Mealtime Tips for Children with Autism

Most families spend a significant amount of time eating and drinking together, and for many parents and children, mealtimes can be a fun and enjoyable experience. However, mealtimes can also be stressful for parents and children, especially children with autism spectrum disorder (ASD). Providing structure to mealtimes, such as following a routine and setting clear expectations, can help make meals more enjoyable and can promote healthy eating and appropriate mealtime behaviors. This parent’s guide for mealtime tips for children with autism will provide parents and guardians with several strategies that will help set them up for success during mealtimes. However, we understand that all children are unique and what works for one child may not work for another. Therefore, this content is meant to be taken as general information and is not specific medical advice. As always, please consult with your pediatrician or another healthcare provider if you have concerns about the health of your child.

Preparing the environment

When preparing your child’s environment for mealtimes, it is important to minimize distractions as much as possible before starting the meal. Unless you are using them as part of your meal, all toys, tablets, games, etc. should be removed out of sight from the meal environment. It is also important to have all materials prepared and ready to go prior to beginning the meal. For some children, this may mean having extra napkins, utensils and/or pre-cut bites handy so that you are not having to stop the meal or leave your child to go find or prepare these items. When choosing which feeding materials to have prepared, keep in mind that this is another way to set yourself up for success. For example, suctioned bowls are great to use for preventing spills. Divided plates may also be a good idea if you are introducing new foods onto your child’s plate.

Appropriate seating is another piece to remember when preparing your child’s environment for mealtime. Your child’s size and safety should be considered when choosing between using a highchair, booster seat, child-sized chair and table or adult-sized chair and table. Highchairs are typically recommended until around 18 to 24 months of age, but there is no formal recommendation on when to move your child from the highchair. Booster seats typically have a weight limit of 40 pounds, but some booster seats can accommodate up to 60 pounds. Once your child can remain seated for meals, this may be a good indication that they are ready to transition from the booster seat to a child-sized chair and table. Additionally, if using a booster seat or child-sized chair and table, it is best to have your child’s back to a wall to increase safety and minimize the ability to get up and leave the table.

Lastly, in preparing your child’s environment prior to beginning the meal, you should be setting and providing clear expectations to your children so that they know exactly what is expected of them throughout the meal. Whether it is a set amount of time for how long you expect them to remain seated, how much of each food you would like them to eat or what they have to do to earn a reward after the meal, these expectations should be clear and understandable for your children, and they should be given these expectations prior to beginning the meal.

Mealtime routines

Structuring your meals in a way that gives your child a predictable routine to follow is one of the best things you can do to create a successful mealtime. If possible, meals and snacks should be given around the same time each day. You should also try your best to have your child sit in a designated mealtime space for both meals and snacks each day. As previously recommended, choose a mealtime space with both appropriate seating and with minimal distractions. You should plan to have your child sit for a designated amount of time during meals, generally 30 minutes for meals and 15 minutes for snacks. Establishing a mealtime routine also includes having your child participate in the pre and post-meal routine. Before beginning the meal, children should wash their hands, and depending on their age, they can be given tasks such as helping prepare the food or setting the table. After the meal, your child’s post-meal routine could include helping clean up the table and/or dishes or putting any extra food away.

Snack time 101

Following a routine for snack times can also have positive effects on your mealtimes. Snacks should be limited to 2 to 3 snack times per day, and snacks should be given a set time limit to reduce grazing throughout the day. Grazing is the unstructured, repetitive eating of small amounts of food over a longer period of time. Grazing occurs outside of planned meals and snack times, and it typically occurs without appropriate hunger or satiety sensations. Grazing can decrease motivation to eat during mealtimes; therefore, it is important to limit eating outside of meal and snack times. Likewise, snack times should not occur within at least one hour before or after meals to increase motivation to eat during mealtimes. Lastly, during set snack times, snacks should be limited to an age-appropriate serving sizes. A good general rule of thumb to follow is that snacks should be one handful, using your child’s own sized hand as the handful.

Tips for challenging behaviors

Even after preparing your environment as best as possible and putting a structured mealtime routine in place, you may still experience challenging behaviors during your meals. One challenging behavior may be out-of-seat behavior. If your child has a hard time staying seated during mealtime, consider using a visual timer that indicates how long you are expecting your child to stay seated before getting up from the table. Start with a short amount of time and gradually increase as you see success with the shorter times. If your child does get up from the table, provide redirection back to the table. You can use praise and/or a reward for remaining seated for the length of the visual timer. You may also experience other challenging behaviors during mealtimes, such as negative statements about the food, whining, negotiation, pushing the food away and more. Try as best as you can to ignore these inappropriate behaviors by not reacting or reprimanding, especially when they are not harmful to your child or anyone around them. On the other hand, when your child is engaging in appropriate behaviors throughout mealtime (e.g., staying seated, taking bites, sitting quietly, etc.), provide frequent, high-quality praise that specifically tells your child what they are doing correctly that you would like to continue seeing (e.g., “I love how you’re staying in your seat!” or “Thank you for taking bites all by yourself!”).

One time during meals that you may see an increase in challenging behaviors is with the introduction of a new food. One helpful strategy to use when introducing new foods is giving your child choices. Would you rather try one bite of broccoli or one bite of carrot today? Do you want to use a fork or your fingers? Giving choices can also be a helpful strategy for other aspects of mealtime. If your child is having a hard time coming to the table for a meal, give them a choice between sitting at their small kid’s table or at the big adult’s table, or give them a choice between the chair on the right side of the table or a stool on the left side of the table. Giving your child choices gives them a little bit of buy-in and gives them a sense of control over the situation.

Another useful strategy for introducing new foods is starting with a very low demand and gradually increasing the demand as you’ve seen success with the previous demands. This might mean starting with only one dime-sized bite of a non-preferred or new food. As you see success with the low demand, you could gradually increase both the size of the bite and the number of bites that you are presenting to your child. Food chaining can also be another strategy to use when introducing your child to new foods. Food chaining works by taking a food that your child is already eating and identifying new foods that are similar in color, shape, texture, smell and/or taste to gradually introduce through successive steps. An example of food chaining could be working from McDonald’s french fries, to different brands of french fries, to homemade french fries, to potato wedges, to baked potato, to mashed potatoes. This allows you to take smaller, more manageable steps towards introducing new foods.

Things to remember in the moment

We understand that sometimes when you are in the middle of a tough meal where your child is engaging in challenging behaviors, it can be hard to know what to do or how to react. These are a few key pieces of advice we can give you to try to help during these moments. First, try as best as possible to stay neutral during tough meals. We know this can be a challenging and stressful time for you but try as best as possible to not get angry or give a big reaction following inappropriate behaviors. Sometimes, children may be looking for that reaction, so when you give them that, you are making it more likely that that behavior will happen again in the future. Instead, make sure you are providing frequent, high-quality praise when they are engaging in appropriate mealtime behaviors. Also, don’t sweat the small stuff during meals. Situations like being messy while eating are developmentally appropriate and shouldn’t be what your focus is on during meals.

Likewise, never end a meal based on the occurrence of inappropriate behavior. Again, oftentimes children engage in inappropriate behaviors during mealtime in order to escape from the mealtime demands, so allowing them to escape from the meal based on engaging in those inappropriate behaviors will only make it more likely that those behaviors will happen again in the future. Instead, you could utilize a visual timer to track the length of the meal, and that way you will have a set time to end the meal based on the timer rather than based on the behavior occurring. Lastly, don’t give into bargaining or negotiating during meals if the meal is not going well. If you have set expectations and rules prior to beginning the meal, stand firm in your expectations and do not lower them in the middle of a meal if it is not going well. You want to teach your child that once rules and expectations are set, they will not change. Do not give attention for bargaining or negotiating attempts, but provide frequent, high-quality praise for appropriate behaviors. If a meal does not go well, you can always adjust your rules and expectations prior to beginning the next meal.

When to seek help

• If your child has a limited variety of foods
  • Limited to certain colors (e.g., all brown diet like chicken nuggets and french fries only)
  • Limited to certain categories of foods (e.g., no fruits or no vegetables)
  • Brand-specific (e.g., only Kraft macaroni and cheese)
• If your child refuses to eat certain food textures or has difficulty transitioning from one texture to another texture
• If you notice that your child has difficulty chewing and/or swallowing their food
• If your child is losing weight, or unable to maintain a stable weight
• If problem behaviors are significantly impacting mealtime

If you feel like your child may benefit from services targeting limited variety or food refusal, please contact the Pediatric Feeding and Swallowing Disorders Team at the Michael R. Boh Center for Child Development at (504) 493-2019 or email at feedingclinic@ochsner.org.