Jackson is a picky eater and frankly always has been. When he was little he would only eat certain color baby food and as we moved into eating solids he would only eat fruit: mostly strawberries and watermelon. It was a struggle to ensure that he was obtaining the right amount of nutrients that would allow him to grow and develop.
When we started ABA we tried what I can only describe as the extinction burst method of food therapy. An extinction burst means that we are going to let Jackson get upset, have a tantrum, and then get over it. Basically we are not going to reinforce the negative behavior by giving him attention for it, or letting him get out of trying the food. We would present Jackson with a food and then we would have him sit at the table and only allow him to leave after he tried the food.
Sounds fun right?
Well let me tell you it was a complete disaster.
We started the session at noon. Jackson was only allowed to eat breakfast and then no snacks so that he would be good and hungry for the therapy session. We had him sit at the table, presented him with a food item, and asked him to eat. Then we waited.
Jackson threw the food…
Jackson threw the plate….
Jackson cried some more.
Then Jackson did something I didn’t know he was capable of… He sat and waited us out.
He knew that at some point the therapist would have to go home…
He knew that at some point mom was going to feed him…
He knew the rules of the game and man he was winning.
The therapist stayed until 6 and Jackson remained defiant, sat at the table, and waited for her to leave.
Of course after she left I feed him one of the four things he would eat at the time and felt completely defeated. It was a long and very trying day. I had just had my second child and I can remember being not only physically exhausted from continuously putting him back in the chair, but also emotionally exhausted.
His will power was so strong that I really just couldn’t handle doing that again. I could see that this approach was just the wrong approach for my son. For 6 hours he cried, screamed, threw food and plates, and we made no progress.
I cancelled this approach and continued to look for another one. We needed an approach that would reward him for taking smaller steps, one that we were able to replicate across clinicians, and one that could be adaptable to real world situations.
We researched other food therapy interventions (CHOC Intervention and food choice) and blended them to create a program for Jackson. We developed a food therapy intervention that allowed Jackson: to get a choice in what he was trying, take small steps before he takes large bites, to get rewarded periodically during the process.
Here is what his food therapy program looks like.
1. Jackson gets to choose between two food items what he wants to eat. If he doesn’t choose something than I would choose the item I felt he would like the best.
2. We get out our “I am working for” paper (you can download your own here)
3. Jackson gets to pick what he is working for. Usually it is his iPad or candy.
4. Then we start out with Phase one which is that Jackson has to pick up the food and kiss it 4 times. That’s it. If he kisses the item four times he gets his reward. After this round we slowly increase the demand until he is taking full bites.
The entire protocol looks like this:
- 4x kisses
- 4x kisses 1x lick
- 3x kisses 2x licks
- 2x kisses 3x licks
- 1x kiss 4x licks
- 4x licks 1x small bite
- 3x licks 2x small bites
- 2x licks 3x small bites
- 1x licks 4x small bites
- 4x small bites 1x large bite
- 3x small bites 2x large bites
- 2x small bites 3x large bites
- 1x small bites 4x large bites
By the time we get to 13 we have a good idea about whether or not Jackson likes the food. Sometimes before we have even finished the protocol Jackson would just start eating the food item even if we were in a break. J We also have it written in his program that if he has gotten to step 9 and 10 and we can tell that he really dislikes the food item then we stop the process and move on to something else.
This intervention has been working really well for us. Since we introduced it Jackson has tried 7 different food items and actually likes 5 of them and we have incorporated them into his regular diet. The other nice thing about this approach is that when we are out in public if we want him to try something new we will first ask him to kiss it and then to lick it, and Jackson it totally cool with it.
I know how frustrating it can be to have a picky eater and I hope that this method might help some of you introduce new food items into your child’s routine. Click here to get the “I am working for” paper and the cut outs for it.