Eating Interventions: Eating too fast or too slow

The other common issue with neurodiverse children is that they eat either too fast or too slow. Some finish an entire meal in 5 minutes; some take up to 2 hours to eat a snack.

Typically, in either case, the child does not chew properly and it affects digestion. The quick eaters usually eat quite a lot of food before their hunger and palate are satisfied. This leads to weight gain and associated negative loops. The slow eaters tend to pocket the food in the mouth - this affects their oral hygiene. Also, the food tastes bland after being in the mouth for a long time and they lose interest.

Intervention for the quick eaters

The key is to create some delay between one mouthful and the next, encouraging them to eat slowly and chew properly. The child has a smiley chart and a bowl.

1. Once the child takes one spoonful of food into the mouth, they fix the smileys from the bowl, on the chart. During this time, they keep chewing and the rule is they cannot take another mouthful till all the smileys are fixed.
2. Once all smileys are fixed, they take another spoonful of food.
3. This time, they pick the smileys from the chart and put them in the bowl.
4. Keep doing this till the food is finished.

Once, we came across a child who would touch food and everything around with both hands. Smiley chart would have been unhygienic. We modified the intervention.

1. A table mat, with spaces drawn for the child’s plate, glass and hands was created. The child was expected to keep the plate and glass on the mat, as well as keep their hands on the spaces indicated on the mat.
2. A number line with numbers 1 to 10 was also drawn on the top of the mat.
3. The child takes a spoonful of food, and uses fingers to count from one to ten on the numberline. They chew while doing this.
4. Once the numbers are counted, they can take the next spoonful.
5. The mat structure helped the child keep their hands clean while eating, as well as introducing delay between spoonfuls through counting.

In both the above cases, the children were older than ten. All the prompts used to remind them to follow the sequence were either written or pictorial so there was not much verbal input, repeated instructions or anyone losing temper.

Intervention for slow eaters

With slow eaters, the key is to create a limit on the time the child keeps food in the mouth. To do this, we mark the beginning and ending of each mouthful so the child has a cue for when the food should be swallowed. We also need to help the child keep track of how much they should eat and how much they have eaten. For this, we use checkboxes or tokens.

1. Establish the average quantity the child can comfortably eat. Measure this in bites, spoonfuls or mouthfuls.
2. Make a visual schedule for the number of measures to be eaten. We provide tick boxes or tokens for each measure. For example, if the child has to eat 15 spoonfuls, we make 15 checkboxes or give 15 tokens.
3. The child takes food in the mouth. We start counting from 1 to 10, in a calm voice, to encourage the child to continue chewing. We can also draw a number line and progress on it if we want to avoid verbal input. This tells the child that they have to finish the mouthful within this count.
4. At the end of the count, the child ticks a box or counts down by removing a token.
5. We can plan a break for every 3 or 5 measures, so the child can pause and does not get overwhelmed.
6. The intervention ends when the food is finished!

You can read the earlier articles below.

Eating Interventions: Attitudes towards food

Eating Interventions: Eating too much

Eating Interventions: Eating too little

Please note that these interventions are shared for general guidance. Designing and executing interventions - more importantly - noticing how the child responds and modifying the interventions so the child does not get distressed, is a specialist job. Consult qualified therapists as necessary.