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Children with developmental difficulties, for example Autism Spectrum Disorder (ASD), often have problems with eating. Research has shown that 40 to 80 percent will have problems with food at some point. This can range from children who over eat, to children who have restricted diets.
As parents or carers, it may be really difficult if you are worried about your child’s eating patterns. Food can be a really emotional issue, and mealtimes can end up being stressful and frustrating for families.
This resource should give more information and strategies to try, as well as how different professionals at The Ryegate Children’s Centre might be able to help.
It is important to remember that we all have a ‘limited diet’ and our own food likes and dislikes. Think about the meals you eat each week, or what you have for lunch each day. It’s probably fairly similar.
Restricted eating only becomes a problem when:
Some children may have sensory difficulties affecting their experience of how food looks, smells or feels.
Social interaction difficulties may mean the social aspect of eating is challenging. For example, sitting in a school dining room, and family meal times. This also means children are less likely to observe and pick up good eating behaviours from other people, such as table manners and politeness.
Children with neurodevelopmental disorders find change difficult, and often prefer when things around them stay the same. This may be because their brains process information differently, or because they tend to have higher anxiety levels than other children. This can make it difficult for children to try different foods or eat in new places.
All the above reasons mean children with neurodevelopmental disorders are more likely to have had difficult experiences of food and eating. They can feel anxious or ‘unsafe’ around certain foods.
An important part of knowing how to help, is understanding your own child’s experience of food and eating. This can help find the cause of the problem. A food diary can be a really useful place to begin. Start to take note of what is eaten and when.
Sometimes keeping a food diary can also be reassuring because you might discover that your child eats a greater amount and wider range of foods than you originally thought.
Lots of children with neurodevelopmental disorders also have sensory processing difficulties.
Taste and smell are 2 of our senses which influence our eating behaviours.
Children can be oversensitive to certain tastes and smells. They often do not like strong tastes and restrict their diet to bland foods. They may not like the textures of certain foods, such as wet, runny, mushy or lumpy foods, and restrict themselves to dry foods such as toast or crackers. The smells of food cooking can be overwhelming for very sensitive children.
Some children are not sensitive enough to tastes and smells. These children tend to crave strong tastes and smells (such as a hot curry), and hard, crunchy textures. They may try to eat non-foods.
Warn your child that a meal is nearly ready (about 5 minutes), so that they can have time to prepare their sensory system.
You can also desensitise their mouth. Some children benefit from some massage around the face and mouth before eating. Let them use their hands or the handle of a vibrating electric toothbrush held against the cheeks and lips for a few minutes.
If possible, avoid cooking and eating in the same room. Some children will be overwhelmed by the smells of cooking and then unable to eat.
Make sure your child is comfortable where they are eating. If they are sitting at a dining table, make sure their feet can touch the floor, or rest on a stool or box under the table. If they prefer to eat with their feet tucked underneath them on the chair, or kneeling up, let them. The extra sensory feedback to their body may calm the oversensitivity in their mouth.
As well as the smells and tastes, some children find the sight of food off-putting because they are visually oversensitive. If this is a problem for your child, accept that they may eat better when distracted by watching a TV programme or an iPad. You may have to lower your expectations for conventional table manners if you want your child to eat.
Busy school canteens and noisy restaurants can be overwhelming for an oversensitive child. If they will not eat at school, ask if there is a quieter, calmer space for them to eat their lunch.
When we are anxious, our senses will be heightened. This means that smells, tastes and textures become more overwhelming. We also experience lots of physical sensations, including feeling sick or a ‘butterflies in the stomach’ sensation when we are anxious. If we feel like this, we may only feel like eating certain things.
We also know that when children are anxious, their behaviour or routines become more rigid. This will make it more challenging to try new foods or change their behaviour around eating.
If your child has a lot of difficult things going on in their life, it might not be a good time to start trying to introduce new foods.
If you think your child’s anxiety is affecting their eating behaviour, it might help to reduce other demands in their life.
Has your child had experiences with food and eating that have caused them stress?
Past feeding experiences can have a big impact on how children eat, even from as far back as from when they were born. If your child was born prematurely and fed by a tube or vomited a lot when feeding, this can cause difficulties with eating later on.
If mealtimes at school or at home are stressful this can affect appetite and reduce the amount a child will eat.
Has your child missed out on eating different textures so they are unsure what to do with foods in their mouth?
A speech and language therapist can advise you how to help your child develop the different skills needed to chew different foods. This might involve some messy food play.
Messy food play can help children explore food without the pressure to eat. In time this will help lessen their anxiety around food. It will also help them explore how foods feel, smell and change. This will help them know how food will feel and behave in their mouth and may desensitise them to the feel and smell of food.
It is important that you communicate with your child in a clear, consistent and calm way.
Presenting information visually can also help. This could be a visual timetable to show when meals are, what foods are on offer at school or pictures of emotions to help your child express how they feel about food.
Try not to categorise foods into healthy and unhealthy, or good and bad. This can sometimes be taken too literally and can cause further problems. Instead look at the different categories of foods and what physical characteristics the foods share. All crisps are hard, beige and crispy so they know what to expect. But vegetables come in all different colours, shapes and sizes. This is one reason why fruit and vegetables are so challenging for children. Try to make a fun game to explore all the types of fruit and vegetables.
The social side of mealtimes can be stressful. Your child might be more relaxed, and eat more volume or variety, if they are allowed to eat in a smaller group or room at school.
If a meal is not going to be at home, prepare your child in advance by telling them:
A social story could help someone to understand why we eat and the function of food.
Most children with neurodevelopmental disorders find change difficult and prefer things around them to stay the same. One reason for this is that their brains process information differently. Children with neurodevelopmental disorders often have a brilliant attention to detail, but can find generalising and categorising objects more difficult.
This means children might:
It also means that children feel like they are constantly experiencing new things. This makes the world feel quite overwhelming and scary. Sticking to the same foods can help them to feel safe.
Sticking to routine around food and mealtimes can help children feel more comfortable. But try to avoid going to extremes to get your child to eat, such as presenting the food in a certain rigid pattern.
The answer to this question is probably yes!
Something is described as a behaviour when we have learned to do something or not to do something. Learning happens very quickly when we have had a ‘bad experience’ because our brains are programmed to keep us safe and avoid danger.
Most people will be able to think of foods they do not eat because of one bad experience, such as being ill. For children with neurodevelopmental disorders, most eating difficulties will start as a sensory issue or a difficult experience with food (e.g. reflux as a baby, being sick). Your child will learn very quickly to avoid certain foods or eating in particular times or places.
When we have learned that something isn’t safe, we have to retrain our brains to realise that it’s okay really. This is called ‘desensitisation’. Desensitisation involves a gradual exposure to new foods. This can lower anxiety and eventually lead to the food being accepted into your child’s diet. However, just like learning anything new, it can take lots of time and practice to feel comfortable.
Children learn very quickly that what, and how much they eat is important to their parents.
If you are anxious, your child will probably sense this. It may make them more anxious, or they may see an opportunity to bargain with you. If your child is healthy and growing, avoid arguing into a debate with them. Let them eat what they want without making a fuss.
Remember eating a new food is challenging for everyone. We will all only try a small taste of something new, do not put the amount of food you want your child to eat on the plate and then have to throw it away, give them the amount you know they might eat.
Your child will probably be feeling really scared about trying a new food. Give them lots of praise every time they make a step towards trying anything new.
Remember that what is ‘normal’ eating for a child with developmental difficulties might not be the same as ‘normal’ eating for a child who doesn’t have developmental difficulties. Think about what should be normal for your family, and try to stick to that.
There are a number of professionals at The Ryegate Children’s Centre who might be able to help you think about your child’s eating and give you advice.
If your child has an Autism Spectrum Disorder (ASD), you will have been invited to a workshop which aims to help parents increase their overall understanding of ASD. As part of this workshop, eating difficulties are discussed and some general strategies are provided.
If your child has ASD and sensory issues that are affecting them in a number of ways, including eating, you can access the Sensory Service here www.sheffieldchildrens.nhs.uk/sensory for more general information and advice about sensory processing.
If your child will only accept a limited range or texture of food, the speech and language therapist will assess your child’s chewing and swallowing. You will then have the opportunity to attend a workshop with the speech and language therapist, to explore strategies that you can try at home.
If your child’s eating difficulties are a symptom of more general difficulties with managing anxiety, you might be invited to a workshop aimed at helping your child manage difficult feelings.
If you or someone else is really worried that your child’s eating difficulties are affecting their health, they may be reviewed by a paediatrician or referred to a dietician to make sure they are growing and have all the nutrients they need. The dietitians are based at Sheffield Children’s hospital and your GP or paediatrician will be able to refer your child to them.
Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.
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