[PDF] - So My Child is a Registered & Licensed Dietitian Nutritionist PDF Document

SLIDE 1

11/9/2018 1

So My Child is a Problem Feeder… What Next?

Brittyn Coleman, MS, RDN/LD, CLT

Registered & Licensed Dietitian Nutritionist
Certified LEAP Therapist
LEND (Leadership Education in Neurodevelopmental Disabilities) Fellow
Sibling of an individual on the Spectrum
Private Practice: Autism Dietitian

Brittyn Coleman, MS, RDN/LD, CLT

Registered & Licensed Dietitian Nutritionist
Certified LEAP Therapist
LEND (Leadership Education in Neurodevelopmental Disabilities)

Fellow

Sibling of an individual on the Spectrum
Private Practice: Autism Dietitian

Conflicts of Interest

No conflict of interest to declare.

Agenda

RECAP: causes of selective eating + picky eating vs problem feeding
Define feeding therapy & help with building a feeding team
Review helpful tips for selective eating
Identify nutrient deficiencies (& how to fix them!)
Review food sensitivities (& how to test for them!)

SLIDE 2

11/9/2018 2

Selective Eating

Children with ASD more likely to avoid foods and exhibit neophobia than their

typically developing siblings and children without ASD (Schreck, 2004)

Children with ASD on average ate fewer foods (33.5 vs 54.5 foods) (Zimmer, 2012)
70‐90% of parents who have a child with ASD report problems with food selectivity

and limited intake of foods (Mulle, 2013)

Odds of children having a feeding problem are five times greater in a child with ASD

(Sharp, 2013)

Why is Selective Eating Common in ASD?

Sensory Processing Disorder
Eating is one of the most sensory-rich activities!
Oral dysphagia (refers to problems with using the mouth, lips and

tongue to control food or liquid)

Nutrient deficiencies
Food sensitivities & other gut issues
Certain medications

Why is Selective Eating Common in ASD?

Sensory Processing Disorder
Eating is one of the most sensory-rich activities!
Oral dysphagia (refers to problems with using the mouth, lips and

tongue to control food or liquid)

Nutrient deficiencies
Food sensitivities & other gut issues
Certain medications

Picky Eaters vs Problem Feeders

Most parents with children with selective eating refer to them as

“picky eaters” due to the lack of terminology

In children with ASD, they are more likely to be problem feeders
Is there a difference?

YES!

Feeding Therapy

Many different types of feeding therapy depending on clinic
My recommended approach:

Sequential Oral Sensory (SOS) Approach

SOS Approach to Feeding was developed by Dr. Kay Toomey

(psychologist) to be implemented by other allied health professionals (Occupational Therapy, Speech Language Pathology, etc)

SLIDE 3

11/9/2018 3

Feeding Therapy

“The SOS Approach focuses on increasing a child’s comfort level by exploring and learning about the different properties of food. The program allows a child to interact with food in a playful, non‐stressful way, beginning with the ability to tolerate the food in the room and in front of him/her; then moving on to touching, kissing, and eventually tasting and eating foods.”

Feeding Therapy

Needs to be done along side a FEEDING TEAM!
Build your feeding team
Occupational Therapy
Speech Language Pathology
Registered Dietitian (an INTEGRAL part of a feeding team)
Pediatrician
Behavioral Health

General Feeding Tips

Limit grazing by structuring 3 meals and 2-3 snacks per day
Have no more than 3 different foods on your child’s plate at a time
Use manageable amounts (start small!)
Use appropriate mealtime language
Use positive reinforcement

Positive Reinforcement General Feeding Tips

Prevent burn-out by rotating the same food every other day
Change one property of the same food each time offered (shape, flavor,

texture, or color)

Keep meal-time a positive and pleasant atmosphere
Do NOT bribe, beg, or force child to ”take a bite”
Practice ”social modeling” and have the whole family eat healthfully

SLIDE 4

11/9/2018 4

Nutritious Foods for Feeding Therapy

Why is Selective Eating Common in ASD?

Sensory Processing Disorder
Eating is one of the most sensory-rich activities!
Oral dysphagia (refers to problems with using the mouth, lips and

tongue to control food or liquid)

Nutrient deficiencies
Food sensitivities & other gut issues
Certain medications

Identify Nutrient Deficiencies

Important to test nutrients inside the cell vs outside the cell to

show functional deficiency

Test a wide range of nutrients to ensure comprehensiveness
SpectraCell tests 35 different micronutrients and shows

deficiencies and borderline deficiencies

Identify deficiencies and correct them with a dietitian or physician

Identify Nutrient Deficiencies Identify Nutrient Deficiencies Identify Nutrient Deficiencies

SLIDE 5

11/9/2018 5

Replete Nutrients

Why is Selective Eating Common in ASD?

Sensory Processing Disorder
Eating is one of the most sensory-rich activities!
Oral dysphagia (refers to problems with using the mouth, lips and

tongue to control food or liquid)

Nutrient deficiencies
Food sensitivities & other gut issues
Certain medications

Self‐Limitation

Children with autism may have undiagnosed food sensitivities or

intolerances causing gastrointestinal pain, constipation, diarrhea, migraines, or eczema

Some children can make the connection between foods and the way

they feel, therefore they self-limit

Depending on severity of ASD or lack of self-awareness, they may not be

able to communicate or describe their discomfort, or may possibly accept it as “normal”

Food Sensitivity

Type 1 (Food Allergy) Type 3 (Immune Complex Mediated Hypersensitivity) Type 4 (Cell Mediated Hypersensitivity) Mechanism IgE IgG IgM Complement T-Cells Cells Involved Mast Cells Basophils Eosinophils Neutrophils Basophils Macrophages NK Cells Eosinophils Monocytes Neutrophils Basophils Macrophages NK Cells Eosinophils Monocytes T-Cells

Food Sensitivity

Type 1 (Food Allergy) Type 3 (Immune Complex Mediated Hypersensitivity) Type 4 (Cell Mediated Hypersensitivity) Mechanism IgE IgG IgM Complement T-Cells Cells Involved Mast Cells Basophils Eosinophils Neutrophils Basophils Macrophages NK Cells Eosinophils Monocytes Neutrophils Basophils Macrophages NK Cells Eosinophils Monocytes T-Cells

Food Sensitivity

Type 1 (Food Allergy) Type 3 (Immune Complex Mediated Hypersensitivity) Type 4 (Cell Mediated Hypersensitivity) Mechanism IgE IgG IgM Complement T-Cells Cells Involved Mast Cells Basophils Eosinophils Neutrophils Basophils Macrophages NK Cells Eosinophils Monocytes Neutrophils Basophils Macrophages NK Cells Eosinophils Monocytes T-Cells

SLIDE 6

11/9/2018 6

Food Sensitivities

Food Sensitivity Food Sensitivity

Why is Selective Eating Common in ASD?

Sensory Processing Disorder
Eating is one of the most sensory-rich activities!
Oral dysphagia (refers to problems with using the mouth, lips and

tongue to control food or liquid)

Nutrient deficiencies
Food sensitivities & other gut issues
Certain medications

Medications

Many medications used in autism or ADHD/ADD can cause loss of

appetite

Some medications can cause nutrient depletions, and long-term

use could cause deficiency

Antibiotics can cause many gastrointestinal issues due to their

effect on the bacteria in the gut

Common Medications in ASD

Medication Nutrient Depletions Antibiotics

B Vitamins Vitamin K Calcium Magnesium Iron Vitamin B6 Zinc

SSRIs

(Fluoxetine, Sertraline, etc.) Vitamins B1-B9 Melatonin Chromium CoQ10

Anti‐Convulsants

(Dilatin, Tegretol, Mysoline, etc) Vitamin D Calcium Folate Biotin Vitamin B12 Vitamin B1 Vitamin K Copper Selenium Zinc

Antacids

(Pepcid, Zantac, Prevacid, etc) Vitamin B12 Folate Vitamin D Calcium Iron Zinc

SLIDE 7

11/9/2018 7 Closing Remarks

1. Build a feeding team for your child with selective eating
2. Test for nutrient deficiencies and correct them
3. Uncover food sensitivities and avoid them
4. Review medications and possible depletions
5. Always have an individualized approach!

Brittyn Coleman, MS, RDN/LD, CLT

1‐on‐1 consults via video all over the U.S.! P: 415-278-1770 | F: 888-977-1915 Brittyn@autismdietitian.com