Disordered & Restrictive Eating
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In this webinar...
Bobbi is joined by our Paediatric Dietitian, Kirri Woodington, who specialises in disordered and restricted eating related to autism and sensory processing disorders. Kirri shared some great insights and strategies that you will find really helpful.
Here's some of the things discussed
Often kids have eating issues often before they are even diagnosed. A well trained dietician can help with early intervention.
One of the biggest thing is from the parent who have friends that have neurotypical children who's children have a fussy eater for a short period as say as a two year old. Your friends will give advice and they won't really get it.
They want to eat. They are not doing it out of spite or that they want to. They are generally struggling. There are many reasons your child doesn't eat - oral motor, tongue difficulties, and other sensory issues.
Eating is a learned process. We aren't born knowing how to eat. And some children need extra help learning how to eat.
One of the strongest biological we have as humans is to not choke because we could die. So if a child has almost chocked on a food, their body feels like that food is now scary and that food could kill them. So their body is trying to protect the child from harm. It is an automatic response for many.
Other children do something called pocketing - which is where they put food in the side of their mouths like little hamsters because they have been taught that spitting it out is rude.
Many children just don't know how chew and swallow. There are actually 32 steps to eating from sitting down, picking up our cutlery, etc. Sometimes children are even sacred to be in the same room as a food. And lots of kids with ASD have transition issues as well. So that would add even more steps.
So we need to focus on eating as a learned behaviour.
This is a learnt fear response and we can help them to learn. It can take at least 6 months of working on one thing to see a shift. This process takes time. But there is help and people who can help you through this.
Vegetables are the hardest thing to bring in. So don't start with vegetables.
If cutlery isn't working for the child, they can safely user their hands. We often try and force cutlery and it can increase the risk of choking. So you and your child can eat with your hands. Fingers are safer than cutlery.
For constipation, for under under 12s, Movicol Unflavoured (do not get talked into a flavoured one), for over 12s, Movicol for adults. (You may be able to get this under NDIS if your dietician writes it up in the progress report.)
For nutrition, for under 12s, PediaSure and for over 12s, Sustagen.
Please know that you are not alone. We are here and we get it. Try and surround yourself with other people that understand what you are going through. You as parents already do so many amazing things and you need support.
What we have found in our work with BCBM, we have seen that the interoceptive awareness. Interoceptive awareness helps people understand what is going on in their body. If your child is really struggling with eating, work with your dietitian, but also an Occupational Therapist that is trained in interoception.
you can also get more information and programs from Kelly Mahler. See her website at: www.kelly-mahler.com
Top 3 Tips for Setting Up the Table for Success
1. Make the Table a Safe Place
For first 10 minutes at the table, do not talk about the food (talk about normal stuff and make it a safe and fun place - we don't want to add to the fear response). After 10 minutes, talk about the food in positive ways (what does the food sound like, what does it feel like).
2. Make Sure Child is Secure in their Seat
If you are trying to eat something new, it can all be too much when they are not secure in their chair. Make the chair secure. It may mean putting a box under their feet, or sitting at a lower table, or having a chair with arms.
3. Call it at 20 Minutes
Don't torture yourself and everyone else. Call it after 20 minutes Don't sit at the table for 2 hours! If they are hungry later, then sit back at the table and sit with them.
Eating Disorders are a mental health eating disorder. A child can have disordered eating can lead to an eating disorder. An eating disorder is about your relationship with food. If someone has a bad relationship with food, people can binge, purge, self esteem and body issues, and it can manifest in many different ways. A child can be struggling with food and that doesn't mean they have an eating disorder, yet, but it can develop into an eating disorder.
Eating disorders do not discriminate and can affect anyone at any age, from as young as two and three and up to people in their 80s. And eating disorders can happen at any age.
Under Medicare, you can qualify to see an allied health professional for 5 visits by getting a GP Care Plan to give you acces to those health professionals. If you are not diagnosed with an eating disorder, you only get 5. If you are diagnosed for an eating disorder, you can get 20 sessions with a dietitian and 40 to a mental health professional. Please speak to your GP as eating disorders are mental health issue.
You Need for a Team
You need a multi-disciplinary team, including a paediatric dietitian, paediatric speech pathologist and occupation therapist. If your child struggles with oral motor meat will also be hard to chew. Start with pasta and fruit. Start where it is tolerable. Engaging with food doesn't always have to mean eating it. It could be feeding food to chickens or painting potatoes. Take the fear response away from food and making food safe again.
To find a dietitian, go to Dietitian Australia.
Listen to the audio recording of the webinar.
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