BEST OF EP

ROBERT K. ROSS ED.D., BCBA-D, LBA

Reducing the Stress of Mealtimes for Picky Eaters

Diet & Nutrition

As a behavior analyst, I learned a long time ago, that fixing "bad" or ineffective routines was extremely difficult. However, creating new routines was always much easier.

THE REALITY VERSUS THE DREAM

For so many parents (with or without children on the autism spectrum), difficulties at mealtime are a daily reality and these struggles can make mealtimes one of the least preferred parts of their lives. Anticipating another battle royale over eating can often lead to anxiety and dread. For too many parents, mealtime is a daily ritual of unpleasant time with their children. This is simply not what we hoped and dreamed that raising children would be like. We never envisioned having to nag, beg, cajole and threaten our children into eating food. We want them to be a happy, well-nourished child, yet they often seem bound and determined to resist our efforts and eat only the things that are not good for them (or the same one or two items every day). As a result, over time, mealtimes have evolved into a desperate struggle to get some nutrition into a child who would rather starve than give in. All we really want is to be able to have a pleasant family dinnertime and our children to eat something other than the same thing every day maybe even something that is good for them. While most parents would love for this mythical event to be possible, for many it is simply not a reality.

RECOGNIZING THAT THE ROUTINE IS NOT WORKING

By the time we realize how much we struggle at mealtime, the pattern of unsuccessful and unpleasant mealtimes is often so ingrained (for both the child and the parent) that it is not easy to change. The good news is that, as with all routines (particularly ineffective or non-preferred ones), they can change. However, the way to fix them does not lie in the mealtime routine. A real solution to this problem will require us to create a new mealtime routine. As a behavior ana lyst, I learned a long time ago, that fixing "bad" or ineffective routines was extremely difficult. However, creating new routines was always much easier. So when I encounter a mealtime routine (or any other routine) that is going badly (for both the parents and the child), my first inclination is to find a way to develop a new routine around eating, rather than try to make the currently ineffective routine work. There is almost always too much bad history and habits to overcome (for both the parents and the child).

To be clear here, I am talking about children who are selective eaters, not about children who refuse to eat and are at risk of serious medical consequences due to malnutrition and other health impacts of food refusal. For those children, specialized medical and behavioral intervention should be sought. But, for those children who prefer a limited set of (often not so nutritious) foods—and will argue, whine, throw a tantrum and, in general, make the lives of parents and caregivers difficult until they finally concede and give them the foods they want (or the child leaves without having eaten the foods their parents have prepared)—change is possible.

ENVISIONING THE CHANGE

As parents and caregivers we want our children's behavior to change, however we often fail to recognize that in order for that to happen we must first change our behavior. It is simply a fact that as long as we continue to do the things that are not working, they will continue to not work. We tend to see our children as obstinate or inflexible, without recognizing that we are both "stuck" in a routine or pattern that is not leading in the direction we would like to go. The first steps down this road are for us to recognize that we need to make the change and then for us to decide what that changed routine would be in our ideal version of mealtime. We literally need to "rethink" what mealtime is and can and could be for us as a family.

When I ask parents and caregivers what they would like mealtime to look like in an ideal world, they often find this very difficult, they have followed the pattern for so long, they have a hard time seeing any other way. But in the end most parent will say that they would like the child to "just eat what is given to them and to be able to have a pleasant time without arguments." These two basic points are in my view essential to a change in mealtimes. What is typically true of problem mealtimes is that we do not simply give children food and have pleasant conversations with them during mealtimes. We tend to do other things most of which are not consistent with this goal.

So the next step is to work with families to rethink how we start, conduct and end activities involving food, and it mostly involves us changing our behavior. When we do this there is a much better chance that our child will change their behavior. Sometimes I will go as far as suggesting that we work on food acceptance in settings other than the kitchen or dining room where meals time problems occur, but often we do not need so drastic a change.

FIRST STEPS

1. Decide to make today successful: You know what your child does and does not eat every day. If you think about it you can tell yourself exactly what will and will not happen. Since you know what will be eaten and what will not, skip the "Not going to be eaten" food (today) and limit the amount of the food they will eat so that you do not have to have a fight today. You want to focus on remaking the mealtime experience for both of you. To do so, new habits will have to be established. One of these habits is having appropriate expectations about your child's eating behavior. Today, your child is not going to suddenly eat food that they have refused every day for the past months or years. Their intake is likely to be similar to what it was the last several mealtimes. Recognize this so you can set reasonable expectations for eating today. If you only present food today that will likely be eaten, there is little to no opportunity for argument. Doing this is a first step in making it so that you do not feel compelled to do anything except provide food and have a pleasant conversation with your child. Doing this will enable you to do step 2. the mealtime experience for both of you. To do so, new habits will have to be established. One of these habits is having appropriate expectations about your child's eating behavior. Today, your child is not going to suddenly eat food that they have refused every day for the past months or years. Their intake is likely to be similar to what it was the last several mealtimes. Recognize this so you can set reasonable expectations for eating today. If you only present food today that will likely be eaten, there is little to no opportunity for argument. Doing this is a first step in making it so that you do not feel compelled to do anything except provide food and have a pleasant conversation with your child. Doing this will enable you to do step 2.

2. Skip the Argument: This is easier said than done, but If your child always refuses to eat the foods when you ask them to eat, consider skipping the "ask," (if the demand always results in refusal, it will today as well). Skipping the part where you ask/tell them to eat, and then they reliably tell you "no" and you then tell them they have to…, is a simple idea with often profound effects. Arguments about food typically require someone to start the argument and, whether we realize it or not, we typically start it. We say things like "you need to…" when in fact the child does not "need to." We really want them to eat the foods we have prepared, but from their perspective (which matters more them than ours) they do not "need to." Recognizing this basic fact and the fact the request to eat is almost always followed by refusal to eat, can free you up to simply present food.

3. Be Social, Not Controlling: Children are smart; they can recognize food and can eat. They do not require you to tell them to do so, the presence of food on the table is enough of a prompt. If you also have food and simply begin eating, without telling your child to eat, they may do so. If they begin eating, great, then you should start a wonderful conversation with them about anything other than food. Tell them about your day, ask them about theirs. Make it social and not about eating (or not eat ing). Be fun, be funny. Have the conversations you always wanted to, the only thing stopping you from talking about what you want to talk about, is you (and a long history of talking about food problems). ing). Be fun, be funny. Have the conversations you always wanted to, the only thing stopping you from talking about what you want to talk about, is you (and a long history of talking about food problems).

THE POWER OF SUGGESTION: Children are smart; they can recognize food and can eat. They do not require you to tell them to do so, the presence of food on the table is enough of a prompt.

4. Recognize that skipping a meal occasionally is not a direct threat to your child's health: Assuming your child is within developmental norms for weight and height, if they do not eat one meal (or only a small amount today) they will be OK, and they will be hungrier at the next meal. I find that many parents today are extremely uncomfortable with the idea of their child missing a single meal. So much so that they try extremely hard to get a child who may not be all that hungry to eat. Become comfortable with the idea that developing children are more and less hungry at times and will not unduly suffer if they decide not to eat and as a result miss a meal. This realization can go a long way to changing the dynamic over mealtime eating. Allowing child to be "all done" if they are picking at, but not eating their meal. Parenting is challenging and we sometimes get so caught up in our role as nurturer that we may see failure to feed our children every four to six hours as a cardinal offense and evidence that we are a bad parent. Often, I find that this is one of the big hurdles for parents to overcome as it can be the source of their overwhelming investment in "making" a child eat when they really do not want or need to.

5. Food Presentation Without Eating Requirement: This is one of my favorite ways to introduce new foods. Simply placing food on a plate that adults (parents and caregivers) take items from and eat, but do not prompt or require the child to take or eat. Numerous studies have shown that when foods are presented without an explicit directive to eat, over time (typically five to 10 days) many children will end up "trying" the food item or items. If little attention is paid to not eating and much social interaction (unrelated to eating the item) follows trying new foods over time,

this habit tends to strengthen. The hard part is for the adults to make mealtime about the time spent together and not about the meal.

Changing the ongoing struggles with our "Making the decision to establish the routine we want to have is a good first step." children around mealtimes requires that we change what we do at and around mealtimes. This time and setting present us as parents and caregivers with choices. We can choose not to make mealtimes a fight, we do not have to feel compelled to make our children eat. We can simply prepare foods for our children to eat and socialize with them while they are eating. If they are not eating we can talk to the other children or adults at the table.

What we say or do is not actually under the control of our children. We choose to nag, argue and negotiate, we can also choose not to do so. That despite how it feels, our kids do not make us tell them things 20 times, we make us do that and we can decide not to continue a cycle that we know is unproductive but often hard to change while it is happening. Making the conscious decision to establish the routine we want to have rather than continue the one we know to be ineffective and unpleasant is a good first step. The behavior of our children can and will change if we recognize that our behavior must change first for theirs to change. •

CHANGING THE SUBJECT: Start a wonderful conversation with your child about anything other than food. Tell them about your day, ask them about theirs.

ABOUT THE AUTHOR

Behavioral Education Assessment and Consultation Inc. (BEACON Services of Massachusetts and BEACON of Connecticut). Dr. Ross is also President Massachusetts Association for Behavior Analysis. He received his doctorate in educational leadership from Nova Southeastern University and his master's in applied behavior analysis from Northeastern University. He is the codirector of the BCBA certification program at Cambridge College in Cambridge, Massachusetts. In addition to his teaching and research roles at BEACON, he consults with programs and works directly with individuals with autism and Asperger's syndrome as part of his caseload responsibilities at BEACON. Dr. Ross has presented more than 100 applied research poster presentations, workshops, and symposia at ABAI conferences and authored several related articles.