Problem Feeders

Parents can become overwhelmed and frightened when their child refuses to eat. Many struggle at mealtime, hoping to find a way for their child to eat and drink without resistance. To best address these challenges, we need to discern if the child is a problem feeder, learn why they are not eating, and provide avenues for parents to get professional and medical guidance, if necessary.

Some signs and symptoms of problem feeding are:

• eating fewer than 20 different foods
• taking too long to eat (generally over 45 minutes)
• refusing food
• vomiting, gagging, or choking when eating
• inappropriate behaviors surrounding mealtime (e.g., hitting, kicking, throwing food)
• refusing entire categories of food textures or food groups
• tantrums when presented with new foods
• refusing to eat a once-favorite food and never reinstating that item back into his food inventory
• medical complications leading to poor growth

While eating fewer than twenty different foods or taking longer than 45 minutes to eat can be signs of feeding problems – these are not uncommon behaviors for a child with autism; typically, additional symptoms are present with problem feeders. For example, if a child ate fewer than 20 foods and took a long time to eat but was generally happy and not gagging or crying at meals, then the child may not be a problem feeder. And, as Julie points out in her article, many children with limited diets (who are not problem feeders) often expand their eating choices once diet changes are implemented.

Here are some of the reasons why a child may become a problem feeder:

• The child may have a feeding or swallowing disorder(dysphagia).
  • Are they having difficulties with eating and/or sucking, chewing, and swallowing different foods safely into their stomach instead of their lungs (aspiration)?
• The child may have medical complications.
  • Are they dealing with gastrointestinal issues such as gastroesophageal reflux (GER), constipation, pain, diarrhea, or inflammation?
• The child may have food allergies, addictions, nutrient deficiencies, or microbial overgrowth concerns.
  • See the current article “Help for Picky Eaters” and the earlier “Diet for Autism” column article titled “Food Allergens, Sensitivities, and Substitutes” (Winter 2008).
• The child may have low tone, sensory, or oral-motor delays.
  • Are they drooling, unable to touch different textures, or having difficulties moving their articulators (tongue, jaw, teeth, and lips)?
• The child may have fears.
  • Are they dealing with neophobia (fear of foods) or phagophobia (fear of swallowing)?
• The child may have daily medications.
  • Are the side effects of these medications poor appetite, constipation, or inability to feel hunger or thirst?

If you think that you may have a problem feeder in your home, you’ll need to address the underlying medical conditions that are affecting the problem. Seek out a feeding therapist certified in several different feeding programs such as The Get Permission Trust Approach to Mealtimes and Sensory Treatment by Marsha Dunn Klein, MEd, OTR/L and the SOS Approach to Feeding by Kay Toomey, PhD. Your feeding therapist should have extensive training in the anatomy and physiology of the swallow, be skilled in identifying and ruling out aspiration, and have experience with the biomedical approach and the positive outcomes of autism diets. A speech language pathologist or occupational therapist is generally the trained medical professional who diagnoses, treats, and specializes in the area of feeding and feeding disorders.

You may be empowered by the gains your child makes with feeding therapy as improvements in overall nutrition and diet compliance improve. You might even bring back some fun at the dinner table while working from picky to plenty. Happy eating!