So My Child is a Problem Feeder What Next?

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1 So My Child is a Problem Feeder What Next? Registered & Licensed Dietitian Nutritionist Certified LEAP Therapist LEND (Leadership Education in Neurodevelopmental Disabilities) Fellow Sibling of an individual on the Spectrum Private Practice: Autism Dietitian Registered & Licensed Dietitian Nutritionist Certified LEAP Therapist LEND (Leadership Education in Neurodevelopmental Disabilities) Fellow Sibling of an individual on the Spectrum Private Practice: Autism Dietitian Conflicts of Interest Agenda No conflict of interest to declare. RECAP: causes of selective eating + picky eating vs problem feeding Define feeding therapy & help with building a feeding team Review helpful tips for selective eating Identify nutrient deficiencies (& how to fix them!) Review food sensitivities (& how to test for them!) 1

2 Selective Eating Children with ASD more likely to avoid foods and exhibit neophobia than their typically developing siblings and children without ASD (Schreck, 2004) Children with ASD on average ate fewer foods (33.5 vs 54.5 foods) (Zimmer, 2012) 70 90% of parents who have a child with ASD report problems with food selectivity and limited intake of foods (Mulle, 2013) Odds of children having a feeding problem are five times greater in a child with ASD (Sharp, 2013) Picky Eaters vs Problem Feeders Most parents with children with selective eating refer to them as picky eaters due to the lack of terminology In children with ASD, they are more likely to be problem feeders Is there a difference? YES! Feeding Therapy Many different types of feeding therapy depending on clinic My recommended approach: Sequential Oral Sensory (SOS) Approach SOS Approach to Feeding was developed by Dr. Kay Toomey (psychologist) to be implemented by other allied health professionals (Occupational Therapy, Speech Language Pathology, etc) 2

3 Feeding Therapy The SOS Approach focuses on increasing a child s comfort level by exploring and learning about the different properties of food. The program allows a child to interact with food in a playful, non stressful way, beginning with the ability to tolerate the food in the room and in front of him/her; then moving on to touching, kissing, and eventually tasting and eating foods. Feeding Therapy General Feeding Tips Needs to be done along side a FEEDING TEAM! Build your feeding team Occupational Therapy Speech Language Pathology Registered Dietitian (an INTEGRAL part of a feeding team) Pediatrician Behavioral Health Limit grazing by structuring 3 meals and 2-3 snacks per day Have no more than 3 different foods on your child s plate at a time Use manageable amounts (start small!) Use appropriate mealtime language Use positive reinforcement Positive Reinforcement General Feeding Tips Prevent burn-out by rotating the same food every other day Change one property of the same food each time offered (shape, flavor, texture, or color) Keep meal-time a positive and pleasant atmosphere Do NOT bribe, beg, or force child to take a bite Practice social modeling and have the whole family eat healthfully 3

4 Nutritious Foods for Feeding Therapy Important to test nutrients inside the cell vs outside the cell to show functional deficiency Test a wide range of nutrients to ensure comprehensiveness SpectraCell tests 35 different micronutrients and shows deficiencies and borderline deficiencies Identify deficiencies and correct them with a dietitian or physician 4

5 Replete Nutrients Self Limitation Children with autism may have undiagnosed food sensitivities or intolerances causing gastrointestinal pain, constipation, diarrhea, migraines, or eczema Some children can make the connection between foods and the way they feel, therefore they self-limit Depending on severity of ASD or lack of self-awareness, they may not be able to communicate or describe their discomfort, or may possibly accept it as normal Mechanism Cells Involved Type 1 (Food Allergy) IgE Mast Cells Type 3 (Immune Complex Mediated Hypersensitivity) IgG IgM Complement Type 4 (Cell Mediated Hypersensitivity) Mechanism Cells Involved Type 1 (Food Allergy) IgE Mast Cells Type 3 (Immune Complex Mediated Hypersensitivity) IgG IgM Complement Type 4 (Cell Mediated Hypersensitivity) Mechanism Cells Involved Type 1 (Food Allergy) IgE Mast Cells Type 3 (Immune Complex Mediated Hypersensitivity) IgG IgM Complement Type 4 (Cell Mediated Hypersensitivity) 5

6 Food Sensitivities Medications Common Medications in ASD Many medications used in autism or ADHD/ADD can cause loss of appetite Some medications can cause nutrient depletions, and long-term use could cause deficiency Antibiotics can cause many gastrointestinal issues due to their effect on the bacteria in the gut Medication Antibiotics SSRIs (Fluoxetine, Sertraline, etc.) Anti Convulsants (Dilatin, Tegretol, Mysoline, etc) Antacids (Pepcid, Zantac, Prevacid, etc) Nutrient Depletions B Vitamins Iron Vitamin K Vitamin B6 Calcium Zinc Magnesium Vitamins B1-B9 Chromium Melatonin CoQ10 Vitamin D Vitamin B1 Calcium Vitamin K Folate Copper Biotin Selenium Vitamin B12 Zinc Vitamin B12 Folate Iron Vitamin D Zinc Calcium 6

7 Closing Remarks 1. Build a feeding team for your child with selective eating 2. Test for nutrient deficiencies and correct them 3. Uncover food sensitivities and avoid them 4. Review medications and possible depletions 5. Always have an individualized approach! 1 on 1 consults via video all over the U.S.! P: F: Brittyn@autismdietitian.com 7