Feeding Therapy for children w/ ASD

Potential Feeding Difficulties

• Oral motor challenges 

• Sensory aversions 

• Selective eating 

  • 1 flavor or 1 color “beige eating”

• Mealtime anxiety 

• Gagging 

• High preference for certain feeding utensils, routines, etc. 

• Crying and irritable during mealtime 

• Refusal to sit at the table 

• Behavioral issues with mealtime

Sensory sensitivities

• Can lead to food preferences. 

• Can be sensitive to: texture, smell, temperature, visual presentation, etc. 

Oral Motor Challenges

• Low muscle tone and/or lack of coordination can impact movement of oral structures. 

• Difficulties coordinating chewing movements, moving food around in the mouth, coordinating swallow. 

• My result in pocketing, gagging, or difficulty chewing.

Selective Eating

• Preference for a limited range or variety of foods. 

• May be preferences based on color, shape, texture, flavor, temperature, etc. 

• Can result in a limited diet. 

• High aversion to new foods.

  • <10 foods

Behavioral Issues

• Children may throw food, utensils, etc. at meals. 

• Children may refuse to sit at the table. 

• Behavioral responses to “force feeding.” 

• Learned responses to parent expectations 

• Child may use behavior to control the situation, avoidance or denial, and or communicate sensory issues.

Remember

• Children with Autism cannot communicate these difficulties and/or their preferences.

• Most parents struggle when they have a child that will not eat.

• There is more to eating than just the food on the plate. We need to look at everything that is happening at mealtime.

• Any intervention will be a slow process that needs to be based on the child’s current skills and the realistic goals of the family.

Start with play

• Start with making play at the table/high chair enjoyable. 

• Process to involving food items in play. 

  • I.e. dry noodles, rice, etc. 

• Once comfortable start play with foods that are desired to be added to the child’s diet.

Food Chaining

• Start with a food that is accepted. 

• Change one property at a time: 

  • Color 

  • Shape 

  • Texture 

  • Temperature

Get creative

• Use food that is shaped like sticks as utensils. 

• Use songs and music to make mealtime more enjoyable. 

• Incorporate favorite toys, characters from shows, etc. 

• Consider using family members as meal time models.

Environment

• Consider the room where mealtimes occur. Are there things happening that are disrupting the child? 

  • Other family members 

  • Overwhelming sights, sounds, smells, etc. 

  • Positioning in chair 

  • Screens

Utensils

• It is okay for kids to finger feed 

• Try switching type of utensil

• Play with utensils

• Provide more than one

Cups

• Children may resist weaning from a bottle and may use bottles for longer than typical. 

• Children may refuse cups. 

• Try a high preference cup. 

• Straw cups over sippy cups

The communicative aspects of feeding

• Eye contact 

• Skin to skin contact and face to face 

• Food is motivating 

• Reinforcer or natural consequence 

• Fosters social relationships - warm affectionate interaction 

• Emotional regulation 

• Language exposure

• Attachment  

• Mimics turn-taking

Avoidant/Restrictive Food Intake Disorder ARFID

An eating or feeding disturbance characterized by apparent lack of interest in eating, sensory based avoidance, or concern about aversive consequences of eating.  

May result in: 

- significant weight loss (or lack of weight gain) 

- significant nutritional deficiency 

- dependency on tube feeding or oral nutritional supplements 

- difficulties are NOT linked to skills deficits

Did you know? 

• ARFID is considered a mental health disorder and is outside the scope of practice for an SLP. 

• SLPs CANNOT diagnose or treat ARFID.