Q&A: Autistic Picky Eaters?

Question:

I am a school-based occupational therapist working with two preschool children with autism. Both are very picky eaters. One of them only sucks on his food. Do you have any suggestions for how I can address this issue?

Answer:

Here are some suggestions:

• Before feeding time, address the needs of the NEAR sensory systems first (proprioception, vestibular, tactile) using a sensory diet
• Assess the oral-motor skills of these kids. Sometimes feeding issues aren’t sensory but rather caused by poor oral-motor strength. If so, that may be the reason one of them is sucking food. Look at the tone in their cheeks and lips. Check their ability to move the tongue from side to side. Can they stick it out then stick it out and it to one side? Do they have good strength when you ask him to bite down on something? Play tug-of-war with a chew toy and see if they can maintain pressure on it.

Once oral-motor development is eliminated as a cause, this is mainly a sensory problem, here are some ideas:

• Start with a food the child likes and alter it slightly. For example, if he likes yogurt, let him take a couple of bites of it first. Next, alter it a little. You might add granola or ask him to dip a graham cracker in the yogurt and take a bite.
• Involve the child in the food prep. For example, if he likes bread, ask him to use cookie cutters to cut shapes out of the bread. Assist him in spreading different things on top of each shape (e.g., crunchy peanut butter, yogurt, cheese spread, marinara sauce). Here’s a worksheet that I use with kids. I typically work on trying one food in a variety of manners. For instance, on this sheet we were working on pears. They tried pears with PB, canned pears, fresh pears, etc. Each time they circle the picture that best shows their feelings about that combination. Bread with a variety of toppings would be another example of sticking with a theme.
• I use incentives. If they at least take one bite from every option offered, they get to choose a sensory activity for the last 5 minutes of the session.
• If they are overly anxious about trying something, gag, or simply refuse, encourage them to smell it, then talk about it. What does it remind you of? What other foods are the same color? Encourage them to touch it with their fingers and talk about the texture. If it is a sauce of some sort, they could finger paint in the sauce. If it something solid, you could cut it into bricks and let them build or make a pattern with it. Theoretically, once our other senses (sight, smell, and touch) can handle the food, we will eventually be able to tolerate it in our mouths as well. When they are no longer over-reacting to the sight, smell, and feel of it in their fingers, they are ready to try a bite. I’m not sure about school settings (parents can be uneasy with this), but in a clinic with the parents’ permission, I eventually require them to take a bite once I am sure it will no longer elicit a gag response.

Best Wishes,
Gwen