Feeding development and difficulties


  • Increasing diet variety on a background of Autism Spectrum Disorder

    • Autism Spectrum Disorder (ASD) a neurodevelopmental disorder characterised by impairments in social behaviour, communication abilities and restricted, repetitive or stereotyped patterns of behaviour. 
    • Children with ASD are at risk of feeding difficulties. The types of difficulties are similar to those of typically developing children however the extent and duration is often greater. Concerns regarding limited food variety are common.
    • Early intervention providing parents with anticipatory guidance on feeding development can prevent or minimise feeding difficulties.  Typical development also provides the template for managing problems once they have developed.
    • Despite rigid and restricted patterns of behaviour achieving changes in feeding are possible. However changes are likely to take longer to achieve as strategies need to be implemented in small steps that aim for ‘just noticeable differences’.
    • Reason given for requesting a referral may in reality not be the parents main concern e.g. children may be referred for concerns about the nutritional adequacy of the diet however during assessment it may became apparent that reducing the stress around mealtimes is a greater priority.   
    • Sensory based approaches may increase food variety for those with sensory based aversions but a supportive mealtime environment with mealtime structures and routines and positive role models is also required.

    Case scenario

    Max aged 4 ½ years is referred due to concerns regarding the limited variety of food in his diet.  Parents are concerned about the adequacy of his diet. He has recently been diagnosed with Autism Spectrum Disorder (ASD) and is receiving assistance from an Early Childhood Intervention Service.  He has delays in communication and cognitive development and difficult behaviours.

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    Question 1

    What are the key elements of your assessment of Max’s feeding difficulty?

    Answer Question 1

    Key elements of your assessment include:

    • Parent’s perception of the problem.
    • Medical, developmental, growth and social history.
    • Dietary assessment.
    • Mealtime observation.

    Your assessment reveals the following details:

    Parent’s perception of the problem

    Assessment is conducted in the home with mum and Max present:

    • Mum is concerned that Max may not be getting all the nutrients he needs.
    • She reports that feeding problems began at around 18 months of age after he was sick with an ear infection. “The only way I could get him to eat was to give him ‘baby food’ and feed him in front of the TV.  That way I could sneak food in without him noticing.”   
    • Now, “Mealtimes are so stressful. They seem to take forever.  He won’t sit at the table with us and I have to feed him. He won’t use a spoon.”
    • He is now fussy about what he will eat. “He can even taste the difference if I buy a different brand. If I put the biscuits into a container he won’t eat them. If I don’t give him what he wants he gets upset and disrupts his father’s work.”
    • Max’s appetite at mealtime is described as being poor. “He never seems hungry. The only time he eats a little more is when we have been out for the afternoon and dinner is late.”

    Medical, Developmental, Growth and Social History.

    • Max has recently been diagnosed with Autism Spectrum Disorder.
    • There are no other known medical issues currently impacting on Max’s general health or feeding difficulties.
    • Despite Max’s limited diet there are no concerns regarding his growth.   
    • Max lives with both his parents and older sister.  Dad works from home and finds it stressful when Max creates a fuss with eating.  Max attends child care 2 days a week where he is provided with his preferred foods but does sit at the table with other children without becoming upset.    

    Dietary assessment

    • Max is usually fed by mum while he watches the TV. Meals take more than 30 minutes and Max requires frequent prompting to open his mouth.
    • Typical foods include: Wheat flake breakfast biscuits with plenty of milk, yoghurt no lumps, mashed potato, commercial smooth baby food which includes some fruit, vegetables and meat. He also eats dry breakfast cereal without milk, plain bread and butter and hot chips which he self feeds.
    • Between meals Max goes to the pantry and requests foods such as sweet biscuits, chips or chocolate which he will self feeds. He becomes upset if he doesn’t get what he wants. 
    • Drinks during the day include: 1-2 small glasses of milk, 2 cups of fruit juice and some water.

    Mealtime Observation

    • Max was observed eating lunch. He sat close to the television. Mum sat beside him and with frequent prompting he completed some commercial baby food followed by yoghurt. He was offered some plain bread which he refused.
    • Max did not participate in the feeding or seem to be aware that he was eating. Although mum reported that if she gave him something that he didn’t like he would then refuse to open his mouth.

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