Parent Needs Help: 4-year-old with Autism Won’t Eat Solid Foods

This week’s “Food for Thought” answer is from occupational therapist Moira Pena, who works within the Autism Speaks Autism Treatment Network at Holland Bloorview Kids Rehabilitation Hospital, in Toronto.

My child is 4 and has been diagnosed with autism spectrum disorder. He’ll eat most anything that I puree. But he refuses to eat even small pieces of solid food except for soft cheese puffs, and he can’t drink from a straw. How can I teach him to chew real food?

Thanks for your question. From your description, it sounds like your son may have oral-motor challenges that interfere with his ability to chew. Cheese puffs, for example, don’t require chewing if he lets them just melt in his mouth. 

Signs or red-flags that may indicate oral-motor challenges include:

• Poor speech (forming the sounds)
• Excessive drooling
• Open mouth when at rest
• Difficulty blowing bubbles/candles
• Difficulty sucking through a straw
• Taking a long time to chew
• Placing fingers inside the mouth to remove or insert food

Many children with oral-motor issues don’t instinctively learn how to chew solid food. To understand the challenge, it helps to consider the muscle skills involved.  

To chew food properly – particularly meat, vegetables and fruit – a person needs to use what we call rotary chewing. This motion involves moving food around from the middle of the mouth to the back molars and then back to the middle of the mouth. In addition, rotary chewing requires one to move the tongue from one side of the mouth to the other. We call this skill “tongue lateralization.”

The importance of a professional assessment 

There are a number of strategies I can give you to help your son at home. But first I urge you to have your child assessed by a professional. This could be a speech-language pathologist or an occupational therapist with experience in feeding issues.

It’s particularly important for the therapist to determine that your son can eat solid foods safely. Introducing foods beyond your child’s ability to safely manage them presents a choking hazard. So it’s extremely important to avoid introducing solid foods until a specialist has determined what level of solid food – if any – your child can manage safely.

In addition, a thorough assessment is vital for identifying underlying factors that may be contributing to your child’s challenges with chewing. These can include behavioral and sensory difficulties.

It’s important that the therapist actually observe your child eating. This is the best way to identify the issues involved. In addition to working with your child, the specialist can give you tailored recommendations for what you can do at home.

Once you’ve determined it’s safe for your child to begin eating solid foods, here are strategies to try – if at all possible under the guidance of a feeding therapist:

• Thicken those purees. Experiment by adding corn starch or powdered baby cereal to the purees you’re making. Focus on making the puree thicker, not chunkier. This will gradually increase the muscle work involved in eating them.
• Try various types of soft foods. Encourage your son to try foods that are already pureed to some degree. Examples include mashed potatoes and apple sauce. Once he’s comfortable with this consistency, try foods that are solid but still soft. Examples include soft cheeses, scrambled egg and soft fruits such as bananas. 
• Model how to bite off small pieces. Rather than placing small bits of food in your child’s mouth, show him how to bite a small piece from a whole.
• Model how to chew. Yes, this involves eating with your mouth open! Have your child see where the food is going in your mouth as you chew. You want to show your child that you are chewing on your back molars. I suggest over-exaggerating the chewing motion at first. Ask your child to imitate you.
• Practice, practice. It’s important for your child to gain experience chewing food. You might start by having him practice biting and chewing foods similar to the cheese puffs he likes. This can include relatively soft animal crackers, “Ritz”-style crackers and veggie puffs (“skinny sticks”).
• Try chewy foods. I suggest progressing to foods that require extended chewing. Examples include dried-mango strips and beef jerky. An added advantage: A bite won’t break off from these foods until after it’s been thoroughly chewed. 

Thanks again for your question. Please let us know how you and your son are doing.