By Lisa Ackerman
Originally written in September 2003
Getting healthy nutrition into the bellies of babes is the source of discussions, angst, and battles for many parents. Ask the parent of a child with autism or other special needs child about nutrition and their child, and you will often hear a response with groans of desperation and exasperation. Good nutrition and children with autism rarely go hand in hand easily. 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 isn’t complicated enough, dealing with children who like “sameness” and routines, especially 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, modeling friends and parents eating the healthy food, and more cajoling and dancing did not persuade 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 most sly 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 into. And for me, it was a constant point of frustration. Each step towards persuading Jeff to eat a new food meant another defeat for mom along the way.
I knew there had to be another way. And for sake of my child’s health, I had to find it.
To find a solution, I first had to look back.
Early on, our son Jeff used to eat anything we 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 friends. Fast forward to age two, and Jeff self-limited down to only six foods, all very unhealthy, including: French fries, peanut butter and jelly sandwiches, Tiger’s Milk bars, Burger King chicken nuggets only, and a half gallon of milk every day. Nothing resembling good nutrition made it past his lips. He was a carbo-loading, milk loving, sugar junkie. Even a stressed out parent with a crying, hungry kid knew this was wrong. So what happened?
Jeff was diagnosed with autism about six months after his food de-selection time period, leading to some clues to why we were having so much difficulty. After much research, in-home behavior-based programs, speech, and occupational therapy began. We also started medical intervention in hopes of improving Jeff’s health. Included in this intervention plan was the implementation of a gluten-free and casein-free (GFCF) diet. Going dye-free and offering organic food replacements became part of Jeff’s daily food repertoire. New allergies to eggs, yeast, and soy were also identified in Jeff’s allergy panels, and these too were completely avoided.
After introducing the GFCF diet in January 2000, we were able to change Jeff’s diet and hide some nutrition in mini-meat loaves (using all kinds of organic meat), cookies, and ever-versatile muffins. Out went the Burger King nuggets and various other unhealthy foods and enter the better, nutritious, organic foods. This took months to master and maintain. 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 their “natural,” recognizable forms. 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. Rather, everything I served him looked like a chicken nugget (without the deep frying.) He could eat like that forever, but I was getting bored with his choices! Where was the variety? How would he ever eat if I did not bring food wherever 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 bite 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 we ate offending foods while sitting next to him, he gagged. The smells, textures, and proximity of the food were too much for him to handle. Time to try something new… again.
Working with Jeff’s behavioral therapy team, using Applied Behavioral Analysis (ABA) principles, and his occupational therapists together, we developed a plan to persuade Jeff to eat new, natural foods in their natural forms. This entire process took six months, but the efforts 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 painstaking process, but netted good results.
We took the long road getting Jeff used to new foods by following these steps:
- Eat the food next to the child and comment, “This ___ is yummy.” (It's important to make sure you have the child's attention and that you're observed eating the new food.)
- A friend of the child or a highly reinforcing person eats the food next to the child and comments, “This ___ is yummy.” (Again, it is important to gain the child’s attention first.)
- During in-home therapy time, school time, and down time, therapists or parents take a picture of the desired food and talk about it. Do drills or sort foods into similar categories. We moved from pictures to actual whole bananas and other fruits in Jeff’s therapy and play activities.
- Put a small amount of the food on a separate plate NEXT to the child’s plate. Point to it and discuss it. Eat a few off the plate and comment, “This ___ is yummy.”
- The big step: Put the food on the child’s plate. The child does NOT eat the food, but has to tolerate the food being on the plate. Tell the child, “You don’t have to eat the ____. It just needs to be on your plate during your meal.”
- Next big step: Put the same food on the child’s plate and during the meal, the child needs to TOUCH the food. Tell the child, “You don’t have to eat the ____, it just needs to be TOUCHED with a finger once during your meal.”
- Next really big step: Put the same food on the child’s plate and during the meal, the child needs to PICK UP the food. Tell the child, “You don’t have to eat the ____, it just needs to be PICKED UP ONCE during your meal.”
- Now we are moving: Put the same food on the child’s plate and during the meal, your child needs to PICK UP AND PUT THE FOOD ON HIS/HER LIPS. Tell the child, “You don’t have to eat the ____, it just needs to be PICKED UP AND PUT ON YOUR LIPS once during your meal.”
- Guess what? The next step includes the dreaded tongue! Put the same food on the child’s plate and during the meal, your child needs to PICK UP AND PUT THE FOOD ON HIS/HER TONGUE. Tell the child, “You don’t have to eat the ____, it just needs to be PICKED UP AND PUT ON YOUR TONGUE once during your meal.”
- Last step–the holy grail: PUTTING THE SMALLEST PIECE in his/her mouth and finally swallowing the food.
- It is highly possible that little chewing will happen the first go-around. Work with your child to chew before swallowing the food as the final step!
Note: Introducing my 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 being added on a weekly basis.
Some children avoid foods they are highly allergic to. If you feel this is an issue for your child, it is recommended that you obtain an allergy panel for your child. However, for many kids, food avoidance is due to behaviors and sensitivities.
For Jeff, working with some good professionals in the areas of behavioral intervention, speech therapy, and occupational therapy helped to persuade him him to eat real, nutritious food, control his behaviors, and make amazing gains. For all parents with special needs children or just plain picky kids, a team approach can help make a difficult situation move in the right direction.
By the end of the six-month period, we had Jeff eating lots of foods from the new, healthy food list including organic hamburger meats and sausage, a new, healthier variation of chicken nuggets, and lots of real fruits and vegetables in their natural form! Looking back, the process was long, but worth it.
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 prior education/reminders 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!
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