Safety First: 4 Questions and 4 Providers for your Child with Autism’s Feeding Therapy Team

Safety should be the #1 priority when it comes to expanding your child’s diet in feeding therapy or at home. Here are the questions you can ask and the people (actually, the providers) who should be involved in your child with autism’s feeding therapy.

There is a common misconception among families that I have worked with around how feeding therapy should begin. Here it is:

Myth: Feeding therapy will begin with my child’s therapist encouraging him or her to start eating new things.

Sounds like this should be the case, right?

The Truth: Way before your child starts eating or engaging in any kind of learning or behavior change around eating, we need to consider your whole child and their safety. We do this by asking 4 key questions.

4 Questions to Ask Before Beginning Your Child With Autism’s Feeding Therapy

Are there any medical conditions that may be associated with my child’s feeding challenges?
This could include constipation, sleep difficulties, an allergy, reflux, prematurity, or a number of other underlying concerns. These are things that may need to be treated by your child’s doctor before proceeding.
Are there any nutritional concerns that may be impacting my child’s feeding challenges?
Here are some examples of nutritional concerns: Your child is missing an entire food group (or groups) from their current diet; Your honey doesn’t notice or tell you when they are hungry; Your child doesn’t recognize when they’ve had enough to eat. These are things that will require partnership with a dietician to improve or monitor during therapy.
Are there any skills my child is missing that may be influencing their feeding challenges?
Perhaps your child struggles with oral motor skills like chewing, is coughing or gagging at mealtimes, or lacks the coordination to use a spoon or fork. If so, an SLP, PT, or OT may be needed to support you child with learning these skills.
Are there any behavioral, developmental, social, or environmental conditions that may be contributing to my child’s feeding challenges?
If your child has ASD, then autism is one factor that likely contributes to your child’s feeding challenge. It’s important to identify if there are any other contributing factors in this area.
Is your child fearful of trying new things? Do they experience anxiety? Maybe your child engages in challenging behavior when you introduce new foods. Does your honey get inflexible when it comes to meals?
If your honey struggles with any of the above concerns, then a behavioral expert, such as a behavior analyst or behavioral psychologist with experience treating feeding challenges, will be an essential part of your honey’s team.

As you can probably see, each of these 4 questions is tied to a different area of expertise and one or more provider types:

1) Medicine: Pediatrician, GI Specialist, etc.

2) Nutrition: Dietician or Nutritionist

3) Feeding Skill: SLP, OT, or PT

4) Psychology and Social Services (Psychosocial): Behavioral Psychologist, Behavior Analyst, and/or Social Worker

There is a wonderful 2019 research article by Goday and colleagues that introduces these 4 key areas of expertise and how providers within them can work together: medicine, nutrition, speech-language pathology, occupational therapy, and behavioral psychology.

Do I Really Need to Do This?

I know taking time to stop and ask all of these questions is going to take time. And, it may be difficult to find the right people to ask. BUT, by taking the time to do this - and doing so before doing any therapy or treatment - you can be sure that 1) you are prioritizing the right treatment for your wonderful, unique child and 2) that you are proceeding safely.

That is -

Your child is not being asked to eat foods to which they have an allergy.

Or, they are not being asked to chew a food that is too challenging for their skill level.

Or, they are not learning that eating is painful because they experience severe reflux symptoms following meals.

Or, they are not being offered too little for adequate weight gain.

Or, they are not learning that inflexible or challenging behavior results in better food options, shorter meals, or avoiding eating all together.

…You can probably imagine how any of these negative experiences or habits may actually help to maintain your child’s food refusal over time, rather than support them with being a more adventurous eater.

Looking For Answers

So, how do you get answers to these 4 important questions - and from these 4 different experts?

There are generally two ways.

One option is to go to a clinic that offers feeding assessments with a team of providers – including providers from each of the 4 areas. This way, you can have an expert in each area assess your child, and the team can provide you with a coordinated treatment plan for your child.

A second option is to select members from each of these areas in your local community yourself, and build your own feeding team for your child. If you choose this route, not all of your providers will be under the same roof, but you will be able to get an assessment in each important area.

At a minimum, you’ll want to include the following providers in your hand-selected team:

1. Your child’s pediatrician - to rule out any potential medical concerns

2. A pediatric dietician - to assess your child’s current diet and hunger (as in, do they experience hunger?)

3. An oral motor specialist (e.g., speech-language pathologist, occupational therapist) - to assess for safety and skill deficits

4. A behavioral psychologist or behavior analyst with experience treating feeding challenges - to assess for things like mealtime stress, disruptive or rigid behaviors, motivation to try new things, and patterns of food refusal or avoidance

Following an initial assessment or screening, you may learn that one or more of these providers does not need to be an ongoing part of your child’s feeding journey. Having that initial consult to rule it out; however, is key to proceeding safely.

Free strategies for picky eater with autism

Moving forward in the weeks and months to come, I am committing myself to provide you with a ton of information about picky eating for young kids on the spectrum. This info is going to come from my perspective as a behavior analyst and draw on my experiences working with real families in feeding therapy as a therapist.

I hope that the resources here arm you with knowledge. I also hope that you find and invest in relationships in your local community with providers such as those suggested here. Providers who can know your child personally and support you with their treatment. Because more than anything, I want your child to grow, safe and healthy and so happy. - That’s actually why I’m here.