Other Sensory, Visual or Cognitive Behavioural Therapy-based (CBT) Strategies to Try at Mealtimes include:
- Encourage Sips Between Bites
Keep a glass of water or another favourite drink at hand and encourage your child to take sips in between bites. The liquid will encourage swallowing before taking another bite. A cold or carbonated drink can also provide additional oral sensory input. The sensory experience can be increased with a straw. As a matter of safety, encourage your child to clear their mouth with a swallow before drinking to avoid choking
Many children, particularly those with autism, do best with visual cues. So try using a visual schedule or picture story to help the child become aware of the number of pieces they put in their mouth at one time. For example, take three pictures of a crisp and another of a glass of water. Attach them to a page or picture board in order and explain “You can eat up to three crisps. Then it’s important to take a sip of water before you have another cracker.” Put this visual aid on the table where your child can see it as a reminder at snack time.
As another potentially effective cue, provide your child with a table-standing or handheld mirror and have them watch themself put food into their mouth and chew. The visual feedback of watching themself eat can help them gain self-awareness and self-control when verbal reminders fail. The use of a mirror will also allow them to see if they have a messy face and to self-monitor as to whether they need to clean their face.
- Include “Alerting” Textures
Some foods are easier to sense in the mouth than others so try and include some sense-alerting textures in their meal or snack choices. For example, rather than a soft slice of bread, give your child a piece of warm and crunchy toast. Similarly, cheese can be paired with a hard cracker.
Increase sensory input by offering a variety of textures in each of the child’s meals and snacks. Combinations might include chewy foods (e.g. dried fruit and Pepperami), crunchy foods (e.g. vegetable sticks, apple pieces, crackers) and soft foods (e.g. pasta, rice). By prompting your child’s mouth to “adapt” to different textures, this tactic may decrease their tendency to needlessly overstuff their mouth.
Encourage “dipping” food into sauces to slow down the eating process. Chicken nuggets, carrots and bread sticks can be dipped in bowls of ketchup, barbeque sauce, etc. In addition to slowing things down dipping increases the variety of textures and flavours.
- Use a Behavioural/Reward Chart
Try a reward system to reinforce learning and motivate your child to stop and swallow between bites. A reward system can involve earning points for each mealtime – or portion of mealtime – completed without overstuffing their mouth.
For each meal or snack completed without mouth stuffing, the child gets, for example, to place a stamp, sticker or check in the corresponding box for that day. When, for example, three reward markers are gained, allow them to select a motivating reward such as a favourite food, small toy, a special activity with you, etc.
- Coordinate with Other Caregivers
Be sure to enlist other caregivers such as school TAs. Explain the goals and the reward system so they can be integrated into your child’s day such as snack or lunchtimes. This will provide your child with consistency that reinforces their new skills and helps them carry these skills over into other environments.
For Further Information and Guidance please contact:-
Liz Skilton, Therapy Lead or Karen Al Khina, Milestone Occupational Therapist