If you haven’t had a chance to listen to last week’s rebroadcast with Dr. Keith Williams, of the Hershey Medical Center Feeding Program, go back and check that out. Kelsey General is joining me for another round of top 5 questions. We are talking all about picky eaters and common feeding problems for children with autism.
How to get my picky eater to try new foods and let me feed them?
As always the first step in the Turn Autism Approach is to assess. How is your child’s growth? Are they meeting height and weight milestones? In addition to these questions, keep a three-day food diary to monitor consumption, complete the self-care checklist (found in my free book resources), and create an Easy-Medium-Difficult list based on what your child will eat. Remember that this is a long game and you won’t go from Doritos to broccoli overnight.
How do I get my child to sit at the table to eat?
Where is your child when they are eating? If they are eating mobile snacky foods around the house, that has got to stop. Start by serving all meals and snacks at the table to eliminate all-day grazing. To encourage table sitting, begin with foods from their easy list of foods they normally eat while walking around. Are they discouraged by the look of the food at the table? Kids often get used to colors and packaging, try serving foods from non-see-through, generic containers to break these associations. Just like any other new behavior, use reinforcements as your building and pairing the table.
How to wean from a bottle and teach drinking from a straw and open cup?
Children over the age of 1, definitely before 2 should be weaned from a bottle and pacifier. There are many problems bottles and pacifiers can cause, not just with feeding but with speaking and oral development as well. Start by eliminating free access to bottles and use during set designated times each day. What are they drinking out of the bottle? Is it necessary nutritionally? If it’s not, eliminate it and begin teaching open cup and straw drinking, an important skill to be mastered at 18 months. Cups like the “Honey Bear” are great for teaching and encouraging straw use because you can squeeze the liquid to the top of the straw.
How can I prevent and fix my child from eating non-edible items?
This is a big concern for safety. Eating non-edible items is known as Pica and is a medical condition. Determine what types of non-edible items your child is drawn to eat and remove their access to them. There are often underlying causes and motivations for Pica. Questions to consider when addressing this are, when does my child eat these non-food items? What foods is my child eating? Could my child have a nutritional deficiency? Seek evaluation and medical attention for Pica related concerns.
How do I get my child to use utensils and eat?
Using utensils is an important and necessary skill but it is not the number one priority if you are still experiencing picky eating and other feeding problems. Seek solutions for the above questions and eliminate picky eating concerns before tackling teaching utensils. If your child is eating normally but not using utensils yet, start with basic skills. Scooping with a spoon is the first skill to work on, start with smooth thick foods like yogurt as you build the skill before working up to thin foods like soup. If your child isn’t tolerating that, try teaching the motion and skill with easy favorite foods like dry cereal or chips for practice, always prompting from behind. After spoon use is mastered, you can move on to fork use and later eventually kid appropriate knife use for older children.
Kelsey and I are really loving this series for recapping important info with common concerns and new knowledge, we hope you are too! Be sure to leave us feedback wherever you listen to podcasts!
- The top 5 picky eater and feeding problem questions.
- How to feed picky eaters.
- What to do when your toddler won’t try new foods.
- How to encourage sitting at a table for meals and snacks.
- How to wean from a bottle and promote open cup and straw drinking.
- What to do when you have a concern about Pica?
- When is it appropriate to teach utensil use and how do you get started?
- Workshops – ABA Help for Professionals and Parents
- Turn Autism Around®️ – New Book from Mary Barbera
- Classic Rebroadcast: Autism and Eating Disorders with Dr. Keith Williams
- Dr. Missy Olive: Medical Conditions Associated with Autism
- Hyperlexia in Children
- When To Tackle Weaning Off Pacifiers with Pediatric Feeding Specialist Melanie Potock
- Mary Barbera
- Mary Barbera on TikTok
- Mary Barbera on Instagram
Mary Barbera – Turn Autism Around Podcast Transcript
Transcript for Podcast Episode: 193
Why Won't My Toddler Eat? Top 5 Picky Eating Q and A
Hosted by: Dr. Mary Barbera
Guest: Kelsey General
Mary: You're listening to the Turn Autism Around podcast episode number 193. Last week we did a classic podcast rebroadcast with the episode from Dr. Keith Williams, which is my absolute one of my all time favorites. They're all about feeding issues. And Dr. Williams was such a wealth of information, but that podcast was originally recorded, I think, back in 2019, maybe now, probably 2020. So it's older and there's a lot of learning that we have done. So Kelsea, our community manager, is back for the top five questions regarding feeding and eating issues with kids on the autism spectrum, or little kids who are extremely picky or have some kind of beating issue or they are, you know, still on a bottle addicted to a pacifier. There's drinking issues, there's feeding issues. There's all kinds of questions, how to use utensils. In this episode, we are starting right now, with the top five questions. Let's get to it.
Narrator: Welcome to the Turn Autism Around podcast. For both parents and professionals in the autism world who want to turn things around, be less stressed, and lead happier lives. And now your host, autism mom, behavior analyst and bestselling author Dr. Mary Barbera.
Mary: All right, Kelsey, we are back. Thanks for joining me today. It's early morning for you and pretty early for me as well. Kelsey's in British Columbia, Canada, and I'm in Pennsylvania. So we are 3 hours apart. And so today we are talking all about the top five questions we get about feeding.
Kelsey: Yeah, so let's jump right into it because we get a lot of questions about feeding. It's a really tricky topic and really stressful for families. It is really stressful. So let's get into it. The first question is my child is a very picky eater but doesn't and doesn't eat any new foods and won't let me feed them. What can I do?
How to get my picky eater to try new foods and let me feed them?
Mary: Yeah. So for those of you out there listening, I'm assuming many of you have the book Turn Autism Around, an action guide for Parents of Young Children with Early Signs of Autism. Even though the subtitle is For Young Children with Early Signs of Autism, this book is really great for any parent or professional working with any child who is still struggling with talking, tantrums, eating, sleeping, potty training. And there's a whole lot in this book, including Chapter ten, which is about picky eating. And in preparation for this podcast interview, both Kelsey and I reviewed Chapter ten, and we both were just commenting that there is a lot in Chapter ten. It's actually probably one of the most useful chapters of this whole book. So if you have the book, chapter ten is a great thing to read. And also last week we republished as part of our classic broadcast series, we rebroadcast the podcast interview with Dr. Keith Williams, which is so helpful. Right? I mean, that is hands down one of our top five of all time podcast interviews. I got to interview him because I sent him chapter ten of my book in draft form, and he really helped me by providing some additional resources and references and all that. So where to start? Well, we always have to start with step one of the Turn Autism Around Approach, which is assessment. You have to assess where your child or client is at in terms of eating and drinking. And also, we need to make sure that this isn't something very serious. And, you know, disclaimer in my blog and my podcast, everywhere you turn in my information, there's disclaimers that everything you hear from me is for informational purposes only. And with feeding, when we have malnourishment, we've got, you know, severe eating disorders, we have mineral and vitamin deficiency. We have swallowing, chewing, gagging, vomiting, you know, all kinds of things that could be very serious. So when in doubt, seek medical evaluations and use the things you're learning today, you know, just to help you move forward. And I think we're going to give out great information today. But so assess, Is your child growing? Where are they on the way? Curb the height curve. And also just assessing. I know when I took Lucas to a feeding program, for instance, when he was four, they had me in preparation just take a journal and journal out every single thing he ate for three days straight. So whether that was the outside of chicken nuggets, four chicken nuggets and just just ate the outsides of them, that's what he used to eat, whether he drank, you know, 2% milk, four ounces. And that's really I think a great assessment tool is just in general, do a three day diary journal of what your child is eating. Another assessment tool is Marcus Sandberg's self care checklist, and he gave me permission in my book to include the important parts of the self-care checklist for this age. And so by about 18 months of age, your child should be eating finger foods, drinking from a cup by themselves, using a spoon to scoop and sucking from a straw. And for those of you that have kids in daycares, daycare settings, drinking out of an open cup is kind of a marker to, like, move to a next class. It's a big deal. But when you have kids at home, like for me, I didn't know I had Lucas drinking out of, you know, the spill proof sippy cups with the valve in them, which are particularly a bad idea for our kids because it's like sucking out of a bottle. It's very not natural. But if kids don't progress with eating, clearing the spoon and sucking from a straw and having the coordination and the lip muscles and mouth muscles to not spill as you're drinking from an open cup, those are all important developmental milestones that if you just are using spill proof sippy cups with valves, they can be missing and it could be affecting they're talking not just their eating as well. And then another assessment that we created and I created based on Kelsey's son Brentley, way back years ago when we were creating the toddler course, Kelsey was, you know, my at the time, my very best success story. Not that you're still not the best, Kelsey, because you are, but, you know, she was. That's when she started working for me when we were creating the toddler course, and she was still having lots of trouble with Brentley and his eating. And she was sending me videos and I was like, Whoa, whoa, whoa, whoa. We’ve got crying at the table. We've got refusal, we've got threats and bribes. And, you know, Kelsey's an amazing mom. And I mean, just like we had Rachel on the show, and I mean, she's an amazing mom, too. But we're still…as amazing moms, we're making all kinds of errors, especially if we don't know how to get a picky eater to eat. So we have the easy, medium and difficult list that we created, and we can talk more about that with interventions. But, you know, that's on page 155 of the book and, and in the first column are all the easy foods where your child will eat them, you know, anytime, day or night. And a lot of times with our kids, a lot of times those are junk foods. And then the medium list is they'll eat them, but maybe brand specific, it has to be a certain day, not always in the mood. And then the third last are the difficult foods, and that's food you want your child to eat and they just outright refuse. But before we move on, you know, and you can chime in here, too. But I also wanted to say that in my book and Dr. Keith Williams shared this and I'm thinking he shared it on last week's podcast, but maybe some of you missed it is that in my book there is a study done, a pretty recent study, 2019, Susan Mayes and Hana Zickgraf published a study that suggests atypical eating, including severely limited food preferences and refusal of different texture foods occurs in 70% of children with autism, which is 15 times more common than typically developing kids. And that extreme picky eating and other feeding issues can be a diagnostic indicator for autism, as kids on the spectrum are far pickier. So, you know, I know we have a lot of kids, a lot of parents and professionals in our toddler preschooler course, with kids that aren't diagnosed with autism yet. And if they are very picky, that is one more sign that, you know, autism can and should maybe be diagnosed. So. Anything to add there with finding your starting point? I know that was a ton of information.
Kelsey: No, I don't think so. I mean, just to make sure before you get started with anything, you also keep your expectations in check, I guess would be a way to say it. We are not expecting kids to go from eating only Doritos to eating broccoli tomorrow. We have to really take small steps. This is a long game and if you need to get nutrition into your child, you should really talk to your doctor about ways to do that while you're slowly supporting their feeding, because you can't just jump into the foods on that hard list. So make sure you talk to your doctor and continue to consult with those people to make sure their nutrition is right. Because also, kids, you know, nutritional deficits can cause picky eating, you know, iron deficiency and certain deficiencies can cause your taste in your mouth to be different. And so we do want to make sure we're doing all of our testing.
Mary: And you might need supplements like zinc supplements, for instance. We've talked about that on the show with Missy Olive and you said in the Sleep podcast, which was kind of new information for me, is that your younger son Lincoln had an iron deficiency which you believe was causing sleep terror.
Kelsey: Yeah. Night terrors.
Mary: Yeah, night terrors. So, like all of these things, we can't just jump into assessing a three day journal without also assessing using my one page assessment, which is now going to be software very, very soon. But we need to assess the whole child, not just the reading part. We need to assess the talking part. We need to assess safety. We need to assess self-care skills and all kinds of things. Because especially with feeding, it's so interconnected with everything else.
Kelsey: Yeah. Yeah. So that would be my only addition to that. And so let's get on to our next question. But it says, where do I start to help with picky eating once my assessment is done? Are there feeding therapists? My child won't even sit at the table.
How do I get my child to sit at the table to eat?
Mary: Yes. So as I said, Lucas did go to a feeding clinic as part of a children's hospital in Philadelphia. KEITH Doctor Keith Williams is at the Hershey Feeding Clinic, both, you know, an hour away from my home. But there are feeding clinics. If you have a child who's failure to thrive, malnourished, having chewing, swallowing difficulties, those sorts of things, you have to seek medical help. So I went to Dr. Keith Williams with a handful or two of my clients, and because of my nursing background and my background as behavior analyst and going to the feeding clinic for ten days with Lucas and then going ten or 20 visits with Dr. Keith Williams and studying more, I became more of an expert in feeding problems, especially with general picky eating and things like that. So I do think that there are steps that we can definitely take, especially if it's not a severe issue yet. So the earlier you can start any of this, the better. One of the biggest things is to get your child sitting to eat. No one does well when they can just graze all day on the easy foods, the junk foods, you know, they can walk around with Doritos or, you know, even a bowl of cereal. I remember one of my clients, he would be with the grandmother and, you know, we're working on feeding. And I show up and he has a bowl of Lucky Charms and he's walking around with it. That was his second bowl. Well, you know, if I try to sit him at the table to eat something, nutrition after two bowls of Lucky Charms where he can just graze around all day. I'm not gonna have much success. So limit or totally eliminate any foods where the child's not sitting at a table. If they are under two a highchair is fine. But over two, I've also seen, you know, three year olds in high chairs buckled in and strapped in. And, you know, that's too old to be, you know, unless they have some physical, you know, issue where that's the only safe place for them. But trapping kids to eat or trapping kids for table time is not on our list of things to do. So we want kids to be running to the learning table. We also want them to be running to the kitchen table or at the dining room table to eat meals and eat snacks. If you're going to serve snacks, then that has to be seated with your snack because all this grazing is just really hurting things. The other things you can do. Like I said, you might need supplementation. Sometimes kids that drink smoothies or milkshakes, you can put supplements in there that are recommended by the physician or nutritionist. You can put vegetables and fruits in there. So that's not not a bad idea either. And then the other big thing is kids with autism or are going to get diagnosed with autism eventually tend to be very hooked on the way things look. So like if they see fries coming out of the drive through McDonald's in the red container, that's what they want. They want fries in the red container. So you make fries at home. They don't want them. So if a child's hooked on baby food, for instance, I would recommend dumping out the jars of baby foods into, like, styrofoam cups or non-see through bowls and not getting in. They have to see the package. They have to, you know, because they're picky enough in terms of texture. And then you add the site and you add the brand specificity. I think you're going to do better just trying to remove the foods from the container. So those are some tips. I mean, not every there's many more strategies. We never want the child to be crying when they're eating. Is that talk about choking hazards like that? That's not good, right? So we want the child to be calm. So initially, I would just cut out the grazing if at all possible. And that includes drinks of any calories like milk and juice and those sorts of things. So water away from the tables, fine, but also keep things not messy. And then at the table, you want to really be giving them easy foods to begin with so they can come to the table and they could have their lucky charms in a bowl. Like Kelsey's point about, we are not going to go from Doritos to broccoli. So you might have to in the beginning serve them a bowl of Lucky Charms the way they like it, dry without milk or whatever, with their fingers, whatever is easy for them. So take their easy list and just serve it out at the table if they need to eat six or eight times a day. Okay, time for another snack. We can sit at the table and we can eat. And if you're at the table also, it'll be easier to work on. Drinking from an open top or a straw where you can work on things instead of having the child just run around the room.
Kelsey: Yeah, I think those are good places to start and I like what you said on picking one thing like the grazing and focus on that and getting seated at the table because that's a good place to start. The other thing is a lot of people want to jump into an answer to this question. Later on, while I want my child to feed themselves, but in the beginning stages of getting them to feed, if your child's only eating on their own with handfuls of lucky charms at the table, your next step might be getting them to eat the Lucky Charms off your spoon as you feed them, because that's going to be the easiest way to move forward with foods. And also after you do grazing and you want to get started on what food should I introduce first? You want to look at your easy medium hard list and go, okay, my child will eat applesauce, turkey and mac and cheese. So maybe those are the three easy foods. Well then instead of applesauce you might give. You know, strawberry applesauce or something mixed with it, you might give instead of. Kraft dinner Mac and cheese. You might try Annie's mac and cheese or you might try something similar as kind of a first step. And again, like Mary said, always keep them in those non-see through bowls. Yeah, those are kind of the places to start.
Mary: And in the food list, in the sample one that's actually Brentley sample one for one because literally I created it. I was like, whoa, he's crying. This does not look good. And I didn't have this list. I was just like, you know, Write down everything easy he will eat, everything. And we created this, you know, based on Brentley's experience. But, you know, in the easy column we have some kind of mac and cheese, mac and cheese, yellow. And in the medium column we have mac and cheese white. So there is an example where once you get a couple good days under your belt with no grazing and just seated at the table eating easy foods, now your child's more hungry for the meals, and now you can and you've already, you know, kind of started dumping out. So they're not seeing the packaging as much. And yeah, so I mean, and these techniques can work for any picky eater. Like even if you yourself listening are picky, you know, really try to try to demand fade in. And I mean, this is all like shaping and demand fading and all the technical terms that we're not using, but these techniques will really work.
Kelsey: Yeah, and they do because even even if your child only is one food and they scream and cry when even something else is put on the table, well then you're not going to start. We're trying to feed them something else. You might start with just them accepting another bowl on the table. That's not their bowl of lucky charms.
Mary: And the other thing we should mention is, you know, I had a client when I started with him. He was two, he drank almond milk out of a bottle and he ate gluten free crackers morning, noon and night. And the only thing else he would eat is if they drove through McDonald's and got those stupid fries in the red container. And they were hot, and it was a full moon. And it was like. We had to, you know. Well, he got intervention with Dr. Keith Williams. But then we were able to really, you know, get him eating. But the big the biggest thing if you do graffiti clinic or if you have a pretty extreme picky eater and these just basic little tips don't work is you need more reinforcement while the child's eating even maybe eating the easy foods or when you're going to slip in the medium foods you do, you don't just you're not probably going to just be able to slip in medium or difficult foods you're going to probably have to have reinforcement may involve, you know, just pairing first we're going to have, you know, something good that we're going to sandwich in something medium, then we're going to sandwich in something easy. So it's going to involve the child watching some electronics while they're eating really difficult foods. And I know there's all kinds of controversy on screen time and those sorts of things. And it's like. For. You know, interventions that are so important and skills that are so difficult. We may need additional reinforcement. And it could involve, like for the little boy that drinks from a bottle and eats, you know, gluten free crackers. He loved letters. He was hyperlexic. Let's say we've done a video blog and podcasts on that. We can link them to the show notes. We used an ABC puzzle. He took a bite of something he didn't like and we had him. You know, put in a puzzle piece or three puzzle pieces, I mean, or we put them in. I don't even remember exactly what the deal was, but we didn't use electronics. We used puzzle pieces. You gotta use what the child likes. And so, you know, in my courses and throughout my book, I talk about how to figure all that out. But don't forget reinforcement, because whenever you want to increase the behavior, you are going to have to have an arsenal of reinforcement.
Kelsey: Yeah. So that's how you start. So let's get on to the next question, which brings us to really popular ones. My child will only drink milk out of a bottle. What can I do? They won't drink out of an open top straw cup, etc..
How to wean from a bottle and teach drinking from a straw and open cup?
Mary: Yeah. So on page 157, in the same chapter, we talk about drinking interventions. It's very common for kids whose parents are professionals or in our course, our toddler, preschooler or course to not be able to do those 18 months skills. So whether they're 22 months, whether they're three or even four years of age, it's not uncommon for kids on the spectrum to get a diagnosis on the spectrum to be taking a pacifier still whatever age. And that is really only advised up until age one, so many of our kids are somewhat addicted to pacifiers and also bottles. So we are going to when we assess part of the assessment is the self-care checklist, right? Seeing what they can do and also as part of my assessment, my Turn Autism Around assessment. I think it's the only assessment where it's like everything's included, including pacifier use because I have seen it with hundreds of kids who I go in or are not talking to are not talking well who are older than one for sure. Sometimes older than three or four and that are still using a pacifier. And pacifiers are bad for a number of reasons, as are bottles. Bottles also should be faded out after the age or around the age of one. So we have to start with assessment of the drinking and the pacifier use as well, drinking from a bottle. And that, as I said in the previous question, the spill proof sippy cups for the valve, not good either. So you can also be looking at that when you do an assessment. So for okay, your child's using a pacifier in a bottle. So now what? Oh, let me let me say before I talk about pacifiers, that they're not good for feeding, but they have an unnatural suck. So when kids get older, they're not supposed to suck anymore. They're supposed to drink from a straw, which is a different mechanism. When your tongue goes to a different place, your lips go to a different place. Your mouth, the way you drink from a straw goes to it's a whole different mechanism. And that's what also helps with talking. So talking, drinking, drooling...I have had kids who drool that needed intervention, like it all is related. So assessment is first for drinking and then on pages 159 and 160 and 161, we talk about weaning from a bottle and pacifier, just like we can't go from Doritos to broccoli. We can't go from almond milk out of a bottle 24/7 to water out of a straw like kids. And if you are having trouble, you may need some additional help to help you. But there are steps to weaning. You could say, okay, no grazing with the bottles. We're going to get it down from 24 seven bottles to four times a day bottles. We could have a bottle in the morning, a bottle before a nap, a bottle at dinner. You could have them drinking a bottle at the kitchen table with their meal, like maybe some of the things they like about the bottle and even the bottle and the milk. Maybe it's just a comfort thing and free access thing and just pair it down to where you can wean gradually. Same thing with pacifiers you could limit it to only at church, only in the car, only at night, only for naps, at night. And that's one of the ways we start to wean is figuring out. We have to figure out when the child needs a bottle or pacifier and when you need the bottle or a pacifier to keep your sanity and then slowly teach your child how to drink out of a straw and open up. And they do have spill proof straw cups, which are fine. We have an episode with Melanie Potok. I think she's got some great resources. We can link to her show in the show notes, but she's got some great resources. She's an SLP, on bottles as far as weaning, which cups are best. I think she's really a great expert at that.
Kelsey: Yeah, I think that's good. The other thing I will say, if your child can drink out of a straw cup, but they just will only drink milk out of a bottle. I talked to your doctor about whether they need the milk nutrition lines? And also switching it, put water or watered down milk and slowly water down in the bottle and put their favorite drink in the straw cup if they actually have the skills to do it. So we want to make the bottle not as useful and the straw cup more useful. Yeah. That's really all.
Mary: I have a honey bear cup that we use when you're trying to trade straw drinking. It's a little honey bear, and you can squeeze the honey bear to make the liquid come out of the straw quicker. You can do the same thing with a juice box, like one of those little juice boxes. If you push on it a little bit, the juice comes out. I used to be really against juice drinking, but after talking to Keith Williams and hearing his podcast episode way back and then, of course, we replayed it last week, he's not all about nixing the Juice, because he feels like kids could get vitamin C deficient and, you know, you could get some vitamins in there, especially if it's 100% juice. But again, no grazing with it because we don't want to fill up on juice or milk throughout the day.
Kelsey: Yeah. Sounds good. Yeah. And we already touched on how to teach drinking from a straw, which is with the honey bear cups. And really just pairing that cup up with good liquids and making it really easy for them by using a cup where you can squeeze it in.
Mary: And don't have the bottles or pacifiers in sight if you are weaning it, like to hide them really well. Like we can't have children accidentally finding pacifiers or you're trying to do a cup, but the bottle is right on the counter. Like, just common sense. Like, let's if we're trying to get rid of the bottles, let's not have ten bottles all in clear view.
Kelsey: Yeah, that's a good one. So we'll move on from drinking and go to where my child is eating, but they're eating non-food items. What can I do?
How can I prevent and fix my child from eating non-edible items?
Mary: So eating, actually ingesting non edibles, is called Pica, which is actually a very dangerous, serious medical condition. I talk about it on page 156 of my book. I also have a podcast on Pica and a couple other podcasts on chewing and mouthing, and we're going to put all of those resources in the show notes for this episode, too, because it's common problem and it's a common question we get is kids mouthing things and then some kids actually eating things like mulch. And I mean, kids can eat stone and kiddy toys and it can be very, very serious. First of all, the stuff that they're ingesting. But if they eat, I have actually Jill Esher was very public about this. She has been on my podcast before and she has two kids on the spectrum, including her 16 year old daughter who doesn't usually eat inedible things. And she got very sick with a fever and she went to the E.R. and it turned out that she actually chewed up a piece of a toy and needed emergency surgery. It almost perforated her, her bowel and everything. So, like, even for older kids, it could come, you know what I mean? Like, if they're chewing on stuff or if they sometimes ingest things, it can be very serious. So you definitely want to seek medical attention if your child is eating inedible foods. But sometimes it can be a vitamin or mineral deficiency that's leading to them having excessive chewing or even ingesting. We need to keep the environment as safe as possible. We need as many eyes on the child as possible so that they don't go, you know, eating things. If they are eating mulch at a certain playground because they like the way it tastes or looks or whatever, you might have to not go to that playground. You might have to go to a playground without mulch, you know, like we just want to protect the situation. I had a student with Pica and I visited his house. I mostly had him at school, but I visited his house and mom had put eye hooks on the outside of the doors to keep this child from going into the doors. Into the rooms during the day and getting into things and eating things. So that wasn't a hook eye to keep kids in the bedroom, it was hook and eye locks to keep the child from going into all the bedrooms. You can also get those twisty knob handles that the child can't open the doors, you know, so to the laundry room, if there if they could get into there and ingest something dangerous. I mean, you can adjust something dangerous everywhere you turn because anything that you ingest that's not food is actually very dangerous for mouthing and chewing. I do think that it might be related to vitamin and mineral deficiencies more than a behavioral thing yet again. I have you know, each child is so different and we don't know. Kids can also be chewing on their shirts, chewing on their sleeves in those situations, sometimes wearing smaller shirts. So like if they're really big shirts, you can get the necks up or they're wearing long sleeved baggy shirts that might be provoking the chewing more. And a lot of people would say, well, just give them a chewy, plastic chewy. I actually don't usually recommend that. Again, there might be situations where a child has something else going on besides autism where, you know, an occupational therapist may be working with a child. I'm not saying Chewy's are the worst thing in the world, but I'm chewing on my shirt and I get a chewy can become a defective mand for a chewy. It's germy, you know, especially in the COVID ages where, you know, it really isn't that well, it isn't sanitary at all to have a child chewing on things, wearing Chewy's around their neck. And it's just I do think that we can get rid of Chewy's in most cases slowly without, you know, we do not want children screaming, crying. This has to be a gradual thing. But I do think chewing, mouthing, Pica for sure all need to be addressed. Yeah. So if your child is having Pica, definitely assess what they're eating and seek attention, but also do all these other things. I remember talking to a Pica expert when I had a Pica situation. Forget who the Pica expert was, and he said, Well, what is the child eating? Like what foods and drinks is the child eating? So don't just think, oh, I have to deal with the Pica, also deal with the eating and the grazing and you know, pacifier use.
Kelsey: Yeah. And also what else is the child doing all day? I mean, I've seen kids who look like they might have pica, but really they just have no idea what to do with themselves and no one's engaging them. And why not eat this? Now I get some attention. Now someone comes and freaks out because I've just eaten a bunch of stuff. So you have to look at that stuff too. And just like any problem behavior, once you've looked at the medical side, is to figure out what times a child doesn't eat things or they don't eat things when we're doing puzzles. Oh, they only eat things when I'm cooking dinner and I'm busy, you know, figure out the times when they do eat stuff and and change that. Like Brentley used to eat a lot of dirt. Like he liked dirt and you wouldn't eat the dirt if we had a bucket and a shovel and we were doing something with the dirt. But if we were just hanging out and weren't doing anything, that's what his go to thing to do with the dirt was. So we would just always have toys and things where we could be functional with the dirt. So it's usually a medical condition, but also look at other things that could be going on.
Mary: Yeah, and that's a great point, Kelsey. And if you are a behavior analyst, listening you know, doing FBA on the pica and you think it's going to be you know. Self-stimulatory or whatever, I found it to be attention in most cases. So Kelsey's point about keeping the child busy, engaged, happy. You know, one of my mentors used to say, you know, a happy, engaged child is not going to have problem behaviors. And so for you parents out there and professionals that, you know, don't have the capacity to do FBAs and everything is fine because like, let's put all these great strategies in place, have the child be happy and engaged and see not just feeding problems go away, but all problems of tantrums going to zero and talking going up. And so it's worth it. It's not like, Oh, I just have to deal with that. Mouthing and chewing things and Pica should not be a part of autism. And nobody should say that that's a part of autism. It's not, it needs to be addressed.
Kelsey: Yeah. And so that brings us to our last question, which is why don't we get asked all the time? So now my child's eating, things are going well, how do I get my child to use utensils and eat?
How do I get my child to use utensils and eat?
Mary: Yes. So I do have a section in Chapter ten and it's towards the end on using utensils. And as I said, the assessment does start out with the drinking assessment, but also in the 18 months list on Doctor Mark Sundberg's self-care checklist is scooping with a spoon. And then about 30 months of age, use a fork to pick up the food and knives, I believe are 30 to 48 months. So if your child is not doing the 18 month skills of scooping from a spoon and the drinking skills of drinking out of an open cup and picking up the eating with finger food and drinking through a straw, you shouldn't jump to utensil use because and especially if they're super picky, like you said before, Kelsey, we can't go. Okay, well, are three. And so they should be using utensils and that's a goal and that's on their IEP or whatever. If we don't have the 18 months skills and we have extreme picky eating and we have grazing all day and we have bottled drinking, it's just like you have to build the pyramids solid before you put the next block up. Right. So Jack is in the book and Jack was in the book quite a bit. He was a client and I didn't realize feeding was an issue and feeding as an early intervention professional, I was the behavior person. I didn't realize that his feeding was completely, it was fine as long as he was self feeding finger foods like he would even eat string beans, I remember. And little chunks of meat. And so you're like, wow, you know? But if you presented anything mushy or presented utensils, especially a spoon, like even a fork, if we would have just gone with a fork, he probably would have stabbed the stuff. But anything mushy just freaked out, like just the sight of it. So he was very picky and I didn't know it. And it wasn't my goal, quote unquote, to work on. So that was a problem because he also wouldn't sit at the table, at the learning table for three of my visits in a row. And like he was very much wanting to do what he wanted to do and would scream if you didn't present it in the right way. So for him, it even involved corn chips. He liked corn chips. So initially we have to get lots of reinforcement and then present a corn chip on a spoon and feed it to him. And that was like the first utensil use of a spoon that he tolerated. And then from there it was shaping and those sorts of things. So I would definitely not jump to utensil use unless you figure all of this out. Like if your child has any significant feeding issues. I would work on everything else first. Now, if they don't have real picky eating and it's fine and you're feeding them, then yes, you should work on utensils first, starting with a spoon. And you might think, well, a fork is easier. Yeah, but a spoon is more developmentally appropriate. It has to get in the base first because there's also a coordination of not dropping things off the spoon. And so one of the best ways to teach spoon use and utensil use is to stand behind the child, to present really favorite foods, easy foods, mushy foods, or maybe not maybe just corn chips or lucky charms. Dry, you know, where they could scoop, get it, and you can stand behind them and gently help them with their arm. The reason I don't like to sit in front of them is because you want to stand behind and gently prompt as little is needed to get the movement right. Just like when you're prompting to tie shoes or you're prompting anything, it's better from behind. You'll be able to just gently see where your physical guidance might be helpful. So that's where I'd start with utensils, but I would wait until we get all of this other stuff figured out, and then utensils should be easy.
Kelsey: Yeah, I don't really have anything to add, but that's exactly what I would do if a child does like yoga or something. Obviously, start with something thicker on a spoon than soup. The easier, the better. But whatever your child likes.
Mary: And sometimes chunky foods are harder than smooth. So sometimes there is no favorite food, like mushy food. So you might have to start with something harder. But yeah, if your child is on baby food too, and I tell this story, I don't know if I've told it on the podcast, but I have this child at school. I only saw him at school and his mom wanted to come in to meet with me and she came in and her husband was fighting in a war. She had two young kids, six and eight, and the six year old was in the class. And I saw him eating corn chips and French fries and that sort of thing. So she wanted to meet with me and she was all stressed and financially and he was very destructive and stores and then we got to what he eats, you know, and she's like, oh, well, he'll eat fries and corn chips. And I'm like, What about protein and vegetables and everything? And she said, Oh, well, only in the baby food. And I was like, he's six? And he's eating French fries and corn chips. And I was like, I didn't want to be alarmed or be like, what he's eating baby food. But, you know, so I was just like, Oh, okay, how much baby food does he get? And she said, 52 jars a week. So we don't know as teachers, as professionals in schools, you know, the extent to which people are really struggling with feeding. So, you know, nobody ever asked her about baby food for a six year old who's chewing and swallowing food. So, you know, if you are in a position where your child's just eating baby food or you or whatever, no matter what the age, you know, start dumping it out, make your own, you know, and then if you start dumping it out, you can start making your own. You could start making it chunkier. You can start adding things and you can start shifting to, okay, he can eat French fries. How about sweet potato fries? Not that they're so much better, but they're different. They've got a different color, different taste, different texture. And you can start making progress. But when in doubt, if there's something serious, definitely seek medical attention. Call your pediatrician, go in for a sick visit, even though they're not really sick. Go in, make an appointment to discuss their nutrition and the concerns you have.
Kelsey: Yep. Sounds good.
Mary: Alright. Well, thank you so much, Kelsey. I'm having a lot of fun with these top five questions, and I think the whole classic rebroadcast is also a really good idea and pairing these up so we can put in our latest knowledge because it's been, you know, a few years since the Doctor Keith Williams interview. And so I really like this combination. So if you're listening out there and you like the top five questions, or if you have a topic or you have questions or you like the classic broadcasts, leave us an Apple Review, email us at [email protected] and let us know what we should produce more of. Because Kelsey and I may love it, but if it's not resonating with you, we will change and make it better. So love having you on, Kelsey. Thanks and have a great day.
Kelsey: Thank you too.
Mary: If you're a parent or an autism professional and enjoy listening to this podcast, you have to come check out my online course and community where we take all of this material and we apply it. You'll learn life changing strategies to get your child or clients to reach their fullest potential. Join me for a free online workshop at MaryBarbera.com/workshop where you can learn how to avoid common mistakes. You can see videos of me working with kids with and without autism, and you can learn more about joining my online course and community at a very special discount. Once again, go to MaryBarbera.com/workshop for all the details, I hope to see you there.
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