Making Meal Time a Positive Experience

When thinking about and interacting with kids who have autism we are often treating skills related to social interactions, play and motor skills. After all, these are some of the areas most commonly associated with autism.

A frequent area of concern that often goes unnoticed are frustrations around mealtime."My child can't sit at meal time!"

"My child will only eat carbs!"

"He never chews anything. He just swallows the food!"

"My kid is such a messy eater, the food always falls out of his mouth!"

So what are parents and therapists to do?

In early February, ICAN Center for Autism sent us (Lyndsey and Shana) to attend a fabulous three day conference on oral motor/feeding in toddlers, preschool and school-aged children. This conference was instructed by Gay Lloyd Pinder, Ph.D., CCC-SLP.

The conference provided us the opportunity to learn appropriate and effective strategies to help and empower our LCA kids and families to successfully participate in mealtime.

We wanted to share some of our favorite information that we learned.

It's all connected!!

Did you know that the first sounds we hear babies make always happen at the same time that their bodies are moving?  If you watch a newborn closely you might be surprised that the first sounds they make (e.g., cooing and crying) are always occurring at the same time their bodies are moving. This is speech production that requires whole body motor coordination rather than just oral motor coordination.  As children mature they are able to separate the finer movements needed for speech from larger motor movements.

The developmental progression of children (e.g., nursing, crying, tummy time, head control, babbling, bringing hands to mouth) are all necessary for our kids to eat independently.  What is fascinating is how missing one of these milestones such as tummy time, can impact a child down the road.  Without tummy time, kids have difficulty with head and trunk control which affects sitting and jaw stability necessary for eating.  Without jaw stability, kids have decreased tongue mobility and may have difficulty chewing food.  When kids don't have the stability to sit independently, they aren't getting enough sensory exploration in their mouths, which can lead to decreased tolerance of textures due to lack of experience. Each benchmark is important for reaching the next developmental milestones.  When we say that everything is connected, this is what we are referring to.

Favorite one liners

Our favorite quote from the weekend was "hips before lips."  What does this mean?  Basically, this means that a child has to demonstrate stability in their hips in order for them to develop the motor skills in their mouth to produce speech and manipulate food while eating. To support stability for babies we provide a cradle during nursing or feeding.  As they get older they develop that stability.  We can't expect kids to have functional control and mobility in their lips and mouth before they exhibit functional control and mobility in their hips.

Our second favorite quote is, "tongue follows the thumb" or "thumb before tongue." This mirrors what you see developmentally in the thumb and fingers (i.e., the thumb's ability to move side to side). We would expect to see this movement for the thumb happen before we see similar signs of movement in the tongue (e.g., the tongue's ability to control food in the mouth and the ability to produce speech).

Take Home Message

• Mealtime challenges are common with children with autism and other developmental diagnoses.
• The development of the mouth happens concurrently and progressively with the development of the rest of the body
• REMEMBER: Hips before Lips & Tongue follows the Thumb!

Please check back for an announcement on our feeding night at LCA in April.

This blog post is a part of a mealtime series. Check back over the next few weeks for the continuation of this blog series.

Written by: Shana Speer, OTD, OTR/L and Lyndsey Aston, MA, SLP-CF