Joan Peters Mental Health Practitioner CAMHS Alder Hey 29/1/19 Fussy Eating Joan Peters Mental Health Practitioner CAMHS Alder Hey 29/1/19

Session Outline Fussy eating and food refusal Children with ASD- Restricted diet Examples of CAMHS interventions When and where to get help

Fussy Eating and Food refusal Very common Most common in pre-school children, but can also be found in school age children Tend to eat favourite foods without any problems Eat normally in certain situations but not in others. Tend to be normal weight and in good health

Some common reasons Showing a sign of independence Demand for attention Children can learn refusing food is very upsetting for parents and therefore use food refusal to influence the house hold. After an illness or infection

Helpful advice Stick to a routine-three meals a day, healthy snacks in between. Avoid snacks and drinks too close to mealtimes- leave at least 2 hours between snacks and meals Ensure main meals involve sitting at a table Eat the same meals at the same time as your children

Try to make meal times enjoyable and sociable Try to make meal times enjoyable and sociable. Invite child’s friends around for meals Involve child in meal selection, preparation and cooking If your child will only eat a few foods, build on these. E.g if child likes potato, try different types such as mash, roast. Same if child likes certain texture , tastes or colours of food.

Offer a new food with a familiar food Offer smaller portions. If these are finished more can be offered.

Try to keep your cool and keep calm even if a meal hasn’t been eaten Try to keep your cool and keep calm even if a meal hasn’t been eaten. If you are anxious and tense your child will pick up on this and it could make the situation worse. So don’t make a fuss- just take the plate away without comment Don’t offer alternative food or drinks; if a meal is refused this may be seen as a reward Never use force, threaten with punishment or bribe a child to eat

REMEMBER Patience Your child will eventually grow out of this phase Encouragement Praise and acknowledgement are always good motivators

Children with ASD- Restricted Diet “I was super senstive to the texture of food, and I had to touch everything with my fingers to see how it felt before I could put it in my mouth. I really hated it when food had things with it like noodles with vegetables or bread with fillings. I would never, never put any of it into my mouth. I knew if I did I would get violently sick” in Atwood !1998)

Some reasons for food restriction in children with ASD Physical health- pain, gastro intestinal problems, medication Communication/understanding Dislike of change-routine, appearance, packaging Sensory difficulties- texture, taste. smell, physical environment The social element

Helpful Ideas First step- create a food diary Visual food charts/ timetables Small steps- gradual exposure Food books- diaries of achievement Games- make food fun! Encourage child to handle and prepare food

More helpful ideas Social stories Environmental adaptations Distraction e.g music, story tape Use special interest e.g Thomas the tank plate Develop oral motor skills- straws, whistles, bubbles Planning ahead and preparing for change or new situations

When and where to get help If your child is losing weight, seems lethargic, weak and /or irritable, or is suffering from fever Discuss with health professional- School Nurse, Health Visitor, GP ASD – Isabella Trust, ADDvanced Solutions, ASD Pathway Training Team

Referrals & Conversations Please call our Single Point of Access on: 0151 293 3662 Please visit our website: http://www.alderhey.nhs.uk/departments/camhs