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How to Handle Feeding Difficulties
By Beverly Resurreccion


According to an article published in Pediatrics in Review (Phalen 2013) as many as 80% of children with developmental disabilities may present with feeding difficulties. In children with autism, feeding difficulties can include limited intake, food or fluid selectivity (i.e., preference for only specific types of food or beverages), problem behavior associated with mealtimes, and food refusal. Like most concerns that arise with a child’s behavior, feeding difficulties can vary greatly in their presentation, intensity, and severity. Before treating your child’s feeding difficulties, it is important to understand and/or rule out any underlying medical concerns, such as dental issues, allergies, oral-motor skill deficits, swallowing difficulties, and effects of medications on appetite. Once these concerns have been addressed, there are some strategies you can use at home to work on improving your child’s feeding and mealtime behaviors.

•Model the behaviors you want to see: Take a bite of the food you want your child to eat and say something about how yummy it is!
•Offer choices: Present your child with a choice between two different foods, both being foods you want your child to consume. For example, if you’re working on introducing vegetables into your child’s diet, present a choice between a bite of peas and a bite of carrots and let your child choose which bite to take.
•Use first/then language: If your child has a preferred food he or she would like access to, present the novel or non-preferred food and say, “First carrots, then French fries.”
•Follow through with contingencies: When you state a rule (e.g., using first/then language), ensure you are ready to follow through. If your child does engage in the target behavior, make sure to deliver the highly-preferred food immediately. If your child does not engage in the target behavior, do not deliver the highly-preferred food. This may mean delaying access to the highly-preferred food or identifying another way for your child to gain access to it.
•Select novel foods based on your child’s preferences: If your child already consumes food of a specific texture, flavor, or color, try introducing foods similar to that food. For example, if your child likes plain apple sauce, you might try strawberry or cinnamon flavored apple sauce. Or, if your child eats white American cheese, white cheddar may be a good option.
•Allow eating to occur only in specified locations within the home: If your family typically eats at the kitchen table, present food only at the kitchen table. Do not allow your child to take food away from the table; if he or she wants to get up, the food should remain at the table.
•Use your child’s rigidities to your benefit: If your child has a preferred plate, bowl, or other container or preferred eating utensils, try presenting the novel food with those preferred
In addition to these helpful tips, there are also a few strategies that are best avoided when addressing feeding concerns.

•Allowing your child to graze throughout the day: If your child has free-access to highly-preferred foods all day, he or she will likely not be hungry at mealtimes. In addition, those highly-preferred foods will be less valuable for use in the first/then strategy if your child has access to them all day.
•Using distractions during mealtimes: Although it may seem helpful to allow your child to watch movies or play with toys during mealtime, children can become dependent on having access to these items to eat. They can also be distracting to your child, making mealtime last longer.
•Having negative conversations about food: Especially during mealtimes, keep conversations about food positive. For example, a sibling talking about how disgusting something looks, tastes, or smells could be detrimental to your child’s feeding.
•Trying to “trick” your child: Although mixing preferred and non-preferred foods can be a helpful approach when done in a systematic fashion, it’s best to avoid trying to trick your child into eating a non-preferred food by hiding this food in something you know your child will eat.

Feeding difficulties can be frustrating, especially for families whose children present with a variety of other behavioral and developmental concerns. With the support of trained staff, addressing these difficulties can be more manageable and efficient. If you and your family could benefit from support with implementing an intervention for your child’s feeding difficulties, contact us today!

*In some children, feeding difficulties can become severe and are considered feeding disorders. These cases are typically treated in in-patient facilities that specialize in pediatric feeding disorders. Referrals are available for these services if your child requires more intensive support.