by Dana Pagliuco, M.S. CCC-SLP and Courtney Shea OTR/L
The holidays can be a hectic time for everyone. The minute Halloween ends, it seems the countdown to Christmas and Hanukah officially begins with Thanksgiving strategically smacked in the middle. Shopping, cleaning, cooking, wrapping, and party-going seem to consume us until January. It’s no surprise that this time can be extra stressful for children and individuals with Autism Spectrum Disorder, particularly for those with feeding difficulties.
Fortunately, there are several ways to ease the difficulty for both you and your child around holiday meals. The weeks and days leading up to big meals can be a great time to incorporate some therapeutic activities to help your child make some feeding breakthroughs.
- Setting realistic expectations for the holiday meal: Holiday meals are usually a big change in routine. You may be eating with extended family, in a different room or a different house, with a different menu. The dinner itself may be more formal, with different plates and utensils, fancy clothes and an expectation of no background TV or iPad. These changes can create some uneasiness in an individual with Autism who might be seeking some control over the situation. Often this control can be manifested in a refusal to eat anything other than highly preferred foods. For this reason, the holiday meal is likely not going to be the meal where your child tries broccoli for the first time. There may even be a few set-backs. Maybe a more realistic expectation is for your child to tolerate novel food on his plate without an expectation to eat it. Maybe it’s just to tolerate novel foods on the same table without an adverse reaction. Setting realistic and attainable goals will make the holiday meal a success for both you and your child and provide a good benchmark for next year’s goal.
- Creating opportunities for exposure to holiday foods prior to the meal: Leading up to the holiday meal, have your child become involved in preparation activities of the foods you may be serving, or you may be served at the event. Offer your child opportunities to engage in meal/snack preparation activities at least 1x/week. Give them a choice of what they would like to make or assist in making. Encourage them to change the shape/color/size of a non-preferred or less preferred food to make it “better”. Show them how they can change the food shape by using cookie cutters, grater, shredder, or child-safe utensils. Show them how we can change the temperature by heating in microwave or toasting (supervised), or by changing the taste by adding a spice, a condiment, or other seasoning. Discuss that some of these changes (potentially small changes to the flavor, temperature, shape, etc.) could be made to items on the holiday, but that some flexibility may need to be practiced if these changes are not a choice at that time.
- Food selection and modification based on your child’s oral motor skills or swallowing disorder: Perhaps feeding is difficult for your child because they have been diagnosed as having oral or pharyngeal dysphagia. Dysphagia means difficulty swallowing and is a disorder that can occur across the lifespan. Oral dysphagia is usually characterized by difficulty breaking down and manipulating food in the mouth whereas pharyngeal dysphagia is characterized by difficulty during the actual swallow. Sometimes individuals with dysphagia are placed on a modified diet to reduce their risk of choking or aspiration (e.g., food/drink entering lungs). Preview the menu ahead of time and see what modifications can be made for your child so that they can fully participate during mealtime. Serve creamy, thick soups if your child is on a puree or thickened liquid diet. Adding extra cornstarch to soups, gravy, and other sauces can thicken them so that they are appropriate for individuals on thickened liquid. Offer ground turkey to individuals on an “easy to chew diet” (e.g., sometimes referred to as a mechanical soft diet) and provide extra sauce/gravy for dry foods for those who have difficulty chewing. There are plenty of cookbooks available specifically written with individuals with dysphagia in mind. The Dysphagia Cookbook: Great Tasting and Nutritious Recipes for People with Swallowing Difficulties by Elayne Achilles is a favorite amongst speech language pathologists. With a little preparation and modification, your child will be able to enjoy the same meal as everyone else, which is important for inclusion and quality of life. If your child is not diagnosed with dysphagia, but you have concerns about your child’s ability to chew or swallow foods, talk to your pediatrician about scheduling a swallowing evaluation with a speech language pathologist.
- Educating family members about your child’s feeding challenges: A quick note, email or phone call to the group with whom you will be sharing your holiday meal may ease your mind and better prepare family/friends to understand your child’s needs in this area. Describing that you are all working together to help this holiday meal be as successful as possible but that challenges may still arise (i.e. needing to take breaks, place food in different places or on placemats, change foods by different attributes, etc.) will likely help all parties involved! Create a point person to be “in charge” of your child’s food interactions who will know when to encourage and when to back off. Your child is less likely to be comfortable with a food if every adult at the table is putting in their two cents.
- Family style serving: Try to serve the meals, leading up to the holiday meal, “family-style”, where everyone eats together with shared food on the table. This allows for more exposure to family foods (e.g., vegetables, healthy proteins, fruits) and more opportunities for modeling successful eating of less familiar or non-preferred foods. On the day of the holiday meal, it may occur in a “family-style” manner and your child will then be more familiar with foods served this way. You can have your child "serve" new foods to other family members. If your child can tolerate a novel food being directly on their plate, praise them for this interaction with the food! If they would like it to be at a bit more of a distance, allow them to put it on a placemat (likely one that could be cleaned easily) and if that remains too close for their comfort level, allow them to have a separate plate for these new foods to remain throughout the meal. You can encourage them to place these novel food items in any of these areas, and then encourage them to engage with that food in one manner (i.e. touch with a finger, smell, kiss with lips, lick, take a bite or eat) before they are able to throw it away by the end of the meal. Likely, if they are unable to have it on their own plate, you would just be asking them to touch the food, as jumping to taking a bite or eating this food is too much for their sensory system at that time
Additionally, there are some strategies that can help ease challenges on the day of the holiday meal so that it can be as smooth and as enjoyable as possible!
- Heavy work play before meal: Offer opportunities for heavy work/resistive play such as animal walks/crawling (over/under pillows on the floor), pushing weighted baskets, pulling appropriately weighted items, crashing/jumping into a pile of pillows in a safe space. Engage your child in such activities in a routine/structured way (i.e. For 20 minutes prior to mealtime with a set number of turns or activities). If able, maybe even head to the playground prior to mealtime to get in some running, jumping, climbing, swinging etc. These activities may support your child's level of arousal and bring them into a calm state prior to sitting for a meal at the table. It may be helpful to try these “heavy work” activities before the holiday meal, just to see if it is beneficial and worth putting in the schedule for that day!
- Supportive seating: Posture is important during meal time not just for safe eating but also to avoid fatigue and minimize need to fidget/change positions in seat frequently. More supportive seating can improve sitting tolerance which can have a positive impact on mealtime participation. At meals (and especially during the holiday meals where sitting and socializing is even more of a priority), ensure that your child has their feet supported flat on the floor or a footrest. Also, if there is extra space between their back and the back of the chair when they are seated upright, fill in the extra space with a small pillow or cushion.
- Mealtime environment: Keep the mealtime environment free from clutter and create a space with less crowding to increase comfort and decrease distraction. Creating a comfortable space for mealtime is critical for individuals who already have some anxiety and apprehension around eating. Try having meals in a consistent location where there is ample space for the family and less crowding. These small changes to the mealtime environment can make a huge difference for an individual with feeding challenges. If the holiday meal is going to take place in your home, you could practice having your child sit in a consistent seat that will be designated for them for that meal. This may serve as a comfort to your child, and they can make something special for their place-setting or placemat that may add relief as well.
With the rush of the holiday season, it can be easy to overlook the true value of the holidays: spending quality time amongst the people you love the most. Take this time to celebrate your family for all its ups and downs. Reflect on all the hard work you’ve accomplished over the past year and set new goals for the year to come. Cherish the sweet moments and learn from the tough moments. Add these new tips to your ever-growing repertoire of great parenting skills, and if your child tolerates, smells, touches or even eats a new food this season, don’t forget to give yourself a well-deserved pat on the back.
Dana Pagliuco, M.S. CCC-SLP
Courtney Shea OTR/L
If you have concerns regarding feeding or swallowing difficulties in your child, please contact the Spaulding Outpatient Center for Children in Lexington, MA atto schedule a comprehensive multi-disciplinary feeding evaluation.