If you do not have access to professionals who can help right now, here are a few things you could consider. Remember that the effectiveness of each tip will depend upon the specific mealtime problem behaviour being targeted and although these suggestions may help in alleviating some of the issues families are facing surrounding mealtimes, they are not guaranteed to decrease or eliminate the problem feeding behaviour you are facing.
*Please note that the suggestions below do not in any way replace the completion of a formal behaviour assessment or behaviour treatment program. Involvement of a Behaviour Analyst with a masters degree in Applied Behaviour Analysis (ABA) or equivalent as well as registration with a governing body (in Manitoba, the Psychological Association of Manitoba or PAM) is recommended.*
Tips for Mealtime
Specific Times and Regularly Spaced Meals and Snacks
Having three regularly spaced meals (i.e., breakfast, lunch, and dinner) will help establish a family routine. Consistency in providing meals at the same time every day will help reduce anxiety and will give the child plenty of opportunities to get the proper nutrients they need. Providing 1 – 3 regular snack times in addition to regular meal times may also be beneficial for children who eat small amounts at meals. Times for snacks could include late morning, afternoon or afterschool, evening or before bed.
No Eating in Between Meals
In order to encourage positive eating behaviours during mealtime it is important to restrict food intake in between meals. This suggestion is aimed at preventing children from learning to avoid food at mealtimes in order to access preferred food later. ‘Grazing’ or eating small amounts of food throughout the day may also lead to the child not being hungry at mealtimes. This could cause lower food intake or lowered motivation to try new foods.
Limit Liquid Intake to Water Between Meals and Snacks
It is important to offer fluids throughout the day for the sake of hydration and as an aid in the digestive process. Offering only water in between each meal or snack time ensures the child stays hydrated without additional calories that could cause lowered appetite at mealtimes.
Limit Milk/Juice Volume During Meals and Snacks
It may be helpful to limit how much milk or juice the child is consuming; the amount should be determined based on the child’s age and needs (speak with a dietician or the child’s pediatrician). Once this predetermined amount has been consumed, the child can be offered water if he or she continues to express thirst. As with the rest of the tips, this suggestion depends upon the specific details of the child’s problem feeding behaviour. For example, if a child tends to consume all of her milk before taking a bite of dinner it might be helpful to start the meal by providing her with a glass of water first and then presenting her with milk after she has eaten a certain amount of dinner first.
Determine Length of Meals and Snacks
Some problem feeding behaviours interfere with the duration (or length) of a meal. For example, leaving the table frequently, packing, or rumination can cause mealtimes to be much longer while other problem feeding behaviours such as eating too quickly, refusal to sit at the table, or food refusal can result in much shorter meals than preferred. In addition to problem feeding behaviours, children may struggle with skills required for self feeding such as balancing food on a utensil, lifting the utensil to his or her mouth or spearing food with a fork. The child may also have skill deficits in chewing or swallowing. These factors should be considered when determining an appropriate meal time length. Approximately 20 – 30 minutes for meals and 10 – 20 minutes for snacks is considered reasonable. The use of a timer may be helpful in maintaining this boundary, particularly for children who have learned to stop meals by engaging in negative food behaviours such as throwing, yelling, or vomiting. The timer becomes the signal to the child that mealtime is completed as opposed to his or her negative food behaviour. For those children who frequently leave the table, it may be helpful to pause the timer each time he or she gets up. For children who are unable to sit at the table for long periods of time, start with short time periods (e.g., 1 – 2 minutes) and then lengthen as they become more comfortable and successful with staying at the table for longer periods.
Model Healthy Eating Behaviours
Watching how adults tackle mealtime and diet can help teach children both healthy and unhealthy behaviours. Even children with low imitation skills, such as those diagnosed with ASD/DD, may observe adults or siblings consuming certain food items such as vegetables and therefore be more familiar with them if presented with some. As a result it is important to demonstrate the desirable behaviour for the child as much as possible during mealtimes. For example, a parent may try to include a variety of foods from all food groups in his weekly meal regimen for a child who refuses to eat certain food groups.
Minimize Distractions during Meals and Snacks
Similar to keeping a consistent routine, having the child eat at the same place for each meal may help make the routine familiar. In addition, it may be important to limit the amount of individuals present at meals initially.
Tips for Giving Instructions
To increase the potential for compliance, keep instructions short and concise (e.g., 1 action). For example, asking a child to put her napkin in her lap. Avoid phrasing instructions in the form of a question which the child can say “No” to: “pick up your fork” versus “can you pick up your fork?” You should also consider whether the child is able to underst and and complete what we are asking them to do. In addition, phrasing an instruction with what the child should be doing rather than what they shouldn’t be doing is a vital distinction. For example, “take a bite of your hot dog” versus “stop playing with your food”. The first instruction tells the child what the expectations are of him in the moment whereas the second instruction only cues the child to the negative food behaviour he has been engaging in. Eye contact or orienting of the shoulders towards the parent may be one way to determine whether or not the child has heard the instruction.
Telling the child exactly what he or she is doing well will help positive mealtime behaviours continue to strengthen and make them more likely at future meals. Providing praise enthusiastically, or at least in a different tone than an instruction, helps the child discriminate between what he or she is doing right. Provide praise immediately after the desired mealtime behaviour occurs.
Separate Medication Administration from Meals/Snacks
For children who have difficulty taking medication it is possible that they may associate this discomfort with dinner if medication is administered right after a meal. In order to prevent this overgeneralization, give the child his or her medication at another time in the day if possible. It is vital to note that some medications have specific instructions regarding when they need to be consumed and some medications specifically need to be taken with food. Therefore it is important to review this concern with the child’s pediatrician prior to changing administration times.