Our child is 4 and has autism. He’ll eat only if I spoon feed him while he’s seated on my lap watching his iPad. How can we encourage him to sit in his own chair at the table with the rest of the family?
This week’s “Food for Thought?” answer comes from psychologist Emily Kuschner, of the Children’s Hospital of Philadelphia. The hospital is one of 14 sites in the Autism Speaks Autism Treatment Network (ATN). With the support of an Autism Speaks research grant, Dr. Kuschner is developing a cognitive behavioral treatment program that addresses the complex reasons behind narrow food choices in many individuals with autism. Also see Dr. Kuschner’s earlier blog: “What Is It about Autism and Food?”
What a great question! I’m sure lap-time snuggles can be enjoyable. But you’re wise to think about helping your son develop good habits for mealtime, family time and screen time. Establishing these routines from an early age will help establish a foundation for your child to build on as he matures.
It sounds like you have a few different factors to navigate:
1. Who is going to feed your son? You or will he feed himself?
2. Where is he going to sit while he eats?
3. What else will he be doing while he eats?
First, it’s important to think about how and why these routines developed and to rule out any medical problems or lagging physical skills that might be getting in the way of the mealtime you’re hoping for.
For an overview of the many factors that may be involved, I recommend the Autism Speaks ATN/AIR-P tool kit Exploring Feeding Behavior in Autism: A Guide for Parents. (Click the text link to download the tool kit free of charge.)
First screen for physical issues
Next I recommend that you consult with your pediatrician to explore whether your son might have swallowing or gastrointestinal (GI) issues that help explain his insistence on sitting in your lap. For example, I suggest that the doctor check whether your son has difficulty eating while sitting straight up – versus leaning back on you in your lap.
In addition, we know that young children need to master certain oral-motor and fine-motor skills in order to bite and chew solid food and otherwise feed themselves. So I likewise recommend a thorough evaluation by a feeding team that has experience working with children who have developmental disabilities. This team might include both a speech therapist for oral-motor skills and an occupational therapist for those fine-motor skills. You can find such teams at specialized clinics such as those in the Autism Speaks ATN. (To find the ATN nearest you, click here.)
Then step-by-step to your goal
Once you’ve addressed these possible physical issues, I recommend that you gradually establish new routines for eating and mealtime. Avoid going straight to your child sitting in his chair by himself, feeding himself, with no iPad. Challenge overload!
Instead, I encourage you to keep your ultimate goal in mind as you plan the small steps you’re going to take to get there. In other words, don’t just wing it!
Before I lay out a possible progression of goals, please remember that the idea is to work your way through these one by one. That is, work on just one goal at a time.
I also recommend giving some thought to the order in which you want to tackle these steps. It’s up to you.
You might start with the goal you think will provide an early success. Or perhaps start with one that you think will make the subsequent steps go more smoothly. For example, do you think that your son will be more likely to feed himself if he’s not distracted by the iPad? Then perhaps eliminating the iPad should be step one.
So with that in mind, here is one possible progression of steps:
Goal 1: Transitioning from lap to chair
You might start by placing a chair directly next to yours. Do what you can to make sure that will be comfortable for your son. I also suggest trying to make his sitting in the chair as similar as reasonably possible to his sitting in your lap. For example, use a booster seat to put him at a similar height. Definitely make sure he can reach what he wants on the table.
Once the chair is ready, I suggest starting with your son in your lap for his first bites of the meal. Then place him in the chair next to you for a brief period – even if it’s just a minute, or even 30 seconds – while you give him one bite of food. If he wants to move back to your lap to finish chewing the bite, that’s fine. Just repeat this shift from lap to chair several times through the meal.
Over the next few days, gradually increase the amount of time he spends in the chair and the number of bites he completes in his chair. For example, move toward his spending two minutes and two bites, then three minutes and three bites. Remember to have patience.
Goal 2: Eating sans iPad
Approach your other concerns in a similar fashion. For example, gradually increase the time and number of bites your son takes without the iPad. You can try asking your son to put the iPad down in front of him while taking the bites. Or make a “trade,” where he hands you the iPad and you hand him the spoon with a bite of food.
As with the transition out of your lap, gradually increase the amount of time spent and number of bites eaten without the iPad.
Goal 3: Feeding himself
As mentioned above, it’s very important to rule out skill impairments before tackling the goal of having your child feed himself. As described above, please consult with a feeding specialist to explore why your child isn’t feeding himself. Once motor and swallowing impairments are either ruled out or addressed, you can tackle this goal with a similar approach to those described above.
For instance, ask your son to feed himself one bite, then you feed him one bite. Gradually increase the number of independent bites he takes at each meal.
As a feeding specialist, I know this works best if you can engage him in the process. So try to make meals fun and exciting. For example, invite your child to pick out a special, new spoon and bowl to use on his way to independent eating. Does he love a certain cartoon character? Consider shopping for a spoon and bowl with its image. Then when mealtime comes, you can say something like, “Look! Thomas the Tank Engine is helping you eat all by yourself.”
For each of these steps, take your child’s developmental level and communication skills into consideration. Remember, your son’s feeding team and/or behavioral therapist can be a great resource here.
Explaining the change
I encourage you to talk with your son – at his developmental and language level – about these new eating routines. Describe why this change is important. For example, you might say something along the lines of:
“It’s hard for us both to eat when you’re in my lap, so we’re going to try something new.”
“You’ll eat by yourself at preschool starting next month, so we’re going to practice at home.”
Resistance is natural
Remember that changes in routine can be difficult for any child – and particularly so for a child with autism. Be patient with setbacks and remind yourself that they’re just bumps in the road as your son develops new skills and adapts to new routines.
Help your son with positive reinforcement
Verbal praise and encouragement can go a long way. I recommend specific comments that are attentive to the skills and routines you’re trying to build. For example, you might say:
“Wow! Look at you by yourself in the chair!”
“Awesome job feeding yourself two bites!”
“I really liked talking with you at dinner,”
Many children respond well to small rewards or prizes. Try a token board or sticker chart (right). Your child earns a token or sticker for completing each small goal. For example, a sticker for spending one minute and taking one bite in the new chair. Stickers, in turn, can add up to a bigger prize. For example, five stickers earns an extra trip to the library or playground.
Remember, slow and steady with a thoughtful plan will get you there. Good luck, and please let us know how you’re doing in the coming weeks and months.
Need more help with issues around food, eating behaviors or special diets? Send your questions to FoodForThought@AutismSpeaks.org.
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