time a reciprocal relationship
3-4 months
  • Infant starts to put hands on bottle during feedings

Foods:

  • Breast milk or formula (approx. 28-39 ounces)
  • ˷4 mo, rice cereal trials
  • Always avoid television or electronics during meal time, practice songs or rhymes
  • Have your infant sitting at the table during adult meal times

 

5-6 months
  • Start to introduce pureed spoon feeds
  • Tongue will continue to “mash” the food to consume

Foods:

  • Breast milk or formula (approx. 27-45 ounces)
  • Overly ripe fruits/vegetables
  • Oatmeal
  • Rice or wheat cereal
  • Puree a food that you are having for dinner to make it easier with food preparation

 

6-9 months
  • Moves to a more upright position during feeds
  • Helps caregiver with moving spoon to mouth

Foods:

  • Breast milk or formula (approx. 24-32 ounces)
  • Sweet potato mash
  • Cottage cheeses
  • Puff cereal bites
  • Encourage infant to hold bottle independently
  • Think of a variety of different flavors to introduce, even mix flavors based off babies preference
  • Take small trials of foods from your plate to give baby to try
9-12 months
  • Progresses from pureed to more textured food
  • Increases finger feeding
  • Introduction of straw based cup or open cup
  • Moves to a more “munching” formation with jaw and tongue

Foods:

  • Breast milk or formula (approx. 24 ounces)
  • Egg-free noodles
  • Variety of fruit/vegetables
  • Mild cheese slices
  • Offer new foods without the expectation of eating the food (he/she can poke, smell, lick, etc)
  • Always offer small portions on a child sized bowl or plate (don’t overwhelm)

 

12-18 months
  • Grasps utensils and self-feeds
  • Complete transfer from bottle to straw based cup or open cup

Foods:

  • White potato mash
  • Chicken
  • Beef
  • Beets
  • Offer foods of different textures: pudding, soup, crackers, mashed sweet potatoes, etc
  • Have child come with you to the store to pick out their “special cup” to encourage discontinued use of nipple based bottle
18-24 months
  • Primarily self-feeding
  • Able to chew different textures and flavors

Foods:

  • Eggs
  • Lentils
  • Beans
  • Cantaloupe
  • Never ask a child “Do you want ____” because you will have to respect if they say “no”
24-36 months
  • Holds open cup independently
  • Eats a wide variety of solid foods

Foods:

  • Cleared to try any food
  • Have your toddler “get messy” with their food, spread the different textures on their hands, face, or even nose
Continuum into childhood
  • Continue to use choices to give your child the “control” during mealtimes
  • Have your child participate in mealtime prep as much as possible

 

Remember, mealtime goals shouldn’t be about consumption, but about a positive experience for the child. Always consult your pediatrician about diet concerns or questions.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

References:

Developmental Stages in infant and Toddler Feeding., Infant & Toddler Forum., 2014.

McCarthy, Jessica., Feeding Infants & Toddlers: Strategies for Safe, Stress-Free Mealtimes. Mosaic Childhood Project, Inc., 2006.

1998, The American Dietetic Association. “Pediatric Manual of Clinical Dietetics”. 1998.

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My Child Vomits When I Encourage New Foods

If this describes your child, then it’s important to contact your pediatricianBlogNewFoods-Main-Landscape to rule out any food allergies, swallowing dysfunction, or other medical conditions, as these can lead to gagging or vomiting and need to be addressed. If you know that your child is not experiencing any of these challenges, then it’s likely your child struggles with oral hypersensitivity affecting his ability to tolerate different textures and temperatures of foods. Oral sensory aversion can negatively impact a child’s diet. There are many signs of oral hypersensitivity, but one sign that is concerning for many parents is vomiting or gagging with new foods. This often occurs when a child’s sensory system is overloaded, and as a result, his body perceives the new food as noxious.

When your child is a problem feeder due to hypersensitivity, mealtime often causes stress and discomfort for both the parent and child.

Here are 5 tips to reduce stress and help your problem feeder to conquer sensory aversion with new foods.

  1. Set aside a specific time each day to work on introducing new foods.

Mealtime is stressful as it is, adding new foods in the mix when you have a problem feeder on your hands can not only escalate your frustration, but can overwhelm your child’s sensory system. Setting aside a separate time to work on feeding with your child will help to reduce the demand, establish a calm and safe environment, and provide the structure of a daily routine that will help support your child in being successful.

  1. Warm-up, provide regulating oral and tactile input prior to beginning.

Your child’s sensory system needs to be in an optimal state of functioning for him to be able to accept novel foods. Providing regulating input prior to beginning feeding time can help to reduce sensitivity and also warm his system up to prepare him. Some regulating oral activities include blowing through a straw or biting on a washcloth. Consider tactile activities as well, such as finger painting, playing with dry rice or beans, or playing with putty or clay.

  1. Set the stage—Reduce additional sensory stimuli to avoid over-stimulation.

Prepare your child’s environment in order to support his success. This includes turning off the television and the tablet and reducing other visual and auditory distractions. Introducing new foods provides a lot of sensory input. By reducing additional stimuli in the room, a parent can prevent over-stimulation and help a child to more successfully interact with the foods presented.

  1. It’s ok to play with your food!

When working with a problem feeder with oral hypersensitivity, it’s very important to allow a child to feel safe playing with his food. This means that he will need to learn to interact with new foods, whether this includes eating the food or not. Start slow, with tolerating the food on the plate, working up to touching the food, and eventually bringing the food to his mouth. Children often require several exposures to a new food before they will feel comfortable trying it.

  1. Praise and encouragement for all improvements, no matter how small.

Remember that the new food that is causing your child discomfort or distress is noxious to his sensory system. Trying and interacting with new foods is hard work, and any progress made deserves praise. Remain positive and provide positive reinforcement for each new interaction your child has with a food.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Feeding Development: The First Year

Feeding your baby the first year is a big task. Below is a guide to what your baby can eat during this important first year.

*Please note, this is just a guide. Consult your physician for specific feeding instructions for your baby.

Feeding Guide-The First Year:

At 0-6 months, your baby can eat the following foods:

  • Breast/Bottle (0-13 months)
  • Thin Baby Food Cereal (5 months)
  • When first trying baby food your child may spit the food out… THIS IS OK. Children must learn how to safely get food out before learning to eat.
  • Eating comes FIRST, then comes manners. Exploring and getting messy with food is part of the process of learning to eat.
  • Thin Baby Food Puree/Stage 1 Baby Food (6 months)

Read our infant feeding series: Starting Solids.

At 7-9 months, your baby can eat the following foods:

  • Thicker Baby Food Cereals AND Thicker Baby Food Smooth Purees/Stage 2 Baby Food (7 months)Feeding Development: The First Year
  • Soft Mashable Table Foods AND Table Food Smooth Purees (8 months)
  • Hard Munchables (8 months)
  • These are hard textured foods for exploring only- NOT CONSUMPTION.
    • Examples: carrot stick, lollipop, hard dried fruit sticks, celery sticks, bell pepper strips,
  • Once a child can move her tongue around the munchable, she can transition to textured table food.
  • Some children will stick objects in their mouths and will not need hard munchables.
  • Hard munchables will help your child practice moving hard solid foods in her mouth, learn awareness of the mouth and become more familiar and comfortable with teeth brushing.
  • If children do not put things in their mouth, it can delay teeth eruption.
  • Meltable Hard Solids (9 months)
  • Melts in the mouth with saliva only (without pressure applied).
    • Examples: Gerber puffs, biter biscuits, graham crackers.
  • DO NOT USE CHEERIOS- Cheerios will shatter in a child’s mouth instead of melting.

Read our infant feeding series: How to Transition Your Child From Purees to More Textured Foods.

At 10-12 months, your baby can eat the following foods:

  • Soft Cubes (10 months)
  • Soft exterior but maintains its shape, needs tongue/munching pressure to break it apart.
    • Examples: Bananas, avocado, Gerber toddler cubes,
  • Soft Mechanical- single texture (11 months)
  • Soft exterior but maintains its shape, needs munching/grinding pressure to break it apart.
  • These foods will help your child learn how to chew food by using a circular chewing pattern.
  • Children need to be able to move food from their tongue to their back teeth to chew textured food.
    • Examples: soft lunch meats, pasta, cooked eggs
  • Soft Mechanical –Mixed (cube + puree) (12 months)
  • More than one of the above textures
    • Examples: macaroni and cheese, fish sticks, French fries, spaghetti, chicken nuggets
  • Your baby cannot eat a mixed textured food unless she can chew each texture individually.
  • Hard Mechanicals
  • Harder textured exterior food that needs grinding/rotary chew (circular chewing pattern) to break apart. These foods tend to shatter in the mouth.
  • Examples: cheerios, saltines, fritos, steak, fruit leathers

Read our infant feeding series: When Your Baby is Turing One Year Old.

Tips to Remember!

  • Eating is the most difficult sensory task that children do!
  • It’s hard to be neat when you are learning to eat.

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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Better Mealtimes For Your Child With Autism

Children are notoriously picky eaters which can make mealtimes very frustrating, and children with autism are no exception. Just like typically developing children the range of pickiness with food varies from child to child. Some children are great eaters and eat a wide variety of foods, while others will only eat certain foods and will engage in negative behaviors when those foods are not available. Another mealtime issue that can arise with children with autism at mealtimes is not being able to sit at the table for an extended period of time. Below are some suggestions on how to make mealtimes more successful.

 Better Mealtimes For Your Child With Autism:

  • Determine what your end goal is and then start small – If your goal is to have your childBetter Mealtimes with Your Child With Autism eat an entire meal at the table with the family, then start by determining what they can already do. Once you know what they can do, begin building on those skills.
  • Ideally it is best to work on sitting at the table first. While practicing sitting at the table, allow your child to engage in preferred activities so they learn to associate sitting at the table with fun activities.
  • Have reasonable expectations – If your child has difficulty sitting and only likes very specific foods, do expect them to sit for 20 minutes and try new foods. If you child is only able to sit for 5 minutes, then have him sit and eat for 3 minutes and reward that behavior. Gradually have him sit for longer and longer periods of time. Always reward the behaviors you want to see increase.
  • After your child is able to sit calmly for at least 10 minutes, you can then work on introducing new foods.
  • Introduce new foods slowly – Allow him to eat preferred foods, with the new foods it sight. It usually takes several exposures to new foods before they will try it.
  • Be sure to reinforce any attempts at trying new foods, or even touching new foods.
  • If you can see your child is starting to get upset about sitting at the table or trying a new food, prompt them to say they are all done and then excuse him from the table. It is better to end on a good note, then to have him have a melt down and then be allowed to leave them table. If this occurs he will learn if he gets upset, he can leave.
  • Make mealtimes fun – Try to do fun things with food, if your child has a favorite TV show or movie, use plates and cups with those characters. If your child will only sit with the TV on, watch TV in the beginning and then you can work on gradually fading it out.

 

What to Expect When You Suspect Autism Download our free, 17-Page eBook

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Reference: http://www.cdc.gov/ncbddd/autism/data.html

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Turn “I Don’t Want That!” into “More Please!”: How to Help Your Picky Eater

As a parent, it is probably not difficult to know when you have a picky eater on your hands. Meal time should be a pleasurable experience for everyone and an opportunity to spend quality time with family. Read the tips below to alleviate stress during meals with a picky eater.

Tips to Make a Better Mealtime for Your Picky Eater:

Make a routine, and stick to it. Make a routine out of meal time. Set expectations such as setting theHow to Make a Better Meal Time for Your Picky Eater table, turning off the TV, and sitting at the table as a family.

Stay relaxed and calm. The more relaxed and calm you are during mealtime, the more likely your child will be relaxed and calm too.  Model the behaviors you want your child to display.

Remove Pressure. Don’t place pressure on your child to eat certain foods. Delete the “you have to” and “if you don’t eat this…” sayings from your vocabulary. This fosters negative feelings and experiences with feeding. We want positive and happy feelings associated with meals in order to support healthy eating habits!

Eliminate distractions, grazing, and long mealtimes. Turn off the TV and put away the toys and electronics! Additionally, keep meal time to 30 minutes or less. The longer a mealtime becomes, the less pleasant mealtime may be. Consume solids first and liquids last, since liquids are more filling. Discourage snacking and grazing throughout the day, because this can lead to decreased appetite at meal times.

Serve a variety of food consistencies and tastes. This ensures that your child has exposure to multiple tastes, textures, and temperatures of food. Involve your child in grocery shopping and in meal preparation. The more a child understands about food and is an active participant in making food and mealtime happenings, the less surprising a new food is likely to be.

Explore new foods and make it fun. This may help decrease anxiety caused by unfamiliar or nonpreferred foods. Play with food, and don’t worry about making a mess! Smell, touch, lick, and bite foods to explore them and increase your child’s exposure. Talk about the food and describe it. How does it feel, what does it look like?

Don’t feel discouraged if you feel like nothing is changing. Your child may not be requesting a well-rounded meal tomorrow, but these tips will help you get there!

Seek the guidance of an occupational therapist or speech language pathologist if your child is particularly resistant and consumes a limited diet, as these may be signs of being a problem feeder.

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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!
Reference: North Shore Pediatric Therapy (2011). Picky eating: when to be concerned and how you can help. [PowerPoint slides].

picky eater or problem feeder

What’s the Difference Between Picky Eaters and Problem Feeders?

Having a child that is a picky eater can mean different things. Sure, your child doesn’t like vegetables and it seemspicky eater or problem feeder
nearly impossible to get anything into their mouth besides chicken fingers and french fries. But, when should you begin to worry that this is a problem that you can’t handle all on your own? For the answer, we need to examine picky eaters vs problem feeders.

A picky eater is very selective about the foods that they will eat. This may be in regards to taste, texture, or appearance. Don’t worry, you’re not alone! Picky eating is not uncommon in childhood and may occur when a child begins to assert independence or when they begin to feed themselves.

A problem feeder may present like a picky eater, with some key differences. Read below for signs and characteristics of picky eaters vs. problem feeders. If your child shows signs of being a problem feeder, call in the professionals!

The Difference Between Picky Eaters and Problem Feeders:

Picky Eaters Problem Feeders
Accept more than 30 foods Accept fewer than 20 foods
Will regain foods lost due to frequent consumption Do not regain foods lost due to frequent consumption
Are able to tolerate new foods on plate and perhaps even taste them Become upset when new foods are presented (throwing, crying, pushing food away)
Eat at least one food from each food group Refuse entire groups of food textures
May be picky about varieties and brands Often demonstrate red flags for feeding disorders (excessive drooling, sensory processing difficulties, immature swallowing and/or oral motor skills, etc.)

 

If your child shows signs of being a problem feeder, seek the help of an occupational therapist or speech and language pathologist.


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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

North Shore Pediatric Therapy (2011). Picky eating: when to be concerned and how you can help. [PowerPoint slides].

 

texture aversion

Tips for Tackling Oral Texture Aversion and Achieving a Peaceful Mealtime

Everyone needs food, so everyone loves eating, right? Wrong! As a parent, you may be all too familiar with sounds and phrases such as ‘Ick’, ‘No, not vegetables!’, and ‘I’m not eating that!’ These phrases may be uttered secondary to behavior issues, or perhaps because your child has an oral texture aversion. There are many terms regarding aversions floating around, and they are all slightly different. First; what is an oral aversion? An oral aversion is reluctance, avoidance, or fear of eating, drinking, or accepting sensation in or around the mouth. An oral texture aversion is specific to reluctance or fear associated with textures of food, while a texture aversion is a more general term that refers to reluctance or fear when touching food, different fabrics, arts and craft supplies, or substances like water.

Oral texture aversion can present itself in many different ways, including:

  • Acceptance of a small variety of textureTackling Oral Texture Aversion
  • Becoming upset when new foods are presented
  • Refusing entire groups of food textures
  • Long feeding times

Mealtime should be stress-free and enjoyable. In a family with a child that has oral texture aversion, this can be difficult to accomplish. The million dollar question is: How can you achieve a peaceful mealtime? Read the few tips below to help guide your mealtime.

Tips to Achieve a Peaceful Mealtime:

Eliminate distractions, grazing, and long mealtimes

Eat together as a family around the table, rather than around the TV! Additionally, keep meal time to 30 minutes or less. The longer a mealtime becomes, the less pleasant mealtime may be. Consume solids first and liquids last, since liquids are more filling. Discourage snacking and grazing throughout the day, because this can lead to decreased appetite at meal times.

Serve a variety of food consistencies and tastes

This ensures that your child has exposure to multiple tastes, textures, and temperatures of food. Involve your child in grocery shopping and in meal preparation. The more a child understands about food and is an active participant in making food and mealtime happenings, the less surprising a new food is likely to be.

Start an Exploration Plate

This may help decrease anxiety caused by unfamiliar or nonpreferred foods. The Exploration Plate can be a designated plate with the unfamiliar or nonpreferred food on it, which should be encouraged to be explored during meal time. Do this by talking about and describing the food, smelling it, touching it, or even trying a bite of it. However, do not place pressure on your child to do these things. Always model the behavior that you want your child to display.

Play with food

Mealtime should be a pleasurable experience, and playing with food will help achieve that. Smell, touch, lick, and bite foods to explore them. Don’t worry about making a mess!

If you are concerned that your child may have an oral texture aversion, consult an occupational therapist or a speech language pathologist today!


New Call-to-action

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!