COMING TO THE TABLE : CREATING A MEALTIME YOUR FAMILY CAN LOOK FORWARD TO

While meal challenges exist for all parents, they can certainly be difficult to manage for children within the ASD community. However, there are some things caregivers can do to make strides towards happier and healthier meals.

ENLIST SUPPORT

First, if you are a parent or caregiver of a child with ASD, you know that you are the absolute expert in your child. You can sense when something is amiss, even when it's invisible to others. You know your child backward and forwards, inside and out; you can do this. Yet, you do not have to do this alone. Enlist the help of experts! Registered dietitians are uniquely qualified to assess your child's nutritional status and recommend various strategies to address dietary concerns. Dietitians can also help navigate special diets like gluten or dairy free. They will work with you to mitigate nutritional risks and explore foods you can try. Occupational and feeding therapists are also valuable allies for helping you create a physically comfortable eating environment and bring in any adaptative equipment if necessary.

Before you make any mealtime changes, it is essential to rule out any physical problems interfering with your child's ability to eat. Dental decay, chewing and swallowing difficulties, constipation, irritable bowel syndrome,

and acid reflux are common issues that may make eating unpleasant for your child. Common medications prescribed for children with ASD may affect appetite and cause stomach upset as well. Once any physical problems have been addressed, consider evaluating the meal environment.

ASSESS THE MEAL ENVIRONMENT

Children and caregivers may experience heightened stress and anxiety around meals. Try relaxing into mealtimes by spending a few minutes deep breathing or meditating. Going for a quick walk around the neighborhood may help ease uncomfortable feelings and set the stage for a calmer environment. Occupational therapist Jenny L. Clark, ORT/L, suggests talking your child through belly breathing with a beanbag animal (outlined below).

It is vital to build a routine around meals to help decrease fears and implement healthy behaviors. Try to eat meals at the same table and have everyone in the same seat. Minimize distractions such as pets, TV, or other background disturbances.

If meals are currently very challenging, start by sitting together at the table as a family (without food), even if it's for just a few minutes. Make sure your child can sit at the table comfortably. If your child slouches, wiggles, or expresses discomfort, consider seeing if you can improve their seating with rolled towels, a booster, or footstools.

BELLY BREATHING WITH BEANBAG ANIMAL

"Have children lie on the floor and place a small beanbag animal on their stomach. Cue the children: 'Breathe in slowly through your nose and feel the stuffed animal rise, breathe out slowly through your mouth and then feel the animal lower.' Repeat at least 3 times. Play quiet music for increased relaxation."16 — Jenny Clark, ORT/L

Food selectivity means that an individual has a small repertoire of foods that they agree to eat.6,7 These foods are often eaten multiple times throughout the day.6,7 Food selectivity can be challenging because it reduces the variety of foods and puts children at risk for nutritional deficiencies.6,7 Children with ASD are more likely to have significantly lower calcium, protein, and fiber intake than neurotypical children.8 Additionally, food selectivity behaviors often favor high calorie, sugar, and fat foods (e.g., pudding, candy, juice), which may increase the risk of overweight and obesity.6,9 In fact, children with ASD are 40% more likely to develop obesity than neurotypical children.5 They also have an increased risk of developing heart disease and Type 2 diabetes.5,6,9-13 Food selectivity goes hand-in-hand with ‘neophobia’or fear of trying new and different foods.5 Children with ASD may actively avoid trying novel foods, and they may become upset when new foods appear on their plate or if their favorite foods are presented in unfamiliar ways.7 Caregivers frequently report preparing special foods or separate meals to accommodate their child’s preferences.

Children with ASD may also exhibit disruptive behaviors at or around mealtimes. Challenging behaviors may be a result of increased anxiety, and may include frequently leaving the table, throwing food or silverware, tantrums, crying, and food refusal.14

"I learned that going into meals, my son isn't able to sit at the table for the whole meal, he won't eat the same foods that I eat, or have excellent manners. But, I started to ask myself, what is

my absolute 'yes' for him? What does he have to do? I told him, 'You have to sit in your chair and you have to eat 2/3 of your meal.' Finding what was an absolute yes on my end helped establish the minimum. Once he met the minimum, we bumped it up." – A.M. about her son R.M. who is diagnosed with ASD.

Mealtime disruptions may ultimately decrease the healthful benefits of family meals, and research has shown, unsurprisingly, that caregivers report increased stress and anxiety around eating.14,15 Parents may also shift their attention from the whole family to their child with autism, thus limiting the benefits of mealtimes to their other children.15 However, there are some things caregivers can do to make strides towards happier and healthier meals (see above).

The "ideal" family meal is one where you and your family feel calm and relaxed, and your child consumes a variety of foods. Meals won't look "perfect" or TV-ready, and it won't always be easy. Still, hopefully, by making a few small changes, you can create a mealtime that you and your family look forward to.

"I have developed a deeper understanding and appreciation for milestones. These tiny wins over time helped us make progress with food. As he got older, my son became much more tolerant. It was gradual shift, but looking back he has made great progress!" – A.M. about her son R.M. who is diagnosed with ASD. • Special thanks to A.M. for generously sharing her time to discuss her son's journey with ASD.