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Food Aversions and the Gut/Brain Connection
GUT-BRAIN Connection to eating problems in children:
Feeding problems: it is a no brainer that these children have feeding problems and gut digestion problems, think about the connection they have to food...not a pleasant experience! Psychologically, feeding is a bad time for them...
Common problems: limited number of foods, texture preferences and aversions, unusual mealtime habits (self stimulation, has to be in a certain container, has to be from a certain restaurant, rituals)
How to help:
Get them comfortable with the environment first. Sit at the table and color, play, watch the noise level, the stimulation, etc.
Gradual progression (put the table in a more comfortable environment)
goal to sit for longer periods at the table, without food, gradually add in things such as utensils, plate, cup, then last is food! Don't overwhelm or overstimulate them at meal times, gradually add in everything...'
Reward for food acceptance, sitting at the table, touching foods for fun, etc.
Play time with foods is essential...
Let the child be in more control of the situation (learn to feed themselves and be in control)
Don't feed a 5 year old and watch what you feed them (mush: oatmeal, baby food, etc.)
Common myths:
1. If a child is hungry enough he will eat. NOT TRUE WITH AUTISM AND SID problems. A therapist in Denver is being sued because she recommended that the mom take away foods and the child should eat what everyone else is eating. The child did not eat for 3 weeks, in hospital for renal failure.
Difference in Picky eater and a problem feeder:
Picky eater: decreased variety of foods less than 30 foods. Foods lost due to burn out regained after 2 weeks, able to tolerate new foods on plate, touch, and taste. Eats at least 1 food of each texture, adds new foods after 15-25 tries or seeing the food.
Problem eater: less than 20 foods eaten, foods not regained once burned out, falls apart when presented with new foods, refuses entire category of textures, adds new foods in more than 25 tries.
Problem eaters are this way because of:
Physical: pain, discomfort, nausea, stool issues, allergies, sensitivities, intolerance
Motor: delayed self feeding, over stuffing, choking, delayed chew, tongue, swallow coordination
Sensory: texture hypersensitivity, oral hypersensitivity, oral aversion, sensory processing problems, auditory (hurts to hear the crunching sounds, or the sounds in the meal room), too stimulating
Behavioral: hyperactive, low frustration tolerance, highly distractable, need for routine, impaired social interactions. If they can't sit in a chair any other time, why would they sit there to eat for 15 minutes or longer?
Impaired social skills: eating meals is very social, they have to answer questions, look at others, possibly touch one another...
Parenting factors:
poor reinforcement, use positive reinforcement only!
Social modeling (parents must be sitting for the meal and making good food choices as well)
don't be inconsistent: need structured meals (PECS or visual calendar is very helpful of course)
organized household
NOT allowed to graze all day long
Home based treatment:
Pre-requisite:
identify and treat GI problems (without medicine or band-aids, get to the real problem)
Evaluate motor, oral motor and swallowing skills and treat this area
Evaluate and treat Sensory Integration processes
Conduct a Behavioral Functional Assessment
Get the parents involved in doing it themselves to model your therapists behavior
Develop an individualized intervention plan
General tx strategies: with any child these can be done!
1. Social modeling: the family eating together, not the child eating separately from the child. Have the family come for part of the meal, so there is an overlap of time together if SI issues.
2. Structure meal and snack times: NO MORE GRAZING. Sit down for eating together at set times in the day.
3. Manageable foods: look at the plate, don't put more than 3 foods at a time, 1 tblsp for each year of age and no more! They become visually overwhelmed!
4. Positive reinforcement: don't say don't, say "do this..."
5. appropriate mealtime language: words mean a lot, don't beg them to take foods (they will take control and say "no") children with disabilities will control with their mouth.
6. prevent "food jags": real problem with these children...eat the same thing over and over, all of a sudden they stop eating that food and never go back to that food. When it comes back they see it as all new food again, so they get smaller diets. Suggested that from early on, do not give the same food more often, every other day, and change the foods shape, what is with it, etc.
Steps to eating: Introduce food in play away from meal time first...one food at a time...
1. Tolerate: the food is in the room with them, the food is on the other side of the table, being 2 way on table, with food in front of the table, look at the food directly in front of food.
2. Interact: assists in preparation, uses utensils to stir or play with the food, uses utensils or containers to serve self
3. Smells:
4. Touches: play!
5. Taste: spit bucket handy
6. Eat & swallow
Remember, a child has to interact with a food about 20 times before they will eat it usually!
When they aren't ready for the next step they use escape mechanisms such as tantrums, run away, scream, be goofy, make you laugh, get another toy...
What is appropriate mealtime language: Choose to ....
And parents and therapists need to remember that:
Feeding problems are not a sprint, a marathon, enjoy the successes along the way!
The SOS (Sequential Oral Sensory) Approach to Feeding notes:
Once the child can tolerate BEING at the table with a food (you have successfully played with a food and they can tolerate being near it) then do the following:
1. do not EVER let the child see the package or container that the food came in, always put it in a ziploc bag, or clear container&they will start to associate the container with the food soon, and then will only eat foods out of that exact container.
2. Do not ever force feed
3. Always make it fun and non stressful
4. Provide a lot of deep pressure touch through massage or brushing and calming choices at mealtime
5. Use a white plate, and white napkin to present foods
6. Let the child cover up the food with the napkin if they don't like it but offer another way to interact with it through play, it is good in this sense to play with your food!!!!
Give the child a "SAFE FOOD" this is a food that they normally eat and enjoy such as chicken. Introduce a new food that is either the same color or the same texture to that child with the safe food, such as chicken with apple chips close to the same color, other examples: green beans and green snapeas (baked snapeas), or potatoe chips and the same color of dried fruit such as pineapple or banana, or green beans and peas, carrots and sweet potatoes
It can be the same color, shape, or texture as the "safe food". Keep talking about how the two foods are the same all through the session and mealtime. Even making PECS and do a matching game of those that are the same. The idea is the convey that the new food is also safe, because it is the same as the food they normally eat.
Save chewy or sweet foods and any drinks for after the meal is eaten only, do not let the child fill up on snacks, juices, milks, or other drinks or snacks in between meals. Make meal time a priority 3 times a day to sit and work on skills. Sweets, drinking, and chewy foods fill the child up quickly, but make them hungry again without giving them the nutrition their brains and bodies need. Then they learn to snack, graze, and drink to get calories instead of eating well balanced meals.
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