Guilt , guilt everywhere

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Mrs Anna Parton Bsc RDSpecialist Dietitian
March 2008
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Abracadabra!

• Food standards for schools including special
  schools seem great !
• But.
• What if the child's is such an extreme fussy
  eater?
• What if the parents and kids are voting with
  their feet and sending in packed lunches?
• Is there any point.

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Nutritionally Balanced

• All children, special needs or not need a
  healthful diet to learn and feel their best.
• Often these kids have multiple problems so
  healthy eating may not even be appropriate as
  wont meet their needs
• But for many SN kids Healthy Eating is relevant
  is too important an issue to give up on. Should
  we be pushing for financial support to mop up
  losses? or whats the point, just give them
  chips

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Robert

• Diagnosed at 3, no language, every challenging
  behaviour in ASD handbook
• Extreme fussy eater nuggets - Sainsburys, milk,
  fromage frais (Thomas), apple juice bread- white
  and chocolate/biscuit, crisps!
• Growing well ,slightly overweight
• Started school wouldnt eat or drink anything
• Same packed lunch apple juice, sandwich,
  crisps,chocolate bar. Often even this came back
  uneaten. No way school meals. Often no fluid also
  all daysound familiar!

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At home.

• Main way of communicating screaming. Any lang
  echolalia
• 1-2hours sleep a day
• No concept I was his mum
• Husband depressed
• Destroying brothers toys
• Neighbours complaining about noise
• No eye contact
• Licking puddles, biting, urinating and and
  defecating if cross

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Where do we start?

• Food and eating very emotive topic
• Parents dont like being told what they can and
  can't give their child to eat (chips through the
  railing??)
• Hard enough with neurotypical kids!
• Put that into a special needs context and youve
  got a really explosive mix

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Healthy eating standards?

• Is it worth the hassle?
• Is it relevant?
• Is is appropriate?
• Maybe it is but maybenot just yet!
• Health professional job keep putting it on the
  agenda
• Need to build a degree of flexibility and calm to
  get best results

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Guilt making judgements doesnt motivate anyone
to change?

• Very easy with these kids to continually focus on
  what's wrong.
• Need to daily celebrate the goods however small.
• Attitude and approach is key

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Communication

• 7 spoken work
• 36 Intonation
• 57 Body Language

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Have you every eaten in a school canteen??

• Canteens are a full on sensory overload
  situation.
• Children with SN often use food as part of their
  repetitive behaviour perhaps in some way soothing
  themselves in a very confusing world
• Doing the best they can need to approach it with
  great respect and understanding
• No quick fix

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Extreme Fussy Eaters

• Often have food jags
• Tough love vs. small steps toward goal.
• I plump for a bit of both.
• Take some time to really observe what the child
  is doing at lunch.
• For the real tough nuts bring in parent(?) to
  observe from a distance, will be much more tuned
  into their child then any health professional and
  also promotes a transparent partnership approach.

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Parents and carers must play a central role

• MDT approach is the best singing from same hymn
  sheet!!
• Dietitian, Teachers,OT,SALT,
• Psychologist, psychiatrist,parent, carer. Include
  child if possible
• Siblings can be pulled in at home as modellers
  if good eaters

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Every child is different but heres my hit list
of ideas

• Visual timetables
• Allow at first to eat alone ?
• Allow to eat on separate table/separate time
  (quieter)
• Self service?
• Maybe even home lunch for a while to break the
  cycle (not always possible)

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Hit list continued

• Note who's opposite extreme fussy eater
• Be aware of environmental put offs
  smells/sounds/noises
• temperature
• Memory phobias
• Time allowed to eat too short?

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I want it and I want it now!

• Make veg the first thing at the hatch. Establish
  this as the norm.
• Clear language for catering staff. Say would you
  like peas or tomatoes, not would you like veg.
• Rota of staff to eat with the kids especially
  challenging teenagers
• Adopt a Im bored, this isnt the magic that
  moves the world approach to food demands.
  Attention for the good eaters

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What's going on at home?

• Mum/dad also Fussy
• No proper structure to meals
• No exposure to new foods
• No table
• Cooking skills
• Modelling family meals

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Ideas how to encourage more healthy eating at
home

• Give the child more control self service (will
  eat/may try foods)
• Start with their motivators Pokemon/Thomas
• Aim to make eating enjoyable again

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Other ideas

• Desensitisation
• Food play
• Shopping for the sake of it
• Food in the centre of the table will eat/may
  try
• Persistence!!
• Social Stories

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Social Stories

• Devised by Carol Gray. Write a story using a
  strict ratio of types of sentences. Try not to
  use a direct command.
• Read or have the child read the story daily
• Every one directive or control sentence, there
  should be two to five descriptive and/or
  perspective sentences.
• Sometimes works even with non verbal kids

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Some People Try New Foods     When I am eating, I
may see food that I have not tried before. I will
not know what it tastes like unless I try
some.   Sometimes people ask me to try a new
food. Thats because they think I may like
it.   I may like to try new foods. Sometimes if I
like it, I can have more.   If I do not like it,
its OK to say No thank you.   Trying new foods
is a good way to discover which foods I like to
eat. Adapted from Carol Gray Social Stories
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Learning to Eat healthy foods.   The four major
food groups are - 1.Meat, fish, egg, cheese and
beans, 2.Milk and things made from milk, 3.Bread
and starchy foods, 4.Fruit and vegetables   It
is important for people to eat from these four
food groups.   Eating foods from the four groups
helps me stay healthy.   I will try to eat
healthy food.   It makes others happy to know I
eat healthy foods to keep my body growing
strong. Adapted from Carol Gray Social Stories
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Special diets , fads and phobias.where should we
stand?
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Fussy eatinga parenting problem??

• Overtired/stressed parents who understandably
  give in
• Children often crave control. You often need
  strong parenting skills and support if
  challenging food requests

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A sobering thought

• Rob 12 just start ASD unit attached to mainstream
• No real friends
• Great insight into own ASD desperate to fit in
• What did you have for school Rob? I had a pizza
  slice for breakfast, then I had sausage-roll and
  chips for lunch and mini dough-nut for lunchoh
  and the ice-cream van was outside school..but
  mum I sat with 4 friendscan I invite 2 home to
  play??
• What's more important??

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What to do???

• Ring in and start talking to the staff about
  changing the menu? More than my childs social
  life is worth so. Has to be professional led,
  parents have too many other battles to fight.

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Any more questions??

• and
• Thank you for listening!