A Beginner’s Guide to Feeding Therapy for Autism

A Beginner’s Guide to Feeding Therapy for Autism

Many autistic people have sensory sensitivities (also known as “sensitivities).  When most people think about sensitivities, they think of bright lights, loud sounds, or itchy clothing.  However, food can also be a sensory challenge for autistic people.  The taste, texture, smell, or even the look of certain foods can make eating difficult for autistic people.

Many children go through a picky eating stage.  However, autistic children may have much stronger food preferences.  They may have a few “safe foods” that feel comfortable to them – foods they prefer to eat, often to the exclusion of other foods.  While these foods may be familiar and offer a predictable sensory experience, they may not provide all the nutrients a growing child needs.  In some cases, autistic children can restrict their food intake to the point of vitamin deficiencies or malnutrition.  When this happens, something must be done to increase intake of diverse foods.  That is where feeding therapy comes in.

Why Do Autistic People Struggle with Eating?

There are many reasons why autistic people may have trouble with eating.  As discussed above, one of the most common reasons is sensitivities.  Some foods may have a texture, taste, smell, appearance, or temperature that feels uncomfortable or overwhelming.  For example, a child may prefer soft foods but refuse soft foods that have a strong smell or gritty texture.

Additionally, many autistic people prefer predictability and routine with their food.  Eating the same foods or the same brand of food can feel comforting because the taste and texture stay the same each time.  There is no stress because those foods will be the same each time they are eaten.  For example, the texture and flavor of chicken nuggets from a specific brand will always be the same.  On the other hand, the texture and flavor of tomatoes can change tomato to tomato – some are soft, squishy, and watery, while others are firm and acidic.

Some autistic people may also struggle with recognizing hunger or fullness cues.  They may forget to eat because they do not feel hungry, or they may continue eating because they do not feel full.  A feeding therapist can teach strategies to help, such as eating on a regular schedule or learning ways to recognize hunger and fullness cues.

Finally, some autistic people have medical conditions that can make eating uncomfortable.  These may include acid reflux, constipation, and food allergies or intolerances.  While feeding therapy does not treat these medical conditions, a feeding therapist can work with families to develop eating habits that make mealtimes easier and more comfortable.  A healthcare provider can also help diagnose and treat any underlying medical problems.

What is Feeding Therapy?

Feeding therapy is a type of treatment that aims to help children become more comfortable with a wider variety of foods. It is often provided by an occupational therapist or a speech-language pathologist who has experience with feeding challenges.  The key parts of feeding therapy include sensory desensitization and behavioral intervention.

Sensory desensitization aims to expose the child to different tastes, textures, and smells of food with the aim of increasing the number of “safe foods” for the child.  Slowly introducing these different foods reduces anxiety and helps children feel more comfortable when trying new and different foods.

Behavioral intervention works on building healthy eating habits.  These strategies are different for every child and can include using rewards for trying new foods, creating regular mealtime routines, limiting snacking before and after meals, and maintaining a distraction-free eating environment.

How Do I Get Started with Feeding Therapy?

If you think your child may benefit from feeding therapy, talk with your child’s healthcare provider.  They can help you find a licensed occupational therapist or speech-language pathologist who specializes in feeding.

If feeding therapy is not available in your area, there are still ways to practice healthy eating habits at home.

Encourage your child to explore a new food before trying it:

Learning to enjoy a new food takes more than just tasting it.  For many autistic children, a food’s smell, texture, appearance, or even the uncertainty of trying something unfamiliar can feel overwhelming.  Giving children the chance to explore new foods before eating them helps make those foods feel more familiar and predictable.  As children become more comfortable looking at, touching, smelling, and playing with a food, their anxiety often decreases, making it easier to eventually take a bite.  The goal is not to pressure your child into eating new foods right away, but to help them build confidence and positive experiences with food over time.

• Encourage your child to explore a new food before trying it. Start by asking your child to look at new foods, then move to smelling the food, then touching the new food with their tongue, and then taking a little bite of the new food.  You may have to space this process out over several days, but it will give your child time to become more comfortable with the food.

• Encourage your child to interact with their food. Giving your child opportunities to interact with their food helps them build familiarity with new foods without the pressure to eat those foods.  To help your child explore new foods, you could ask your child to help wash fruits and vegetables that will be part of dinner.  You could ask them to help make dinner by stirring ingredients together.  You could even let your child make food art!

• Introduce new foods that are similar to what the child already likes. Children may be more open to trying a variation on a favorite food than trying an entirely new food.  For example, if the child likes plain crackers, try whole wheat crackers.  If they like vanilla yogurt, try strawberry yogurt.

• Encourage a “three-bite rule.” If your child is comfortable doing so, encourage them to try at least three bites of a new food.  Three bites mean that the child will get to try something new, but there won’t be any pressure to keep eating after three bites.

Make mealtimes more positive:

Mealtimes should be a time for families to connect, not a source of stress or conflict.  When children feel pressured to eat foods they are not comfortable with, they often become more anxious and even less willing to try new foods.  Creating a positive mealtime environment helps children feel safe, reduces anxiety, and builds trust around food.  Over time, these positive experiences can make children more willing to explore new foods and develop healthy eating habits.  The goal is not to “win” a battle over food, but to help your child build a positive relationship with eating that will last a lifetime.

• Praise or reward your child for trying a new food or showing positive mealtime behaviors – even if they only try a small piece of the new food, progress is progress! Celebrating small wins encourages your child to keep trying.

• If possible, see if you can figure out why the child likes the foods they like and dislikes the foods they dislike. Think about the sensory aspects of food – Do they like crunchy food and dislike cold food?  Do they like salty food and dislike foods with a strong smell?  Use that information to guide food choices.  For example, if a child likes crunchy foods like Doritos, they might be open to trying crunchy carrots or crunchy crackers.  If they don’t like food with strong smells, you’ll probably have more luck getting them to eat if you don’t use garlic or a lot of spices in their food.

• Offer the child choices about what to eat. Offering the child choices about what to eat gives them a sense of control, keeps mealtimes from becoming unpleasant, and makes the child more likely to cooperate.  As a few ideas, you could offer the child a choice between carrots or cucumbers for dinner.  You could also ask them if they want to eat dinner on a red plate or a yellow plate.

• Keep mealtimes positive. If children know that they are going to be forced to eat food that they don’t like at mealtimes, they will start to dislike mealtimes.  Which, will make mealtimes unpleasant for everyone involved.  To keep mealtimes positive, don’t force a child to eat.  Encourage them to try new foods, but if they refuse a food don’t force the issue.  Also, if a child isn’t quite ready to try a new food, praise exploration of the food.  Remember: pressuring a child to eat increases mealtime anxiety and food refusal.

Make mealtime predictable:

Many autistic children thrive on routine and predictability.  When mealtimes are unpredictable, children may feel anxious or overwhelmed before they even sit down to eat.  Creating a consistent mealtime routine helps children know what to expect, making meals feel safer and less stressful.  As children become more comfortable with the routine, they may be more willing to participate in mealtimes and explore new foods.

• Use visual supports are mealtimes. Before meals, show the child (using written words or picture cards) what foods will be served, what order the food will be served in, and what’s expected of them.  Knowing what to expect can help reduce how anxious a child feels about mealtime.

• Build structure around eating. That may mean eating at the same time every day and limiting snacks between meals.  Eating at the same time everyday helps children create a routine around eating.  Limiting snacks will make your child more motivated to try new foods at mealtimes.

Remember that every child is different, and learning to try new foods takes time. That’s okay. The goal is not to make your child eat every food. The goal is to help them feel safe during meals and more comfortable trying new foods. Even small steps are signs of progress.

When to Ask for Help

Many children go through phases of being picky eaters, and these phases often improve with time.  However, some feeding problems need extra support.  Talk with your child’s healthcare provider if your child eats only a very small number of foods, suddenly stops eating foods they used to enjoy, is losing weight or not growing as expected, gags or chokes often while eating, or seems to be in pain during meals.

You should also ask for help if mealtimes have become stressful for your family or if your child’s limited diet is making it difficult for them to get the nutrients they need.  Your child’s healthcare provider can help determine whether there is a medical reason for the feeding difficulties and, if needed, refer your child to a feeding therapist or registered dietitian.  Getting help early can make it easier to address feeding challenges before they become more difficult to manage.

Take Away

Food sensitivities are common in autistic people and can make eating a healthy variety of foods difficult. Feeding therapy can help children become more comfortable with new foods while building healthy eating habits. Working with a trained professional is often the best approach, but families can also use simple strategies at home to support their child’s progress. With patience, encouragement, and the right support, many children can expand the foods they are willing to eat over time.

Article by: Kaitlyn Bennett and The Autism ToolKit

Sources:

Esposito, M., Mirizzi, P., Fadda, R., Pirollo, C., Ricciardi, O., Mazza, M., & Valenti, M. (2023). Food Selectivity in Children with Autism: Guidelines for Assessment and Clinical Interventions. International journal of environmental research and public health, 20(6), 5092. https://doi.org/10.3390/ijerph20065092