Sharing meals with friends and family is a cherished part of many holidays and events. However, for families with children who have picky eating habits, these occasions can become stressful and anxiety-inducing, leading to feelings of isolation and frustration. The challenges of managing mealtimes can feel daunting, but with the right strategies and support, behavior analysts trained in feeding therapy can help create positive changes that make mealtimes more enjoyable for both children and their families.
Feeding issues are particularly prevalent among children with autism, impacting an estimated 62% of this population, with research showing a range between 30% and 84%. (Adams, 2022). his is a significant contrast to the general pediatric population, where only around 4.8% experience similar feeding difficulties.(Baraskewich, 2021) For families, this can mean navigating a range of mealtime difficulties that include aggressive behaviors, food refusal, throwing food, or extreme reactions such as screaming, crying, gagging, or even vomiting. Children with these feeding issues may have diets restricted to a limited range of highly preferred foods, leading to weight loss, growth curve flattening, and weights that fall below the 5th percentile for their age. These feeding difficulties can extend into adolescence and adulthood, bringing with them increased risks of developmental delays, stunting, and both malnutrition and obesity. These persistent issues can place a significant strain on families, often leading to stress, frustration, and feelings of isolation as they attempt to manage these daily challenges.
While comprehensive feeding therapy programs offer the most effective path to meaningful progress, they require thorough assessment and individualized intervention plans. These programs often include parent interviews, structured observations, and the use of tools like food diaries. Additionally, they may involve graduated exposure techniques, pairing non-preferred foods with preferred ones, and targeted strategies for managing challenging behaviors. Such in-depth programs are essential for developing sustainable, effective feeding solutions that cater to the unique needs of each child.
For BCBAs, it is crucial to gain appropriate training and mentorship to become competent in conducting thorough feeding interventions. This is why specialized training programs, such as my ICW: Behavioral Feeding Therapy, are ideal for professionals looking to develop their expertise in this area. These specialized workshops provide valuable resources and a structured approach to guide behavior analysts in implementing high-quality feeding interventions.
However, even without extensive training, there are straightforward strategies that can offer families quick wins, particularly during holiday gatherings like Thanksgiving. These practical approaches can help make meals more manageable and enjoyable for everyone involved.
Below are five strategies to consider for a smoother and more positive holiday mealtime experience.
1. Create a Predictable Schedule
Children with feeding challenges, particularly those with autism, often feel anxious about unexpected changes or unfamiliar routines. To ease this anxiety, create a detailed visual schedule leading up to Thanksgiving. This schedule should map out the entire day, highlighting key moments such as when guests will arrive, when the meal will be served, and what foods will be present. Include any activities or traditions that are part of the day, such as family games or watching a parade. Visual schedules can provide clear cues and set expectations, helping children mentally prepare for each transition throughout the day.
Practical Application: Create a visual schedule with pictures or icons representing each event. A social story to use as a visual and verbal prompt can be written in simple language explaining what will happen during Thanksgiving, who will be there, and how the child can participate. Practice reviewing these resources together multiple times before the holiday so that the child becomes familiar and feels more at ease.
2. Offer Safe Foods
Ensuring that there are familiar and preferred foods on the table can provide comfort and reduce mealtime stress. These safe foods act as a safety net for children who might feel overwhelmed by unfamiliar dishes. Including these foods helps to create a more positive association with the meal, as the child can eat something they enjoy while exploring other foods at their own pace. This strategy can also encourage them to stay at the table longer, which promotes social interaction and gradual exposure to new foods.
Practical Application: Communicate with the child or their caregivers in advance to determine which safe foods should be included. Make sure these items are easy to serve and readily available. For instance, if the child likes plain pasta or bread, have these options on hand. This simple accommodation helps ensure they have something they feel comfortable eating without being pressured to try something new.
3. Use Positive Reinforcement
Positive reinforcement is a vital for encouraging new behaviors. During Thanksgiving, use positive reinforcement to acknowledge and reward small, successful interactions with non-preferred foods. For example, if a child is willing to touch, smell, or taste a new dish, praise them or offer a small reward. This reinforcement should be immediate and specific to help the child understand what behavior is being recognized.
Practical Application: Identify what type of reinforcement is most motivating for the child. This could range from verbal praise, like “Great job touching the turkey!” to non-food rewards, such as stickers or extra playtime after the meal. Keep the reinforcement consistent and tailored to the child’s preferences to maintain their interest and motivation. Remember, the goal is to create a positive experience associated with trying new foods.
4. Gradual Exposure
Introducing new foods gradually and in low-pressure environments can build a child’s tolerance for them. This means starting the process weeks before Thanksgiving by incorporating these foods into smaller meals or snacks. Gradual exposure helps desensitize the child and familiarizes them with the look, smell, and taste of new foods. By the time Thanksgiving arrives, the foods presented at the holiday meal will feel more familiar and less intimidating.
Practical Application: Begin by placing small amounts of the new food on the child’s plate without any expectation for them to eat it. Allow them to interact with it in other ways, such as touching or smelling it, while offering positive reinforcement for these small steps. Over time, encourage them to take a bite or even just lick the food, gradually building up to tasting it.
5. Model Enjoyment
Children often learn behaviors by observing the adults around them. Modeling calm and positive interactions with food can encourage a child to mimic these behaviors. During Thanksgiving, show excitement when trying different dishes, making sure to comment on the taste, texture, and enjoyment you experience. It’s important to keep the atmosphere positive and pressure-free so that the child feels safe exploring new foods without any expectations.
Practical Application: Sit next to the child and try a variety of foods yourself, making fun and light-hearted comments like, “Wow, these mashed potatoes are so fluffy!” or “I love the crunchiness of this salad.” Avoid making direct comparisons or urging the child to copy you, but instead, let them observe and decide on their own if they’re ready to try something new. This observational learning can gradually shift their behavior toward greater openness with different foods.
By incorporating these practical strategies, families can create a more positive, inclusive, and stress-free environment during holiday meals. While these tips can provide meaningful support, more comprehensive training and interventions may be necessary to fully address complex feeding challenges. For professionals interested in developing their expertise in behavioral feeding therapy, consider exploring my ICW: Behavioral Feeding Therapy course for in-depth guidance, tools, and mentorship. This resource is designed to empower BCBAs with the knowledge and skills needed to deliver effective, evidence-based feeding interventions.
Wishing you and your families a joyful, relaxed, and gratitude-filled Thanksgiving! May your celebrations be full of cherished moments, progress, and shared successes at the table. Happy Thanksgiving!
References
Adams S. N. (2022). Feeding and Swallowing Issues in Autism Spectrum Disorders. Neuropsychiatric disease and treatment, 18, 2311–2321. https://doi.org/10.2147/NDT.S332523
Baraskewich, J., von Ranson, K. M., McCrimmon, A., & McMorris, C. A. (2021). Feeding and eating problems in children and adolescents with autism: A scoping review. Autism : the international journal of research and practice, 25(6), 1505–1519. https://doi.org/10.1177/1362361321995631
Peterson, K. M., Piazza, C. C., & Volkert, V. M. (2016). A comparison of a modified sequential oral sensory approach to an applied behavior-analytic approach in the treatment of food selectivity in children with autism spectrum disorder. Journal of applied behavior analysis, 49(3), 485–511. https://doi.org/10.1002/jaba.332
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