I am a school-based occupational therapist working with 2 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?


Here are some suggestions:

* Address the needs of the NEAR sensory systems first (proprioception, vestibular, tactile) through the use of a sensory diet, before feeding time.
* Assess the oral-motor skills of these kids. Sometimes feeding issues aren’t sensory. For example, the kid that only sucks his food: This makes me wonder if he has the oral-motor strength to chew and handle the bolus of food. Look at tone in his cheeks and lips and see if he can do things like move his tongue side to side, stick it out, stick it out and to one side, etc. Also see if he has good strength when you ask him to bite down on something. Play tug-of-war with a chew toy and see if he can maintain pressure on the object.

If you conclude that the oral-motor development is there and 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 bites of it first, then alter it a little by adding in granola or asking him to dip a graham cracker in the yogurt and take a bite of the cracker with yogurt on it.
Involve the child in the food prep. For example, if he likes bread, start with bread, and ask him to use cookie cutters to cut shapes out of the bread. Then assist him is spreading different things on top of each bread shape—crunchy peanut butter, yogurt, cheese spread, marinara sauce, etc. I can send you a copy of 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, and they tried pears with PB, canned pears, fresh pears, etc., and each time they circle the picture that best shows their feelings about that form of pears. 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, then they get to choose a sensory activity to do 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, 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 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 with it or make a pattern with it. The theory is that 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,