December 6, 2023
Feeding is part of our daily life. Most people eat at least three times per day and mealtime is typically a pleasant experience; however, for children with feeding problems, this daily routine can become an aversive situation for children and their caregivers.
Studies suggest the majority of children with autism have some type of a feeding problem (Volkert & Vaz, 2010). Feeding problems can include complete food refusal, disruptive mealtime behaviors, inappropriate pace of eating, lack of self-feeding skills, and “picky eating,” as caregivers often refer to it.
“Picky eating” may consist of a variety of selective feeding behaviors such as only eating foods of certain textures (e.g., crunchy, pureed), brands (e.g., from a particular restaurant), types (e.g., meat, starches), or colors. When a child does not eat enough or does not eat a wide enough variety of foods, there may be significant medical implications (e.g., weight loss, malnutrition, poor growth) or social implications (e.g., not eating with peers, at family gatherings, or at restaurants). Children with feeding problems can create additional burdens on caregivers if caregivers need to prepare a separate meal for one family member, bring special food on community outings, or decline attending social events in fear of how their child may behave when presented with novel foods.
Extensive research has been conducted in the field of applied behavior analysis on feeding interventions for children with and without autism. Like any behavioral intervention, feeding interventions are specifically tailored to a child and his/her family to produce the best possible outcomes. An intervention that works for one child may not work for another. Additionally, there are several reasons why a child may not be eating and these reasons will vary from child to child. It is important to assess why a child is not eating (i.e., a medical or behavioral reason) before beginning an intervention. Feeding problems can involve many complex factors, and interventions to help children with feeding problems are by no means a one-size-fits-all situation. This is when the help of specialists is crucial. Often, feeding interventions consist of a team of specialists which may include doctors, occupational therapists, speech therapists, nutritionists, and Board Certified Behavior Analysts. Caregivers, being a specialist in their child, are also a vital part of the feeding intervention team.
Caregivers may be resistant to feeding interventions and may have negative perceptions of what feeding interventions entail. Some may think feeding interventions consist of extremely aversive procedures, such as forcing a child to eat; however, there are several less intrusive interventions that have demonstrated successful results for a number of children.
Some interventions simply alter what is done before a meal begins to increase the likelihood that a child will eat (e.g., telling the child, “first dinner, then dessert,” creating a dinnertime routine, mixing a non-preferred food with a preferred food). Some children respond well to these less intrusive strategies, but some children require more intensive feeding interventions (Seubert, Fryling, Wallace, Jiminez, & Meier, 2014). Depending on the severity of the feeding problem, a feeding intervention can be a challenging and lengthy process; however, after a feeding intervention has been successfully implemented, the once unpleasant mealtime can become an enjoyable experience for both the child and his/her family.
In my own experience working with clients, I have had the opportunity to see many of the rewarding effects of feeding interventions. Here are a few examples of successes that can be achieved through intervention:
A child who only ate pureed foods received intensive intervention and began to eat the same meal as his family, smiling and laughing in the process. Another family could not eat at a restaurant because their child would scream, cry, and refuse to eat restaurant food; after slightly modifying their restaurant routine, the family could enjoy a relaxing meal together at a restaurant with their child eating food the restaurant served.
One particular selective eater refused to eat anything except chicken, which limited his ability to attend social events; more foods were slowly introduced to this child’s diet and eventually, he was able to eat many foods that were previously refused, including enjoying pizza and cake at a friend’s birthday party. Growth and weight are a common concern of parents. I have seen a child who regularly refused to eat and was completely below the growth chart; after training her parents on a feeding intervention, she steadily gained weight and is now back on the growth chart and continuing to grow. It is important to keep in mind that all interventions are individualized, but these are just a few examples of the positive changes the right team and the right intervention can have for children and their families.
It is remarkable to see this difficult, daily routine become an enjoyable experience for those involved. Effective intervention for feeding problems can truly change the quality of life for our families.
If you have concerns about your child’s eating or food selection, speak to your child’s pediatrician.
Seubert, C., Fryling, M. J., Wallace, M. D., Jiminez, A. R., and Meier, A. E. (2014). Antecedent interventions for pediatric feeding problems. Journal of Applied Behavior Analysis, 47,449-453.
Volkert, V. M. & Vaz, P. C. M. (2010). Recent studies on feeding problems in children with autism. Journal of Applied Behavior Analysis, 43,155-159.