Sunday, July 21, 2019

How to feed a child with autism

The child does not eat anything: selectivity in food or developmental feature?

80% of children with developmental disorders have problems with eating. There may be very different reasons behind this - both physical (for example, difficulties with chewing, swallowing) and associated with food selectivity. How to help such children? For Russia, this topic is quite new. The situation in the United States, where much attention is paid to the study of autism spectrum disorders (RAS), is slightly better. The Naked Heart Foundation for Children, which works to create a free services system for families raising children with special needs, invited Valeriy Volkert, the director of the children's eating disorder Marcus Center at Emory University to discuss this issue.
Also Read: How to Teach Your Baby to Fall asleep.

How often do nutritional problems occur in children with special needs?

Often, children with special needs are very selective in eating. This interferes with parents but does not affect the physical development of the child. But there are more severe eating disorders. For example, a child generally does not take food and water through the mouth and receives it through a gastrostomy tube or a probe.
At the same time, problems with nutrition and, for example, autism should be very carefully linked. If a child does not eat well, this does not mean that he has autism. We, experts, do not include feeding problems as diagnostic criteria for autism. But if we are talking about a number of symptoms that indicate rigidity, inflexibility in behavior, including excessively high food selectivity, this may indicate autism.
And here I would pay attention to one more moment. If a child prefers not too healthy food, for example, semi-finished products with high carbohydrate content and at the same time refuse vegetables and fruits, then in kindergarten or school, this child may have problems with learning because of an unbalanced diet.
Eating is a very important and multifactorial process that can be disrupted for a variety of reasons. Therefore, the successful solution of this problem may require the knowledge and efforts of various specialists - gastroenterologists, nutritionists, physical and occupational therapists, as well as specialists in the field of applied behavioral analysis.

When should a child learn to eat by himself?

We expect the child to eat on their own by two years. If this does not happen, then there may be a lack of self-help skills, a lack of motivation, or both factors together.
The process of self-eating seems simple and natural, but actually consists of many stages: you need to want to eat at all, then take a fork or spoon in your hand, scoop up the food with a spoon or chop it on the fork, bring the device to your lips, put in your mouth close your mouth, chew and swallow.
To teach a child to eat on their own, you need to understand which of the stages of eating have difficulties. I would recommend using physical hints - for example, hand support at all the steps described.
But there are children who have all the necessary skills for eating, but for some reason, they do not want to do this. This may be due to a lack of hunger. Or maybe, for them, unlike us, food is not at all something pleasant — that is, reinforcement.
Of course, to teach a child to eat independently, you can use various reinforcements (something that motivates, interests a child) - toys, cartoons, etc. It is important to change the consequences (what the child gets) depending on whether he ate or notate the food.
First, we propose, for example, independently eat a spoonful of yogurt. It is worth noting that the more food on a spoon, the less likely that the child will eat it. About 5-10 seconds are allocated for independent food intake. If the child does not do this, then the adult gives him three to five spoons in a fairly fast mode. If suddenly a child is sick (and this is not related to a medical reason), then it is worth responding calmly, not focusing on it, not making comments or comments, washing the baby, but then continuing the feeding process. If the child is sick of only one type of certain food, and everything else he eats calmly, then this type of food should be abandoned and replaced with something else.

How to teach a child to keep food in the mouth, swallow and chew it?

There are special methods that teach a child to keep food in the mouth, for example, serving food with a spoon overturning. First, hold the spoon with food straight, bring it to the mouth, then place it in the middle of the tongue, press on the tongue with the back of the spoon, then turn the spoon 180 degrees in the middle of the tongue, the food remains in the mouth, and remove the spoon from the mouth.
Also, for some children, food in the mouth helps to keep the chin support. After all, very often children with problems in eating eat with their mouths open, with their heads tilted down, and then the food itself falls out of the mouth.
A child with chewing difficulties may try to swallow before eating, try to stretch the food, pressing it with the tongue to the sky. To avoid this, it is necessary, as soon as the food gets into the child’s mouth, to say to him: “Chew five times” (or more, depending on the consistency of the food). It is necessary to explain what needs to be done. In the process of how a child chews, we loudly think: "One, two, three ..." If the process was a success without an additional hint, we praise the child very much.

What other approaches for children with eating disorders do you use?

It is important to adhere to the following rules:
  • Avoid reinforcement of unwanted behavior in the child when you refuse to eat (do not remove the food and do not remove the requirement to eat if the child shouts, turns away or tries to throw out the food);
  • insist on eating, praise and encourage the child if he begins to eat;
  • maintain an adequate feeding rate (not too fast, but not too slow, so that the baby is not distracted).
At the beginning of the aid program, the amount of food that the child needs should be capable of, the texture of the food should not radically change. Keep a clear schedule of meals (the duration of one should not be more than 30 minutes). Limit the child’s walk with food — use high chairs. Remove the distractions - TV, tablet, etc.). Show a positive example and do not demonstrate that you don’t like some products - children copy it instantly. As often as possible, offer children new tastes and new types of food. New products enter in small portions.
You can also use the strategy of simultaneous delivery of two types of food: for example, if a child loves ketchup, then food is poured over them, which he does not particularly like so far. Another way to get your child interested in new food is to mix food: for example, add a little unloved carrot to your favorite apple sauce. First, the proportion of 90% apple and 10% carrot, gradually the proportions change, and the number of carrot increases.
Another strategy is a sequence of tasks with a high probability of accomplishment: an adult gives a child a series of preferred foods and then gives an unpredictable type of food. For example, cracker, cracker, cracker, and then - broccoli.

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