October 4, 2018
Today I met with Barclay’s amazing team of therapists. They looked over the data I had been collecting and based on that we made some goals.
Goal One: The first goal is to get him hungry. At this point, Barclay seems either too active or distracted to recognize he’s hungry or the or the grazing is keeping him satiated enough. We are going to establish set routines and times for meals and snacks as opposed to pushing food on him all day. Hopefully with more time between eating, he can begin to feel hunger at meals and eventually increase the volume of food. This is the main goal for home.
Goal Two: Encouraging Barclay to eat a wider variety of foods. Barclay eats macaroni and cheese every single day for lunch at the center where he is in his ABA program. Even when I have attempted to replace it with foods he does moderately tolerate he refuses them. At lunch the therapists will now start the meal with moderately preferred foods, such as oatmeal and raisins. Then after a set time, he can then have the macaroni and cheese. They are also going to push back when he normally eats by about 45 minutes to increase his hunger which hopefully will make him more willing to eat what he’s initially offered. Once we move some of his moderately preferred foods to the highly preferred category then we will try to move some foods he used to tolerate and now doesn’t to the moderately preferred category by using the same strategy. I created the graphic below to explain this a little better.
Preferred Food Tiers
Think about the food your child eats. Tier 1, the green tier, would be foods they eat willingly most of the time. For us, mac and cheese would be in that category. Tier 2, the yellow tier, would be foods they eat willingly sometimes. Barclay will eat chicken nuggets only if he’s really hungry and only if a highly preferred food isn’t available. Tier 3, the blue tier, would be foods the child used to eat, but now refuses. Barclay used to eat blueberries and now he refuses to eat them. Tier 4, the red tier, are the child’s food aversions. These are foods the child never has liked or has always had an aversion to. The goal here is to look at those foods a little more closely to find out why. Barclay has an aversion to extreme temperatures in food. He won’t eat ice cream or popsicles or foods most people prefer warm like soup. So if I serve him soup at room temperature he will eat it. The aversion isn’t the taste or texture, it’s the temperature. If a child doesn’t like crunchy apples but will eat applesauce or baked apples then you know the aversion isn’t the taste, it’s the texture. Taste is a little harder to overcome and sometimes people never do. It can even be body chemistry. Some people can’t tolerate the herb cilantro because a gene in their body makes it taste unpleasant to them. Also, sometimes a child may have an aversion to a food they have an intolerance or an allergy to. For example, they may be lactose intolerant and diary foods may make them not feel well. This would be why they refuse them. So it’s so important not to keep pushing the foods they have an aversion to until you really analyze and figure out why.
I took these four categories and made a list in each one of the foods that fit Barclay’s current eating habits. Now the goal is to slowly move as many foods as we can into Tier one. We are going to start with foods in Tier 2. Today was super successful. When he woke up from his nap I didn’t let him have a snack to build his hunger. After a few hours I was surprised when he asked for peaches. Canned peaches are a highly preferred food for him. Had I given him peaches he would have eaten them and it would have been hard to get him to eat anything else. So instead, I served him chicken nuggets and corn on the cob which are Tier 2 foods for him. I also made him sit in his high chair so he was focused. To my surprise he ate it all! Then after I let him have the peaches which he also ate all of! This was just the first day of addressing his restrictive eating and I am already thrilled with the results! He consumed more food in one sitting than he has in a very long time!
If your child is struggling with restrictive eating hopefully the steps above will help give you some ideas. It is so far working for us!