Caroline Pringle, Families and Professionals Advisor for Child Enquiries, shares some strategies for eating and mealtimes with your child in her 'Snippets of Advice' blog series.
I have had some calls/emails to the advice line about children’s eating habits and felt it might be useful to highlight a few issues and share strategies that have worked for families.
The following information is for guidance only, any parent who is unduly concerned about their child’s diet or eating should consult with a medical professional.
A varied diet is good for us all and children with Fragile X may eat bland or what is often called ‘beige food’ and their restricted diet is a concern for families. I know parents have been able to puree vegetables and add them to a meal without a child realising and thus providing essential nutrients. The NHS have an Eatwell guide that looks at food groups. Keeping a food diary can help; families I have worked with in the past have found it useful to write down what their child had eaten during the day and surprisingly, sometimes it was healthier than they thought. Also, a food diary is useful information to take to an appointment with a GP or dietician.
Think about the environment your child is eating in; is it too noisy, are there strong smells to distract your child? Often school canteens are sensory overload for them, and this will impact on their eating. It has helped some children to go into the canteen first before the other children ‘charge in’. Where they sit is important, I am aware that many children with sensory processing difficulties like to be in the corner of a room so that no one can walk around or behind them and they can face into the room to know what is going on.
Mealtimes with the family is a good activity as you can model behaviour by eating together rather than sitting with a tray watching TV. Allowing your child to be involved in choosing or even helping to prepare a meal can help as well as helping to lay the table. However, being realistic with a busy household I appreciate that this can’t always be a daily occurrence. You don’t want mealtimes to be a battle as this will cause more stress for your child and heighten their anxiety levels. Some families have found using a weighted lap pad makes their child feel more ‘grounded’ when sitting at the table but this needs to be used for mealtimes only so as not to reduce the effectiveness. (An OT can advise you further on this).
Cutlery can be difficult to hold and looking into shaped or weighted cutlery may help, also plastic rather than metal cutlery can be better. Non-slip mats or plates/bowls with suction pads underneath might help to stop the food shifting around. I know from families that plates with dividers that keep foods separate helped their children cope better when eating a meal. Some children with Fragile X can be hypermobile and have lax ligaments and an upright sitting position for eating and holding cutlery can also be difficult for them. It is important for them to be supported to prevent them choking when they eat. An OT will help you with this as well as a speech and language therapist if a child has problems chewing and swallowing food.
We do tend to worry that we are serving up a dinner that is hot enough, making sure it is piping hot and served on warmed plates. However, I was informed by an OT that many children eat better if their food has cooled down to room temperature, so that might be a consideration for your child, also don’t have the plate too full.
Considering sensory issues, as previously mentioned noise levels can affect a child, and the smell and texture of foods can also be difficult for them. They may over stuff their mouth, prefer crunchy food or pureed food. Do consider that if your child has low muscle tone this may impact on how easily they can chew foods.
Trying new foods can be very difficult for a child and this process needs to be taken very slowly, working towards touching and tasting something like a raw vegetable, progressing to a few bites at a time, then leave it and try again the next day. It is called a graded exposure approach and you may wish to seek professional advice before starting this. Some individuals may eat whatever is available as they are seeking out sensory input and will endeavour to eat stones, dirt, wood etc. this is sometimes classed as PICA. It is acknowledged that some people with Fragile X have eating patterns associated with Prader Willi Syndrome. They overeat and are constantly seeking food and are unable to know when they are full up or hungry.
Visuals prompts for mealtimes and what foods they are having can reduce a child’s anxiety and support them with the transition from an activity to a mealtime. Some families have found it helpful to put the day’s menu on a chart. Using first and then (also known as first and next) cards to let children know when food is ready, along with using a sand timer or pointing out on the clock face when dinner will be ready helps. Praise for your child’s efforts is important and perhaps using a simple sticker reward chart could be option.
Two of our papers that might be of interest are:
Although they were written some time ago the information is still very relevant.
May I reiterate if you are unduly concerned about your child then do consult with a medical professional.
Professionals who can help include:
Speech and Language Therapist (SALT)
Occupational Therapist (OT)
If you have any tips/suggestions that I can share with other parents, then do let me know and I can add it to this blog.
I hope this information has been of some help and please do not hesitate to contact me for further support.
Many thanks to the following organisations whose information has been of help:
Contact (formerly Contact a Family)
National Autistic Society