SB is a picky eater. I know, I know, lots of kids are picky eaters. But kids with autism can take the word “picky” to a whole new level. Many people over the last 6 years, some parents and some not, have given me this advice: “Oh, just keep offering him healthy foods, and eventually he’ll get hungry and eat.” This is very bad advice. When SB was at his worst with his eating, I was warned by several doctors to NEVER “starve out” a child with autism, because they will end up in the hospital. I have also met several parents with autistic children that had to be put on feeding tubes because they just refused to eat. Eating issues can be very serious. For some kids, the issues are sensory. Maybe they can’t stand to eat crunchy foods, or soft foods. One of SB’s former therapists worked with a child who would only eat foods that were orange. I don’t believe SB’s problems were sensory, though. He ate a variety of tastes, colors, and textures. I think his problem was an irrational need for sameness and a huge fear of any food that was unknown.
When he was 2, SB would eat exactly 5 things: chicken nuggets (only the oval-shaped frozen ones from Tyson. No funny shapes, and not even McDonald’s), Goldfish crackers (the original cheddar only – don’t even think about giving him those funny colors or “Flavor-Blasted” anything), applesauce (just plain and yellow), bagels with cream cheese (cinnamon-raisin bagels only, and don’t you dare try to top them with butter), and peanut butter and jelly sandwiches (there are to be no chunks of fruit in that jelly, and the sandwich must be cut into rectangles, NOT triangles.) Strangely, he didn’t seem to mind eating the bread crusts of his sandwiches like most kids do. He would drink one thing – milk, and it could not be skim. You also could not combine any of the items from these foods, such as cream cheese on a piece of sandwich bread, cinnamon in the applesauce, or jelly on a bagel.
I knew that a good Mommy would not let him eat chicken nuggets for dinner forever, so I tried to introduce new things to his plate. But when I say that he wouldn’t eat new things, I don’t mean that he would sit at the table quietly and not put other foods in his mouth. If I put something on his plate that was unacceptable, there would be screaming, there would be crying, there would be tantrums, and there would most definitely be food on the floor, and sometimes the walls as well. For many months we didn’t dream of taking him to a restaurant. Mealtimes became a terrible ordeal for me, making me feel incredibly stressed, unsuccessful, and hopeless. I would either give him what he liked and feel bad that his diet was so narrow, or give him something he didn’t want, watch him refuse to eat it, and suffer the tantrums, still feeling bad that his diet was so narrow. It was pretty much lose-lose.
I tried lots of different things to try to fix this problem. First, I went online to search for books or articles about picky eaters. There are hundreds of articles out there about what you should be feeding your kids: fruits and vegetables, whole grains, lean proteins, blah blah blah. Are there really that many people out there who don’t understand the food pyramid? Of course I knew what foods he should be eating. I needed advice on how to get him to put these foods into his mouth. Anything I came across that was not simply a list of healthy foods was about how to make healthy eating “fun,” such as making happy faces out of your sandwiches using raisins and carrot sticks. I was pretty darn sure that any raisins I gave to SB were going to end up smashed into the carpet.
The pediatrician suggested that I make an appointment with a nutritionist. That sounded reasonable, so I went. What a huge waste of time that was! She handed me a few printouts from the internet about the food pyramid, which I tucked away, trying not to let her see me roll my eyes. I attempted to explain to her my dilemma and how difficult and stressful every single mealtime had become. She asked if SB ate with the rest of the family at the table so that he could model our behavior, because sometimes people feed their toddlers separately and they never get to watch their parents eat. Yes he does, I told her. That was her only real piece of advice. She then started listing foods she thought I should try. “My son likes waffles. Oooh, and tacos! Have you tried tacos?” That’s when I started to collect my coat and purse. Clearly, this person did not know how to help me.
Another idea that seemed good at the time but didn’t work at all was Jessica Seinfeld’s cookbook called Deceptively Delicious. The concept of her cookbook is to hide vegetable purees in your recipes, so that your kids get the nutrients of vegetables without knowing that they are eating them. I saw her promoting her book on the Oprah Winfrey show, and I was sold. She had made chicken nuggets with sweet potato puree, macaroni and cheese with butternut squash puree, and brownies with spinach puree, and had a whole classroom of first graders gobbling them up enthusiastically. So I bought the book, and made the chicken nuggets. I’m not really sure what made me think SB would actually eat them, since they didn’t look like anything he had ever eaten before. Maybe it was because of Oprah Winfrey. Maybe she is some sort of witch, using her supernatural powers to influence people by making crazy ideas seem perfectly reasonable. (I once insisted that my husband help me paint stripes on the walls of our living room because I saw it done on Oprah’s show.) I made several of the recipes in that cookbook, and they were all a bust. Not one bite.
So what finally helped? SB was in a special ed preschool at the time called PAC, which stands for Preschool Autism Class. His teacher during the 2008-09 school year (he was now 3 years old) noticed his narrow diet and decided to help us do something about it. Her approach followed the principles of ABA therapy, which stands for Applied Behavioral Analysis. (ABA is a scientifically-proven treatment for people with autism. It breaks down any task into the simplest of steps, and then teaches each of these steps to the child using frequent rewards for success. If that doesn’t make any sense, think of how Helen Keller’s teachers taught her to communicate – it’s a lot like that.) She and her classroom aides would take the class to the cafeteria, and buy the school lunch for SB and a few other children. (SB was not the only child in the class who needed help with this.) The first thing she would do is put his milk out of his reach. He could not have free access to that! Then she would offer him a choice of 2 things, neither of which he liked. “Would you like a bite of rice or a bite of peaches?” “MILK!” he would cry. “You may have some milk after you eat a bite of rice or peaches. Which will it be?” After a few struggles, and because she was not his Mommy and so therefore could be emotionally detached about the whole thing, he would eventually choose one of the foods. He would complain and cry and make faces, but when it finally went into his mouth, he was allowed a few sips of milk. The entire meal went like this. Every day. There was no way that she could sit and enjoy a meal at the same time, but she didn’t have to. Her lunch break was later. I watched one day with my mouth hanging open. How incredibly tedious and frustrating! But over the course of that school year, with her help and using the same principles, I was slowly able to introduce a few other foods into his diet at home that he had eaten at school with only minimal complaining and tantrums.
One place I have seen this type of approach in print is in the book A Work in Progress by Ron Leaf and John McEachin. I once heard Dr. Leaf speak about eating habits (and also toilet training) for kids with autism, and I thought he was excellent. One of the things his approach suggests is that you only introduce new foods that are very similar to the foods your child already eats, and expand his diet very gradually. He said something during his lecture that made a big impression on me. Forgive me for paraphrasing, but it went something like this:
I know you all want your kids to eat vegetables. Vegetables are very healthy. But if your kid will only eat M&M’s, (Dr. Leaf had worked with a child who did just that) then I am not going to try broccoli as the first new food. It just won’t work. If the child will eat nothing but M&M’s, then the first new food I am going to introduce is Reese’s Pieces.
That was the moment I realized that expanding SB’s diet was not going to take weeks or even months. It was going to take YEARS.
I think the hardest thing about getting SB to eat was that it was such an emotionally charged issue for me. I had a very difficult time being rational, and I took it so personally when he wouldn’t eat, especially if I had worked hard to cook the meal. So if you have a child with autism who has eating issues and you decide to tackle the problem, I suggest you don’t do it alone. Get an ABA therapist or an Occupational Therapist, especially if you think the issues are sensory, to help you come up with a plan of action.
It is now 4 years later, and SB is still picky. His diet is still narrow, but it is better than it used to be, and gets better each year. I can’t remember the last time he threw his food onto the floor. He is now willing to take one bite of just about anything, which I see as huge progress. He still cries and complains a lot about having to take that bite, and sometimes his brother does, too. (They still talk about the horror of “June 23 – the day Mommy made us eat couscous!”) And corn is the only vegetable I can give him in a reasonable-sized portion of without hearing, “But I don’t LIKE ____!” Oh, and I still wouldn’t dream of allowing my kitchen to be depleted of either chicken nuggets or Goldfish crackers. But I believe it will continue to get better if we keep working on it. Patience eventually pays off.