Since feeding involves all sensory systems (sight, smell, sound, touch, and taste), eating is the most difficult sensory task that children face. Feeding issues are especially common in children with autism, including those with Aspergers, because of difficulties with sensory processing. In many cases, this leads to eating challenges at mealtimes.
“Food chaining,” from the book by the same name, is based on the child’s natural preferences and successful eating experiences—specifically the idea that we eat what we like. Food chaining introduces new foods that have the same flavors or sensory features as foods that are already preferred by the child, increasing the likelihood that the child will like the food.
A food chain consists of four levels that build upon one another. By following the levels of the food chain, the child will be able to build upon success with small changes.
For example, if your child’s accepted food is chicken nuggets, a sample food chain might look like this:
| Level I | Level II | Level III | Level IV |
| Maintain & Expand Current Taste & Texture | Vary Taste & Maintain Texture | Maintain Taste & Vary Texture | Vary Taste & Texture |
| Other brands and sizes of chicken nuggets (i.e., strips/popcorn/bites, both fast food & home-prepared); fried chicken patties cut into pieces (fast food & home prepared) | Different flavored chicken nuggets (barbeque, honey mustard, hickory smoked, etc.) Use sauces/dips to vary tastes. | Chicken strips (not breaded); chicken leg/drumstick; chicken breast; ground chicken patties | Breaded seafood (scallops, shrimp); breaded fish (fast food & home-prepared); breaded turkey breast; breaded vegetables; breaded baked chicken; crusted/breaded pork tenderloin; ground meats |
Here are some other food chaining tips:
- Offer one new food with one snack and/or one meal a day.
- Offer a new food with an accepted food (different from the new food). The child doesn’t have to eat it right away. You can model eating it, then let child approach it on own.
- Keep offering new foods even if they have been rejected. It may takes multiple exposures. Typically-developing children can reject new foods 12-15 times before trying them.
- Place food on plate next to (but not touching!) other food. Use a divided plate, if you wish.
- Use transitional foods between bites of new foods (i.e. piece of accepted food, or drink of accepted fluid).
Remember, be patient! Expanding a child’s food preferences takes time, so be prepared to move slowly.
By Loree Primeau, PhD, OTR, Executive Director, Autism Community Network
Source:
Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Fraker, C., Fishbein, M., Cox, S., & Walbert, L. (2007). New York: Marlowe & Co.
Providing the weekly Medical Blogs are the team of professionals, doctors, occupational and behavioral therapists at San Antonio’s premiere Autism Diagnostic Clinic, the Autism Community Network.
Contributors include:
Executive Director Dr. Loree Primeau
Medical Director Dr. A Patricia Del Angel
Training and Research Director Dr. Berenice de la Cruz
Carrie Alvarado, OTR, PhD©, DIR/Floortime-Certified
Lupe Castaneda, MS, BCBA
Adriana Sanchez, MA, BCBA
Dr. Gayla Aguilar, OTR, OTD, C-SIPT
Megan Kunze, MA, BCBA
The ACN teams works to maximize the potential of children with autism through their administrative, clinic, training and development departments. Their expertise on Aspergers Syndrome is offered to you through aspergers101.com.
I am an occupational therapy student and I am interested in collecting practitioner’s and parent’s experience with food chaining for a child with a feeding difference or a child who prefers to only eat specific foods.
I am an SLP and have been asked to do food chaining with a child I work with who only eats chips, cookies, candy, soda’s and his primary source of nutrition has been pedicure in a bottle. This child is almost 3. What foods should I introduce to him first. This is something I have never done before and I do not want to do it wrong. I have been reading a lot about food chaining but would like any advice I can get. Thank you. Susan
My son is a picky eater. I would like to try food chaining but not sure what food to start with. His 4 main accepted dinner options are peanut butter on waffles. Peanut butter sandwich. Macaroni and cheese but it has to be really soupie and has to be the microwaveable cups. And dinosaur chicken nuggets
My son does not have aspergers or any type of autism he’s just a really picky eater
Hi and thanks for this insightful article.
Can you perhaps give an example similar to the chicken nuggets one where the child eats only porridge/weetabix, plain white rice, and yogurt. I dont know how to go about this so suggestions would really help me. my son is 3.5 years old, no diagnosis yet but has a speech delay and plain out refuses to even touch a new food and would scream at the idea or sight of me offering something different.
This does not work for my son.
I have aspergers and my parents would tell me to take 3 more bites or say I had to sit there until I finished and that was like torture and as a result I had a pretty limited diet. I got here because I googled about expanding your diet after reading an article for picky eaters about offering yourself food on fat nutritionist (I am no longer a picky eater because now that im on my own and dont have people force feeding me I can try new things like liver and sushi and brussles sprouts, all fantastic foods. I still am interested in the topic and adding my perspective because to me it’s obvious exactly why people wont eat and that most common parentingapproaches to get them to make them shut down more when considering the autism ) The advice in the article was something I feel like parents of autistic kids should be aware of, and could even direct them in how to explore all of that confusing sensory information that is a new food in a supportive way so that you dont compound the issue by adding in control and obedience and health fears to the mix when theyre already struggling to overcome so much and need understanding. This is what fat nutritionist recomended picky eaters do and I would say that since a lot of autism comes with executive functiong problems that if an NT needs guidance from a blog, it’s even harder for an autistic kid to figure it out. Especially if they dont have support. For example, it’s hard enough for a kid to grasp the concept of trying a new taste, and a normal part of new foods is that if the food makes you want to vomit, reconsider finishing it, basic agency. If you chew up a bite of food it’s so unpleasant you spit it out, the right kind of feedback can make that an exciting new experience, telling them oh boy that was yucky next time we try to experiment with this food well cook it this way and put spices that way and maybe youll like it but at least now you know what it tastes like vs being criticized for spitting and now being scared to try anything new ever because you know youll be forced to say it. Here is the list of ways to explore new foods:
an approach a food without eating it in the following ways:
Simply glance at it while it sits there.
Pick up the plate and look at it more closely.
Poke it with your finger, or move it around with your fork, or cut it in half to see what’s inside.
Sniff the air over the plate.
Put another food or a sauce or salt on it, and look at it or smell it again.
Put a little of it on your eating plate and let it sit there.
Touch your finger to it, and then taste your finger.
Touch a tiny part of the food to your tongue.
Put it in your mouth and take it out again.
Put it in your mouth and chew it a little, then spit it out (napkins are handy for this.)
Also the food is not a toy. The point of this is to comprehend the food as a food. Dont play with the food.
Too add on, id basically in my attempts to communitcate living with autism had come up and been handing out all of that advice on my own and stressing the the goal is not to get them to eat. There really cant be any pressure.
Thank you so very much for your insight and taking your time to share it with others! Would you mind if I shared your suggestion(s) on an upcoming blog on our website? Again, we thank you! – Jennifer Allen/Aspergers101
I am an OT who is food chaining with a student on the spectrum at school. Parents are requesting ABA methodology and data charting and I am struggling with how to provide this while keeping the sessions pleasurable and child-centered. Any advice? Research?
HEllo…we took your question to Dr. Loree Primeau/Executive Director of The Autism Community Network in San Antonio. “As an occupational therapist, I would explain to the parent what the differences are between the food chaining approach, developed by 2 speech therapists, a nutritionist, and a medical doctor, and a feeding program developed and implemented by an applied behavior analyst. And that while the food chaining approach does incorporate some principles of behavioral theory, it is not an applied behavioral analysis approach. As an occupational therapist, you can guide the use of this approach while the student is at school and at home. You can also help the school personnel and the parents identify and track specific student-centered outcomes related to feeding that are important to the family and can be achieved using the food chaining approach. But, if the family wants to use an ABA approach to feeding with an ABA methodology and data charting, then this becomes a different type of feeding program that should be implemented and guided by a BCBA (Board Certified Behavior Analyst).”
-Hope this helps! Thank you for your patience, Jennifer Allen
Olga, What you are describing is called food jagging. As a feeding therapist, that is typically what my kids do too. You have to expand on their preferred foods at that time so they don’t lose it or do just noticeable differences in their foods. For example, if he only eats goldfish crackers, expand to a different flavor of goldfish cracker (e.g. pretzel, pizza..etc.). He also appears to be very environmentally specific on where he eats certain foods (e.g. I only eat chips with grandpa, but no where else). That is why it’s so important that when they do gain a new food in a new environment you have him help pack it so that he sees it is coming home with you guys. If he throws a fit, just present it to him at home and do food play. Have him crush it with his trucks..etc…Get him used to playing with it and work from the outside in.
This implies that the child has preferred foods. Our 6 year old son with PDD NOS does not. He has foods he might prefer temporarily – for a few weeks or a few months. But then he stops eating them, sometimes for good. A slight variation on such temporarily preferred food sometimes leads to it losing its preferred status.
There is also an assumption that once a child tries a new food and likes it, he will include it in his diet. Not so with mine. Just an example: once upon a time, a year or so ago, our son ate a whole turkey cutlet. It literally happened once. Never since. In fact, he doesn’t eat any meat, poultry, or fish.
But then again, we are told (not just by the school personnel, but also by his behavioral aide) that he eats almost everything they serve at his school, including ground meat. This is a family owned private pre-school/kindergarten. They serve mostly home made food. So, it is not like he likes it because it’s junk. He doesn’t even like junk food, any of it. He used to eat chicken nuggets and French fries, but not anymore.
He eats food at school, but not the same food at home. He eats some things at my parents’, but if my Mom gives me some of it to go, he won’t eat it at home.
I am a mom of 4 children with varying degrees of special needs on the Autism Spectrum (otherwise known as ASD’s), ranging from simple ADD to Aspergers to Autism w/PDD NOS & ADHD to Severe Disabling Non-Verbal and typically violent Autism w/ other medical conditions. I am also quite a good cook and maintain my own Food & Entertainment website. I have combined those two talents (Yes, being an ASD mom is a talent) and discovered a way to help my children, regardless of their disability, eat or at least try any type of food. Real food, like you and I eat; not chopped up or pureed meat or veggies hiding in a sauce or a pizza. By now, I have become able to articulate this in a meaningful way and to help parents who have children with “food issues,” whether they have ASD or not.
I saw your informative article and I thought I could add some information. I know it sounds doubtful, but take a few minutes and read my story. HOW I GOT MY ASD KIDS TO EAT REAL FOOD at http://www.debsfood.com/107124962
Thank you for sharing your story, Deb.
“Validation” would be my choice if I had to name my feelings reading this statement by Loree Primeau, PhD: “Since feeding involves all sensory systems (sight, smell, sound, touch, and taste), eating is the most difficult sensory task that children face.”
Eating continues to be the most difficult sensory task faced by this woman on the autism spectrum. To expand my palate, my husband and I take an approach very similar to the “food chaining” discussed by Primeau at Aspergers101.
An experience that is already fraught with challenges on the basis of unfamiliar or unpleasant tastes or textures is further burdened by past experiences and prevalent social attitudes.
My journey with food took me from the anger and recrimination of being labeled by caregivers as “picky,” “spoiled” or “bad,” to the social pressure and arguments from peers who can’t conceive of someone disliking chocolate.
It intrigued me, reading Primeau’s post, to learn that there is a name for my husband’s and my approach to food and that, moreover, an entire book was written on the subject. It’s worth checking out for possible inclusion among my recommended books about autism.
Glad you and your husband were able to find this type of approach helpful!
How about fruit and vegetables? My son tried eating vegetables and fruit and he gags! The first reflex is the tongue immediate rejection. I know that he wasn’t doing it on purpose.
Depending on the child’s preferred food textures, you can try chewy fruits, such as fruit roll-ups or fruit leathers or other types of dried fruits or you can try crunchy fruits, such as fruit chips. Again, depending on the child’s preferred food textures, try adding fruit to milk shakes or yogurt smoothies by combining in a blender. If the child tolerates purees, try apple sauces or other pureed fruit cups (shop the canned fruit aisle and look at the different varieties of pureed fruits available). You can also try to “mask” the flavor by using dips with fruit pieces, such as chocolate sauce, cream cheese, peanut butter, etc.
These same tips can be applied to vegetables. There are vegetable chips out there to try for a crunchy texture. If the child likes French fries, then trying sweet potato fries is an option. Flavor masks can be used here as well, such as cheese sauces or butter sauces. Breaded vegetables are another option: bread zucchini sticks. Some children do better with raw vegetables, such as carrot sticks, celery, bell peppers.
Remember:
Keep offering new foods even if they have been rejected. It may takes multiple exposures. Typically-developing children can reject new foods 12-15 times before trying them. Be patient! Expanding a child’s food preferences takes time, so be prepared to move slowly.