When eating becomes a really restrictive beige diet, when children refuse more foods than accept them, and when it impacts on your ability to function well as a family, it’s time to consider outside help like an OT.
How can an Occupational Therapist (OT) help?
Occupational Therapists (OTs) can specialise in eating and the sensory issues around eating. They can help expose and de-sensitise your child to food smells, textures and looks, either at home or at their consulting rooms. OTs can also provide advice on how to best prepare and set up the table for positive eating experiences, giving a common language and support for the adults. Occupational Therapists can discuss senses (smell, taste, touch, look etc) and eating and provide sensory and regulation activities for during eating times.
Here’s 7 things our OT has worked with us on to improve a restrictive beige diet in our child with autism.
1. What is Division of Responsibility?
The Division of Responsibility in feeding is an approach documented by Ellyn Satter in 1986. It is well documented in the literature and is highly regarded as a best-practice feeding model for children. This approach supports the autonomy and well-being of the child, and is considered to be positive and responsive in it’s feeding approach.
Most simply put, the Division of Responsibility is “parents provide, children decide“. The parents are responsible for the routine of feeding – when (time), where (location) and what (food) is on offer for a meal. The children are in control of whether they will eat, what and how much they will eat (from the choices made available by parents). This allows the child a level of control and autonomy without being controlling or demanding.
2. How to create positive meal routines
As part of the Division of Responsibility model, routines for meal times are encouraged. Parents should choose the times for set eating (e.g. 6 times a day at breakfast, morning tea, lunch, afternoon tea, dinner and supper). Outside of these times snacking and sugary drinks should be discouraged.
A positive and calm environment at the dinner table is also important. We don’t want dinner time to be an hour of conflict, fighting, yelling and throwing food across the room. Where possible, don’t pay specific attention to what people are eating and don’t talk about food. Make general family conversation and keep feeding times as positive as possible.
3. How to making eating time safe
When there are only a few ‘safe’ foods that a child will eat, it can be tricky serving out foods and hoping the child will have enough to eat. Children need to learn about regulation of hunger, and sometimes this will mean going hungry in between meals, or until the next meal if they refuse completely. In transitioning to the new routine, parents can offer safe (or ‘okay’) foods in addition to more challenging food so the child is always comfortable to eat something. This empowers the child and makes it their choice whether to eat, and what to eat (not just relying on being offered safe foods all the time).
It’s also helpful language to talk about ‘okay foods’ or foods that are ‘safe enough’. Okay foods might not be the most favoured foods in a beige diet, but they have been tried and tolerated in the past so are okay. There may be aspects to the food that are a little bit challenging, but if they were put in a lunch box and the child was hungry they could eat it. For our daughter, dried apple is an okay food. It has a beige look and the texture is tolerable, but sometimes the apple tastes sour rather than sweet.
4. How to not make a fuss
Intentional nonchalance is not paying specific attention to eating. This can be helpful for reducing anxiety, emotion, and increasing the chance a child will eat something. A child is more likely to try a new food if a) no one is telling them to do it, b) they think no one is watching them and c) they get an intrinsic reward for the behaviour (i.e. not being hungry anymore). Try to keep conversation on other topics and don’t draw attention to what or how much is being eaten.
With intentional nonchalance, it’s also important to avoid praise. It’s an instinctive response to want to reward and praise our child when they try a new food. However, this can draw attention to eating and let the child know that you are watching them eat. It can backfire too. If a child is thinking about trying a new food, but isn’t sure if they will like it, they might choose not to try it so as to not disappoint you. They’ll remember that last time they tried something you made a fuss over them and were happy. This time, they might not like it and don’t want to disappoint you or have you be sad, so they don’t try something new at all.
5. How to allow choices at meal time with viking eating
Serving out meals in a deconstructed buffet style (or ‘viking style‘) can support children. It can casually expose them to new foods and smells, but also support them to make their own choice on what to select and eat. In a viking family meal, all parts of the meal are deconstructed in the centre of the dining table. For example, a pasta meal might be broken into three components – the cooked pasta, tomato sauce, and grated cheese. Everyone can then serve out their own bowls, choosing what and how much to eat.
This teaches that all foods are no different from others (there are no ‘special foods’). It also allows for sensory exploration of flavours and textures of many foods.
6. How to give exposure to non-preferred foods beyond the beige diet
Banana and weet-bix are two very challenging foods for our daughter. An OT is able to help expose her to foods not in her restrictive beige diet in their kitchens. At home we struggle, but a different environment and person helps. Sessions often involve cooking muffins, cakes or biscuits that contain challenging foods. Preparing a chocolate banana bread means being challenged to persevere through and tolerate challenging textures, smells and visuals.
As well as preparing and cooking with new foods, we have lots of other ways to get kids to try new foods and broaden exposure to non-preferred foods.
7. How to be calm and have emotional regulation at meal times
A lot of the work around non-preferred foods is challenging. Alongside exposure to new smells and textures is teaching of calming and regulation activities. This provides opportunities to practice calming without food triggers. When faced with a challenging dinner, hopefully rather than screaming and throwing the plate upside-down across the table, we can calmly regulate and problem solve through it.
Breathing activities, slow breathing and ‘blowing out candles’ may help manage arousal levels. Other calming ideas for managing anxiety and big emotions involving big body movements or sensory input may work better.
Conclusion: how an OT can help with a restrictive beige diet
In working with a specialised OT, we have learnt to
- Have an eating routine with Division of Responsibility. Parents decide what is offered, when and where we eat, but the child decides how much and what to eat.
- Create positive meal times with everyone around the table having positive and calm conversation
- Make meal times safe by providing some preferred foods (so hunger can be satiated). Also provide variety with non-preferred foods that can be explored together
- Display intentional nonchalance and not praising or being negative about food choices
- Allow food choices and exposure to foods through viking style buffet or deconstructed meals at the table
- Expose our child to non-preferred foods through sensory cooking
- Be calm and build our repertoire of emotional regulation strategies
Working with our OT has been important for building life skills in eating and dealing with the restrictive beige diet. Our team of specialists also help with improving sleep and toileting. It’s a long journey, but with all our team of professionals supporting us we’re getting there.